Home births have been, for a long time now, the subject of endless controversy and polarized discussions among physicians, midwives and strongly opinionated women. Indeed, the idea of giving birth at home sounds attractive. With the growing  interest for an “all natural” lifestyle, natural home birth looks like a logical way to go. What’s more, celebrities are doing itand midwives are becoming a status symbol!

home-birth-gisele-pregnant-resizedEven mass media has embraced the trend: since 2008, when the documentary The business of being born was aired in the USA many women were “converted” to fanatic home birth supporters. This documentary follows a New York midwife who delivers babies at home, while it “uncovers” -what they consider- the major business childbirth has become for doctors and hospitals. In the UK, the series Call the midwife, with its empathetic view of midwives have experts hoping that “it will spark a resurgence in home births…as women see the holistic care that midwives can deliver”.

home-birth-business-of-being-bornAnd all this “campaign” seems to have worked! Home births have seen a considerable increase in many countries, including the USA, Canada, UK and Australia.

So why the fuss about giving birth at home? Why do women want to deliver like in the 1900s? The answer to these questions is not straightforward…

While reviewing the bibliography on home birth, I realized how massive the amount of information on this subject is, both in scientific and lay sites, and how contradictory it becomes sometimes…

If you are considering home birth, check out this article where I analyze the reasons women choose to have their child at home. In order to simplify reading, I divided it in three parts; read all three so that you can make your responsible and educated choice.

1) “A delivery at home is a wonderful experience”

Embed from Getty Images

                          Satisfaction is home birth’s raison d’être

There is no doubt that birth is a unique, life-changing experience for every woman, and no one can deny the importance of the emotional and psychological aspects of a bringing a child to the world. As mentioned earlier, the reasons women choose a home birth are many: some women feel that the privacy of their home will make them feel more comfortable, less stressed out, and with more control of their own labor. Others find that being surrounded by friends, relatives, or their older children is of utmost importance. Finally, many woman choose home birth out of curiosity, as they have heard so many stories about amazing, empowering, ecstatic, or even “orgasmic” home births. Actually, personal satisfaction seems to be the main reason women want to deliver at home.

home-birth-transfer-primiparousBut is home birth always this pleasurable, fantastic experience women expect?  Unfortunately, this is not always the case. According to Birthplace, a recent British study, a high percentage of women will need a hospital transfer: up to 45% of first-time mums (nulliparous) and 13% of second and subsequent time mothers (multiparous) were transferred to a hospital. Similar figures are reported in the Netherlands, a country with a long tradition of home birth: 49% of primiparous and 17% of multiparous women are transported during labor. Most of the times, transfer to a hospital is not a great experience for the couple, as their expectations for a home birth are not fulfilled; this has been uniformly demonstrated by several studies from different countries (such as Sweden, Netherlands and Belgium). Moreover, a Dutch study evaluating women’s views of their birth experience 3 years after the event revealed persistent levels of frustration, including serious psychologic problems, in transported women compared with those who delivered at a hospital.


There is another fact we should not ignore: labor is inherently painful. Even though at home women may be more comfortable and this may result in less pain, sometimes it may be impossible to cope with pain and an epidural may be necessary. Pain relief is actually one of the most common reasons for transport to the hospital, since pain can become overwhelming, In fact, a recent study showed that inability to control labor pain may increase the risk of developing postpartum depression.

2) “Home births are safe for the mother”

home-birth-painfulHome births result in less interventions, including pain relief…

Besides personal satisfaction, another common reason women choose home birth is because it’s less invasive. The dreadful “cascade of events“, that is, one intervention leading to another during a hospital birth fills with terror most home birth supporters. Indeed, almost every study shows that home births are associated with less interventions as compared to hospital births. The term “interventions” includes: epidural anesthesia, ventouse or forceps delivery, cesarean section and episiotomy (see also here, here and here).

Another controversial intervention that has gained a bad reputation among home birth supporters is continuous fetal monitoring, as they think that it is not needed, it gets in the way of the natural birthing process and it increases interventions such as cesarean section and forceps delivery. But what is the scientific evidence on this subject? According to a Cochrane review, the use of fetal monitoring increases the cesarean delivery rate, vacuum and forceps operative vaginal delivery; in addition, fetal monitoring does not seem to reduce perinatal mortality, neither cerebral palsy risk; however, it reduces by 50% the risk of neonatal seizures, that is, of brain damage.

