Homebirths LESS risky than hospital according to BMJ(29 Posts)
I had a low risk pregnancy and DS would be dead if I'd had him at home.
You just never know, though the idea is lovely and it suits some women
Home is a much nicer place to be generally!
I'm not refuting your situation Orchard but the evidence appears to suggest that being in hospital can sometimes cause the chain of events that lead to higher risks and possible 'close to death' difficulties.
What I mean is a lot of women say 'thank god I was in hospital and could have a c/section', when the very act of being in hospital meant that all the things that could trigger the need for a c/section were increased in probability, i.e. disturbed labour, non-optimal lighting, interference with hormone production, bad positioning of baby due to hospital protocols making it difficult for the woman to go with her instinct that could reposition, need for drugs that can affect labour etc etc.
Given that women who are at higher risk will be advised to have a hospital birth, these figures don't prove anything. Obviously they'll be seized upon by homebirth evangelists as 'proof', but what they prove is that homebirth evangelists don't really understand stats.
The groups are carefully controlled for. I studied statistics at degree level.
They discounted higher risk and match the mothers with the only variable being where they planned to give birth.
You can't remove the variable that women having home births are often likely to be more relaxed about the birth, which will make it go smoother, and also be less inclined to have pain relief/medication than women who want the security of the hospital.
I think the majority of people who have a hospital birth would be a lot more scared at home, I liked having the security of knowing NICU was just through the doors and there would be no fast ambulance ride after if anything was wrong with baby immediately (which there was)
I do think labour is easier the more relaxed you are, but I think if you look at women giving birth in
hospital with 1 to 1 midwifery care(which I was lucky to have) and who do not want/have pain relief then there would be very similar outcomes.
'You can't remove the variable that women having home births are often likely to be more relaxed about the birth'
I think you can, with research/questionnaire prior to birth, though I don't know if that has been done.
I do know, that my reasons for choosing a homebirth was because I was anything BUT relaxed about childbirth and couldn't stand the thought of 'going with the flow of a hospital policy' or being anything other than completely in control of everything. I trusted no-one and was extremely anxious.
I would place a bet on a decent number of homebirthers choosing to do so for similar reasons.
Oh I hadn't thought about that reason for homebirth star,
I think for low risk births, there is less likliness to be complications during labour as it is less likely to be as traumatic if it is where the mum feels most relaxed, especially if a homebirth is nearby to a hospital I wouldn't see much difference for labour.
But I still think if the woman feels able to refuse any interventions she doesn't want, and has a caring midwife, that hospital is safest for baby after birth (purely based on having DD born needing resuscitation and being rushed to NICU, I don't know how things would have gone with an added ambulance ride)
I'm glad but don't believe it much. There will be another study next year saying opposite. Don't like Safety First culture, anyway.
I've had one of each. DS was far quicker & easier at home but then that was perhaps partly due to him being #2. I think it should be easier for women to choose & having more studies discrediting the scare-mongering, hysterical reaction of "it's not safe - won't somebody think of the baby!!" can only be a good thing. If a woman want hospital birth, that's fine. If she wants a home birth, that's fine too.
Starlight I chose a home birth for the same reasons. I also did hypnobirthing and totally agree with general principles of it. All my nct friends who had natural births in hospital were rushed, cut, stessed, in tears and all swore they would only have a second child if they could have an elective c-section. They pretty much had the experiences my hypnobirthing lady told me about and those experiences were exactly what I wanted to avoid.
I had a 5 hour labour with no gas and air, DD was born in water, I bled very little and only had a tiny graze with no stitches. I didn't use the hypno techniques but I had totally signed up to the fact that birth and labour didn't have to be medicalised. I'm pretty sure that a large part of my "easy" labour was due to mindset. And I suspect that other people choosing home birth would have a similar approach and therefore, in most cases, have an "easier" and subsequently safer time of it all.
Of course, this study shows higher risk of homebirth - also covers the Netherlands.
If the birth goes well having your delivery at home is safer. But you don't know if it's going well or not. If it's not going well..... help might come to late.
Help might come to late in hospital soon - with over-worked MW & full wards. Personally & anecdotally, I know that MWs in hospital have been far too keen to send women home instead of admitting for monitoring, resulting in near unplanned home births &/or serious issues progressing where greater intervention has been required. Nobody knows what's going to happen during labour & birth, but I do know I felt a hell of a lot safer with a MW sat on the end of my bed & another one on the way compared to hurtling up the motorway to get to the hospital...
Should read "help might come too late in hospital too". Would blame my phone but it was me
In a hospital setting they are much, much quicker to intervene.
I was told I could only go 1 week overdue. I was given a sweep THEN my blood pressure taken- of course it was up, wouldn't yours be?
