I confess that I wasn't familiar with Woomble's current favourite bit of pre-parenthood reading, Grantly Dick-Read's Childbirth Without Fear. As people who benefited from the services of the NCT, though, we surely will have been influenced by Dick-Read's philosophy. We certainly shared his concerns about the medicalisation of childbirth, which was a big factor in our choosing a home birth for our second child. Living as we do in a sparsely populated area, we were lucky to have midwives who were very comfortable with the idea of delivering at home. For those further up the dale, who may be an hour away from the nearest maternity ward, delivering at home is a very realistic scenario. It may not suit everyone, but it was a happy and satisfying option for us.
Whatever our reasons for choosing a home delivery, I don't think we were ever really doing it in the hope that it would lead to a smarter, happier or more well-adjusted baby. Thinking about it from some distance, I have been wondering whether there is any research on the topic. The medical profession seems increasingly satisfied with home birth as an option (as evidenced by the latest NICE guidelines' advice that it should be offered routinely), but what do the psychologists say?
I cannot find any evidence specifically relating to planned home births (the NICE document admits that decent evidence is missing in several areas) but certain questions are obviously worth asking. According to NICE, planned home births seem to be associated with a greater likelihood of vaginal delivery, reduced perineal damage and greater maternal satisfaction. Breastfeeding may be more easily established as a result. The less frequent use of pain-reduction drugs like pethidine means that mothers and babies might be a bit more alert in the first few hours. I can't imagine, though, that greater wakefulness would have such a big effect on babies' learning opportunities, to the extent that sleepier babies could not later catch up.
What about that element of maternal satisfaction? Does, for example, a mother who remembers her baby's birth more fondly (or at least without memories of pain and fear) have a better relationship with that baby? A woman's perception of that event may be more important, in some respects, than the medical facts of the matter. In one study, we found that mothers' tendency to rate their pregnancy as 'difficult' did not correlate with the obstetric record of actual complications. Some women who had 'objectively' had very difficult pregnancies nevertheless remembered them as having been undemanding. Others, who had no medical problems at all, paradoxically rated their experiences as arduous.
It also seems likely that mothers' perceptions of the birth itself will be as important, psychologically speaking, as the medical details. It is not whether the delivery is objectively normal or abnormal that matters, so much as how the mother feels about it now. If anything is likely to make a difference to the baby's subsequent development, it is not the presence or absence of forceps or pethidine. It is the mother's mental representation of that birth: the story she tells about it, the way she represents it for herself.
We have been looking at this issue in a recent study, in which we gathered both subjective and objective data about pregnancy and birth. Mothers who rated the birth more positively (in terms of their description of how they had felt when they were handed the baby for the first time) showed a special kind of sensitivity to their infants when playing with them in our child development laboratory. Specifically, those 'positive perception' mothers were more likely to treat their babies as individuals with minds, in the sense of making reference to their thoughts, wishes and desires when they were playing with them. We call this variable mind-mindedness, and have been exploring its associations with several other important aspects of development, such as attachment, theory of mind, language acquisition and play.
Quite rightly, the NICE document has a bit to say about the psychological effects on the mother of different delivery options. It would be nice to think that a future version of these guidelines could include something on psychological effects on the child. My hunch is that the two kinds of psychology will be strongly correlated, supporting the view that people should choose the delivery option that makes them happy. Let's not leave paternal psychology out of the picture, either. Having a birthing pool to fill, and cups of tea to make, helped me to feel that I was involved and useful, or, at the very least, prevented me from the getting in the way of the serious business.
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