home-birth-helpBut while some women may experience fetal monitoring, episiotomy or vacuum delivery as a traumatic experience, others may not get particularly bothered by an episiotomy -and many will feel blessed by the epidural “intervention”. So maybe a more important question is: What about severe maternal complications and maternal deaths? In regard to this matter, there is not much information, and the studies’ conclusions are contradictory. A Dutch study  looked at “severe acute maternal morbidity” (such as admission to intensive care unit, uterine rupture, blood transfusion, etc) and found that women who delivered their first baby at home had the same risk with women delivering at a hospital, but parous women had increased risk of postpartum hemorrhage and blood transfusion when delivering at a hospital; however, another study, also from the Netherlands, did not confirm these findings. Therefore, a hospital birth leads to more interventions, but it does not seem to increase the risk of serious maternal complications. Regarding maternal deaths, they are a rare event; thus it is not possible to draw conclusions from the studies.

There is something that every woman considering home birth should understand: the studies results apply only to very low-risk pregnancies. Higher risk women, such as those with twin pregnancies, previous cesarean sections, prematures, post term pregnancies, were excluded from most studies, although it is no secret that they are also having home births (it’s easy to realize it just by checking the social media…). It is certain that for these women the risks is much higher, not only for them, but also for their babies.

3) Home births are safe for the baby

A healthy baby and a healthy mother are supposed to be a birth’s ultimate goal…

Studies analyzing the baby’s risk yield completely different results according to the country they were done, but they also differ in different areas of the same country, or according to the scientist analyzing the data! In here, I mention the most important studies evaluating neonatal risk by country of origin:

home-birth-canada-babyCanada: A recent study showed that planned home birth was not associated with a difference in serious adverse neonatal outcomes as compared to hospital births (Hutton et al, 2016). This study was limited to the Ontario area, had very strict inclusion criteria and high transport rates (see below).

home-birth-dutch-pregnantThe Netherlands: The Netherlands are usually considered the “gold standard” due to their long tradition in home births. In 2009, de Jonge  showed that home birth does not increase the risk of perinatal mortality and severe perinatal morbidity among low-risk women. However, some aspects of this paper may have underestimated the risk (e.g.,  paediatric data on intensive care admissions was missing for 50% of non-teaching hospitals, among others). In fact, a subsequent Dutch study showed that infants of pregnant woman at low risk under the supervision of a midwife had 2,3 times higher risk of perinatal death than infants of pregnant women at high risk  under the supervision of an obstetrician. Moreover, infants of women who were referred by a midwife to an obstetrician during labor had a 3,66 times higher risk of delivery related perinatal death than women who started labor supervised by an obstetrician (See below for more details on home births in the Netherlands).

home-birth-british-babyEngland: A 2011 large study, the Birthplace study showed that, for low-risk women,  home birth had 60% higher chances of “baby events”. The events included death (13%), neonatal encephalopathy (brain damage due to lack of oxygen, 46%), meconium aspiration syndrome (the baby swallows stools, a sign of suffering, 30%), brachial plexus injury (damage of the nerves of the arm, 8%), fractured humerus or clavicle (4%); if the analysis was restricted only to nulliparous women, this risk was almost 3 times higher. For multiparous women (2 or more children), there were no significant differences in the incidence of adverse outcome by planned place of birth.

home-birth-australian-babyAustralia: in a paper by Kennare et al, although there were no differences in perinatal mortality, home birth was associated with 7-times higher risk of intrapartum death, and 27-times higher risk of death from intrapartum asphyxia (lack of oxygen). Interesting enough, one of the authors (Dr. Keirse) was the chairperson of the working party that developed the Policy for Planned Birth at Home in South Australia.

home-birth-american-babyUSA: The largest American study comparing home and hospital births was published in 2013, including data on more than 13 million births. This study indicated that babies born at home are 10 times more likely to be born dead and have almost 4 times higher risk to have neonatal seizures or serious neurological dysfunction (that is, brain damage) when compared to babies born in hospitals. Moreover, the risk of stillbirth in women delivering their first baby at home was 14 times the risk of hospital births. Dr. Grunebaum, one of the authors, explains that most likely the risks are even higher than that: “… the outcomes for patients whose care began out of the hospital but were then transferred to the hospital due to complications are reported as hospital deliveries. If the data were corrected, the risk of out-of-hospital delivery is likely to be much greater.” Another American study confirmed these findings, which, contrary to the British study, showed that the neonatal outcome was worse both for nulliparous and multiparous delivering at home.

home-birth-international-babyPooled data from USA, Australia, Switzerland, Netherlands, Sweden, Canada & UK: A study by Wax et al. showed that home births are associated with a risk of neonatal death three times higher as compared to hospital births. The results of this study led the reputed medical journal The Lancet to write an editorial stating “Home birth: proceed with caution”. Wax’s study though was highly criticized on methodological grounds.

