CHILDBIRTH AT HOME

The author, who went through three hospital deliveries before deciding on home birth for her last two children, summarizes the difficulties that accompany childbirth in the average--and often even the very good--hospital. Once hospital routine takes over, the mother's wishes (even if previously agreed to by her doctor) may count for nothing. She may be subjected to distressing annoyances (enemas, pubic shaves, intravenous hookups), long isolation in the labor room, and actual interference with normal labor (oxytocin injections, various regional anesthetics of dubious safety, premature use of forceps). Even so simple a matter as the position in which a woman delivers is wholly outside her control. As for the hospital's supposedly greater safety, the finding of a Stanford University study (printed as an appendix) is that though complications can be handled more speedily and effectively in a hospital, there are fewer of them in home births--humans, like cats or dogs, deliver most safely in familiar and comfortable surroundings. When Sousa turns from such issues to other obstetrical options, she becomes a lot fuzzier. As she points out, the difficulty of obtaining expert medical or paramedical assistance at a home birth can be insuperable, but she moves much too glibly to instructions for the inexpert attendant--don't poke the baby with the scissors in cutting the cord! We also doubt that anyone with a brain in his or her head will feel qualified to get the newborn breathing properly on the basis of a few sentences about how to aspirate mucus. As a critique, highly persuasive; as a manual, a pretty shaky reed. As an exploratory effort in the field, a welcome sign of new medical approaches--and, we hope, a forerunner of more systematic, thorough treatments.