This then set in motion a whole series of protocols which further increased my anxiety. Pre-ecplampisa was mentioned despite the fact that my BP had never been up until hat point. I had no headaches and no protein in my urine. Someone came along to break my waters. I was told I had to lie on my back with a monitor strapped to me when I really wanted to get up and move around.
Finally I insisted on be in able to walk about, and thankfully my labour progressed really quickly at that point but I was told if nothing had happened in 3 hours they would start drug intervention. I had a midwife who wouldn't accept that I didn't need gas and air and kept trying to put the mouthpiece in my face. She also attempted to take my blood pressure DURING a contraction. After DS2 was born (thankfully it was really quick) I just wanted the hell out of there. I wasn't allowed to leave till the morning as it was "too late in the evening and there is no-one to discharge you" .
The consultant (a woman) was horrid and as I was leaving said "You never really had any of the true signs of pre-eclampsia". It was near new Years Eve and I know they were trying to organise my labour around their holiday cover. I regret the hospital birth and wish I had had him at home
hello I would agree about the mindset thing. I had no pain relief for either of mine . I knew it would be very sore but opted to sort of ride the pain wave as each contraction came. In both births as I was reaching the point of "I can't cope now" the baby was born. (But I'm a bit of a control freak so maybe that's why it worked for me)
"If the birth goes well having your delivery at home is safer. But you don't know if it's going well or not. If it's not going well..... help might come to late."
That might be true if you are having an unattended birth or an unplanned homebirth. It is certainly not true if you are having a planned NHS homebirth.
If you have a planned homebirth you are guareteed one to one care from a very experienced midwife for the first stage and then two to one care in the second stage. (assuming that midwife no. 2 makes it in time!) NHS midwives are trained in resuss, they carry oxygen and have a saline drip if a woman loses a lot of blood.
In a hospital situation a newly qualified midwife might be looking after four women and miss complications until an advanced stage. It is the lack of one to one care and an over reliance on machinery that cause the cascade of intervention.
I agree that women who choose to give birth in hospital have a different mindset from those who give birth at home. Often they have done far more research into labour options and pain coping strageries. They have researched how to maximise chances of a natural birth.
Childbirth will always be risky whether you choose to give birth. Women need a range of birth options so that they can choose what is safest for them.
Hop and starlight
I think your both right in my case
DD2 was born at home, because I was pretty relaxed about pain in labour, giving birth bit, but find hospitals and being told what to do very stressful.
Ds2 was a planned home birth, after a long back to back labour which wasn't progressing, my waters were broken to find fresh myconeum (sp?). I was then blue lighted to hospital where he was born with the aid of a ventuse (again sp)
However I'm pleased I laboured at home as it was much more relaxing, but if there were ever another time, I would choose a hospital.
Given that women who are at higher risk will be advised to have a hospital birth, these figures don't prove anything.
I think this is the study the BBC news article is discussing: www.bmj.com/content/346/bmj.f3263. The study only compared the home/hospital births of low-risk women, therefore higher risk women who are advised to have a hospital birth won't skew the results.
I have seen these results and find them interesting.
I do think you need to consider that the best thing is almost certainly to give women the type of birth they feel most comfortable with. If I had to give birth at home I would have freaked out all over the shop - so people like me would change the stats if for eg all low risk had to give birth at home.
I'm not sure that data that excludes the death rate from the calculation is the best measure of what is less risky.
Unless the death rate is zero, which it isn't, it can't be excluded if you want an accurate result unon which women can reliably base their decision.
And women having an accurate basis for making their descsions is far far more important than anybody's personal or finatial need to big up one way of giving boirth pver another.
The author is a Dutch homebirth midwife. She represents people who earn more if a child is born at home than they earn by caring for a woman who either tranfers or opts for hospital birth. Cui bono from massaged results that leave out the death rate and thus somewhat innaccurate conclusions reached by lay people who are motivated to choose "less risky". ?
I support women giving birth where they like (within reason, shark infested seas or yoga retreats in the middle of nowhere in an undevolped cpuntry for example don't attract my support). There probably is an i creased risk of death or harm from home birth in relative terms. But the rate will still be low enough to be called low risk. Rough if you personally draw the short straw, but in terms of Europe with its trained home birth midwives (unlike America) not a basis for withdrawing or overegging the risks the option.
However women deserve a full picture unpon which to make their decsion. They are the ones who live with the outcomes should they or their child fall into the very small, but exisiting group that got seriously unlucky. They are more important than any professons desire to protect their income stream.
I personally won't ever give birth more than once due to what happened to me in hospital. So I do understand why people turn away from that location. But midwives replicating the self interest, god(dess) complex and lack of true adhesion to informed consent that occurs in hospitals is not best foot forward. It's just same old, same old, with women and children at the bottom of the heap in terms of priority and consideration.
It doesn't address the issue of patient first, professional interest last. It just exapnds the settings where that topsey turvey dynamic takes place.
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