Why such a disparity in the results of the different studies?

There are many possible explanations:

  • The lack of randomized trials, as it is not possible to force women to deliver at home or at a hospital against their will. It is clear from different studies that women delivering at home are different from those delivering at hospitals (usually home birthers are more educated and come from a more socioeconomically advantaged area); populations may also differ from country to country.
  • Underreport. In many home births studies there are missing data; in others home births that were transferred to hospitals are included in the hospital group.
  • Midwives’ training. In most European countries and Canada, home births are attended only by midwives or physicians; midwives have a university degree and undergo intensive training. In most states of the United States, besides certified nurse midwives (with formation equivalent to European midwives), births are also attended by “direct-entry midwives” with no university degree and diverse training; the only requirement for them to practice is a high school degree.home-birth-all-babies
  • Eligibility criteria for a home birth. Studies with good outcome had very strict inclusion criteria for home birth, that is, they excluded women with twin pregnancies, preterm labor, preeclampsia, etc.
  • Transport rates. Best outcome was associated with a very high transportation rate: about 40-50% for nulliparous, 10-20% for multiparous. On the contrary, the US studies -with more adverse results- report overall transportation rates of about 10%.
  • Efficiency of transport system, midwives’ integration to hospitals. Rapid availability of ambulances -such as the so-called Obstetric flying squad in the UK- and hospitals in tight collaboration with midwives working in the community seem to be essential. But even so, some complications may not be solved, even by the most efficient form of transport.
  • Distance to the hospital. Although shorter distance to hospital seems to be crucial, even this may not prevent certain complications. Hospitals have what is called the “decision to incision” rule, that is, the maximum time that should pass between the decision to make an emergency cesarean section and the time it is actually done. This rule is 20 or 30 minutes, according to different countries. It is clear that this time frame cannot be achieved with home birth, not even with close distance to a hospital.


Read the second part here:  Home birth: smart choice or risky business? (Part 2)

Photo Credits:

Intro: Flickr.comPinterest.comWikipedia.org; 1) Gettyimages.comwhich.co.ukwhich.co.uk; 2) booshparrot.com, herb.co; 3) Flickr.commoveoneinc.com, Pinterest.com, sheknows.com, blogqpot.combabynames.allparenting.com,  mercatornet.comlaineygossip.com


Stromae papillon

Μετά την Ελλάδα, θα ήθελα -μετά τα πρόσφατα τραγικά γεγονότα- να κάνουμε ένα μουσικό ταξίδι στο Βέλγιο… Και αν σκέφτομαι Βέλγιο, ένας καλλιτέχνης έρχεται αμέσως στο μυαλό μου: ο Stromae.

‘Ισως μερικοί από εσάς αναρωτιέστε, ποιος είναι ο Stromae;

Αφίσα του Stromae σε έναν τοίχο στο Ώστιν, Τέξας

Μπορεί να μην έχετε συγκρατήσει το όνομά του, αλλά κατά πάσα πιθανότητα θα έχετε ήδη ακούσει -και χορέψει- μία από τις απόλυτες επιτυχίες του: το Alors on dance, το οποίο το 2010 έφτασε στην κορυφή των charts στις περισσότερες χώρες της Ευρώπης. Η φήμη του όμως έχει πλέον ξεπεράσει τα ευρωπαϊκά σύνορα: σε μία πρόσφατη περιοδεία κατάφερε να ξετρελαίνει και τους Αμερικάνους.

Αλλά ο Stromae -το όνομά του προέρχεται από την αντιστροφή των συλλαβών της λέξης Maestro– είναι επίσης ένα σούπερ σταρ στο YouTube: τα βίντεό του έχουν ένα δισεκατομμύριο προβολές!!

Ποιο είναι, άραγε, το μυστικό της επιτυχίας του Stromae, ιδιαίτερα λαμβάνοντας υπόψη πως τραγουδάει μόνο στα γαλλικά; Η μελωδική του μουσική; Οι βαθυστόχαστοι στίχοι; Το αινιγματικό του παρουσιαστικό;

Stromae yellowΑν και η μουσική του έχει επιρροή από ηλεκτρονικούς και hip hop ήχους, δεν περιορίζεται μόνο σε αυτούς: κάποια τραγούδια έχουν αφρικανικούς, άλλα latin ρυθμούς, οι οποίοι αναμειγνύονται αρμονικά μεταξύ τους. Αλλά αυτό που κάνει τον Stromae να υπερέχει από άλλους καλλιτέχνες είναι ότι, στα δήθεν ελαφρά ακούσματα των τραγουδιών του, κρύβεται ένα ισχυρό κοινωνικό μήνυμα: μιλάνε για το AIDS, τον καρκίνο, τις σχέσεις, τα σεξουαλικά κλισέ … Ωστόσο ο Stromae πιστεύει πως το να καταλάβεις τους στίχους δεν είναι και απαραίτητο: «Κανείς δεν καταλαβαίνει Αγγλικά [στο Βέλγιο], αλλά όλοι ακούνε αγγλική μουσική, γιατί μπορούν να διαισθάνονται το συναίσθημα και το groove των τραγουδιών, και αυτό φτάνει για να χορέψουν και να νιώθουν τη μουσική», λέει χαρακτηριστικά.

Η εκκεντρική του εμφάνιση ήταν αναμφίβολα καθοριστική για την ευρεία του αναγνώριση: τα εξωτικά φυλετικά χαρακτηριστικά, το σκούρο δέρμα και τα πράσινα μάτια του -ο πατέρας του ήταν από τη Ρουάντα, η μητέρα του είναι Βελγίδα -καθώς και το εκφραστικό, μελαγχολικό του βλέμμα. Και φυσικά το εξίσου εξωτικό του ντύσιμο, το οποίο συνδυάζει με απόλυτο στιλ την βρετανική κομψότητα και την αφρικάνικη αισθητική.

Επομένως, ίσως το μυστικό της επιτυχίας του είναι πως ο Stromae συμβολίζει την Ευρώπη: είναι ένα μείγμα από διάφορες φυλές, στυλ και πολιτισμούς, προκλητικός και αντιφατικός, με απόλυτη προσοχή στην αισθητική, με ελαφρότητα αλλά και κοινωνικά ευαισθητοποιημένος…

Stromae Cheese

Το πρώτο hit του Stromae ήρθε σχεδόν κατά τύχη: ενώ εργαζόταν ως μαθητευόμενος σε ένα βελγικό ραδιοφωνικό σταθμό, ο μουσικός παραγωγός άκουσε το “Alors on dance” και αποφάσισε να το παίξει. Η επιτυχία ήταν άμεση. Τα πιασάρικα beats του τραγουδιού παραδίδουν ένα μήνυμα: «Η ζωή είναι χάλια, ας χορέψουμε”, και το τραγούδι ήρθε στο κατάλληλο μέρος, τη κατάλληλη στιγμή: στην αρχή της οικονομικής κρίσης της Ευρώπης το 2009. Το βίντεο δείχνει έναν άντρα απελπισμένος με τη ζωή του και την κοινωνία, έτσι το μόνο που του έχει απομείνει είναι να χορέψει.

Το πρώτο του άλμπουμ, το Cheese, κυκλοφόρησε το 2010. Εκτός από το smash hit “Alors on Dance” περιέχει και άλλα ωραία κομμάτια, ίσως το αγαπημένο μου είναι το “Te quiero”.

Stromae Racine Carree

Το αριστουργηματικό του δεύτερο άλμπουμ, το Racine Carrée (“Τετραγωνική Ρίζα”), το οποίο κυκλοφόρησε το 2013, είναι ακουστικά πιο ποικιλόμορφο και ολοκληρωμένο, ενώ διατηρεί παράλληλα τους βαθυστόχαστους στίχους. Συμπεριλαμβάνει πολλά υπέροχα τραγούδια, τα περισσότερα εκ των οποίων έχουν φτάσει στο νούμερο 1 των charts της Γαλλίας και του Βελγίου. Είναι δύσκολο -αν όχι αδύνατο- να επιλέξω μόνο ένα τραγούδι από αυτό το άλμπουμ. Αυτά είναι μερικά από τα αγαπημένα μου:

Papaoutai” (“Papa où t’ai/Μπαμπά που είσαι”) μιλάει για απόντες πατέρες: ο πατέρας του Stromae σκοτώθηκε κατά τη διάρκεια της γενοκτονίας στη Ρουάντα, και ο ίδιος μεγάλωσε με τη μητέρα του. Στο πολύχρωμο, οπτικά άψογο βίντεο –με περισσότερα από 300 εκατομμύρια προβολές στο YouTube!– ένα αγόρι χρησιμοποιεί έναν κούκλο για να αντικαταστήσει τον πατέρα του:

Stromae Tous les memesFormidable”, είναι η ιστορία ενός αστέγου. Το βίντεο έγινε viral στο YouTube: για να το κάνει χρησιμοποίησε κρυφές κάμερες σε μια στάση του τραμ και προσποιήθηκε πως ήταν μεθυσμένος.

Tous Les Mêmes” (“Όλοι ίδιοι”), στο βίντεο ο Stromae εμφανίζεται ντυμένος μισός άνδρας, μισός γυναίκα, και αναλύει διάφορα στερεότυπα για τις διαφορές μεταξύ φύλων.

Carmen” χρησιμοποιεί κινούμενα σχέδια για να περιγράψει τους κινδύνους της υπερβολικής χρήσης των μέσων κοινωνικής δικτύωσης:

Quand C’est?” (Πότε είναι; στα γαλλικά ακούγεται σαν “Καρκίνος”) είναι το τελευταίο του βίντεο, περίτεχνο και σκοτεινό, όπου εξερευνά τον φόβο και τον πόνο που μας προκαλεί ο καρκίνος:

Μάθε περισσότερα για τον Stromae εδώ:

Stromae Mosaert

Η σελίδα του στο Facebook  

Ο λογαριασμός του στο Twitter 

Το fashion label του Mosaert


Stromae papillon

After Greece, I felt compelled to travel -musically speaking- to Belgium, moved by the recent tragic events… When thinking Belgium, one artist comes straight away to my mind: Stromae.

Many of you may wonder, Who the hell is Stromae?

Stromae poster on a wall in Austin, Texas

If you live in Europe, chances are that you have already heard -and danced- one of his absolute hits: Alors on dance, which in 2010 topped the charts of most European countries. His fame though, has now largely exceeded the European borders: in a recent tour he managed to take the USA by storm.

But Stromae -his name comes from reversing the syllables of Maestro–  is also a YouTube superstar: his videos have one billion views!!

So, what’s the secret of success, particularly for someone who sings only in French? His melodious tunes? The meaningful lyrics? His enigmatic look? The answer is: all of them!

Stromae yellowAlthough his songs are influenced by electronic and hip hop music, they are not confined to these two genres: some songs have african, other latin sounds, blended harmonically together. But what makes him excel above other artists is that, under the easy-listening rhythms, a powerful social message is hidden: he tells stories about AIDS, cancer, relationships, sexual clichés… Yet Stromae believes that understanding the lyrics is not that important: “Nobody understands English music [in Belgium], but everybody listens to English music, so we can understand the feeling, understand the groove, and it’s enough actually to dance on it or to feel”, he says.

Stromae’s eccentric look has certainly been instrumental for his wide recognition: the exotic racial features, dark skin and green eyes -his father was from Rwanda, his mother is Belgian- as well as his expressive, melancholic regard. And of course his signature, equally exotic dressing style: a blend of British elegance and African aesthetic.

Thus, maybe the secret of success is that Stromae is a symbol of Europe: a mixture of races, styles, and cultures; exhaling a great deal of contradiction and provocation; with utmost attention to aesthetics; weightless but socially engaged at the same time…

Stromae CheeseStromae’s first hit came almost by chance: while working as a trainee at a Belgian radio station, the music manager heard “Alors on dance” and decided to air it. The success was immediate. The song’s catchy beats deliver a message: “Life sucks, so we dance”, which came out in the right place, the right time: at the beginning of Europe’s economic crisis back in 2009. The video shows a guy feeling hopeless about his life and society, so the only thing left is to dance.

His first album, Cheese, was released in 2010; besides the smash hit “Alors on Dance” we find other nice tracks; maybe my favourite is “Te quiero”.

Stromae Racine CarreeHis masterful second album, Racine Carrée (Square Root), is musically more diverse and accomplished, while preserving the relevant lyrics. Released in 2013, it contains many wonderful songs, most of which have reached number 1 in France’s and Belgium’s charts. It is difficult -if not impossible- to pick a single song from this album; these are some of my preferred ones:

Papaoutai” (“Papa où t’ai/Papa where are you”) talks about absent fathers -Stromae’s own father was killed during the Rwandan genocide, and he grew up with his widow mother. In the colourful, visually  impeccable video -with more than 300 million views!- a boy uses a mannequin to replace his absent father:

Stromae Tous les memesFormidable”, a story about a drunk homeless, went viral on YouTube: to make the video, he used hidden cameras at a tram stop and pretended to be drunk.

Tous Les Mêmes” (“All the same”) features Stromae dressed half a man, half a woman, and depicts various stereotypes on gender differences.

Carmen” uses cartoon to accurately describe the dangers of social media overuse:

Quand C’est?” (When is it?; in French sounds like “Cancer”) is Stromae’s latest artful, dark video, where he “explores the pain caused and inevitable fear of cancer”:

More info here:

Stromae Mosaert

His Facebook  page

His Twitter account

His fashion label Mosaert