To be fed up of the "home birth is risky" misinformation?

In yesterday papers a young mum and her baby died when she chose to have a home birth when allegedly she was told there was risks to them both . How sad and possibly avoidable 🥲

The issue is spelling it out this clearly had been discouraged because women don’t like feeling heavily criticised (or ‘coerced’ as they call it) for their bodily autonomy choices.

I’m part of a birth trauma FB group after the birth of DC2, and the sheer number of posters who are convinced they were heavily pressured into hospital/CS ‘for no reason’ is so high it’s probably 80% of the posts. When you read on, they then say ‘they wanted me to do this as I had group B strep/a haemorrhage before/baby has a heart problem… BUT my doula said this wasn’t a reason I couldn’t have a home birth’.

Either we are autonomous beings who just need facts laid out without emotion to make our own minds up, or we need full counselling and steering by medical professionals who use scary words like ‘death’ (if applicable). Everyone seems to want the former then switch to the latter after it’s all gone wrong.

Given the reduced funding for maternity care I do wonder about that.

A key maternity fund was recently slashed from £95 million to just £2 million, which is an absolute joke. That fund was put in place to help the increasing failures of maternity care in this country.

no but you can argue that the bare stats don't tell the whole story

You are right OP, if we are talking evidence based medicine it's very positive towards home births having very good outcomes for low risk mothers, often more so than in hospital bitrgs. Similarly in terms of low risk mothers the best outcomes are typically for mums being managed by midwives, GPs, and OBs, in that order.

These aren't strange stats, they make a lot of sense both within the context of labouring mothers' responses to environment, and how differernt kinds of medical practitioners manage a birth.

However there has been a massive shift in the population across the English speaking world, from the center-left to the progressive left, against evidence based medicine and towards a differernt kind of thinking that it's difficult to charachterise, but which i would say is a kind of authority/control/expert driven thinking and practice. You see very much the same thing in people's thinking about education, despite the fact that it's not evidence based. People want some expert, in authority, to control situations, and they believe that must give better outcomes. A lot if fear based I think.

I suspect a lot is the aftermath of the pandemic, many people's need to take actions that give the illusion of expert control was pumped up and never really went away.

I would have bled out if I’d birthed at home. As earth mothery as I am, I can get that fix elsewhere. Personally there’s no way would I risk my or my child’s life for a home birth. Did I love the hospital atmosphere? Nope. But I’d be dead if I had opted for a home birth. Even in the hospital they had a hell of a time to get the bleeding stopped.

This case is quite astonishing. Unlike others, I think every member of medical staff who met this lady did need to tell her ‘your decision, with your history, may well kill you’. She needed to hear this very clearly.

But their liability does not mean that this lady herself can be absolved of responsibility. It seems very cruel to criticise the dead, but for the sake of other women & their babies I think we need to be honest about the fact that she was astonishingly irresponsible- both to her son left motherless, and her daughter, deprived of any chance at life. I simply cannot understand what on earth she was thinking & think the inquest should look at the online influences she was subject to with a view to exposing them.

It reminds me of the Shemirani case.

It is absolutely true that hospital births have some risks that home birth doesn't (infection, cascade of interventions). It is also true that the unexpected can happen (in my dd's case, cord round neck). There are also other key factors like how far you are from a hospital.

We'll have the maternity services we deserve when the ghastliness of maternity services is not a factor in decision-making.

The problem is risk is just probability based on various known factors but can't take unknown factors into account. Me and my DD nearly died having a home birth, but our risk was assessed as low and we'd been with the lovely home birth team all the way through with full support and several midwives in the house. And the midwives came round right at the start of labour too, and I didn't have to travel and had a lovely birth pool. But you can't know what dangers will occur. For us luckily the ambulance was fast enough, and we were able to have an emergency C-section and my DD got treatment in special care baby unit. I couldn't have known in advance I needed them. Whereas there will be plenty of hospital births that are the opposite, everything goes perfectly fine and they'd have been fine to have a supported home birth but this is only obvious afterwards. The advantage of a hospital birth is this emergency treatment is available as an option. Given the choice of my traumatic hospital birth or a lovely easy home birth of course I'd prefer a home birth, but you can't choose for the home birth to go smoothly what happens happens and you can't know in advance whatever the risk assessment it's still just a type of guess.

Yes I completely agree. If we knew a birth would be complication free then I would be all for home births. But we don’t. So I agree the unpredictability makes every home birth risky.

I think it’s an odd thing to be annoyed about. The risk is different for everyone, and women certainly don’t need more shame for choosing a hospital birth whether they are high risk or otherwise. Home birthing advocates do seem to be mostly very young and healthy and low-risk, great for them.

Each to their own, minus pressure that one is better than the other. I’m another who’d have died along with my baby without medical intervention so

I had a straight forward first pregnancy and my midwives discussed a homebirth with me as the risk factors were really low. I was really keen on the idea, my husband was very nervous (he's naturally more cautious than me) and felt we would be safer in hospital. We opted for a hospital birth.

After a very straightforward labour our DS was born unresponsive and not breathing. It took a team to get hm breathing again and then he had to be transferred to a different hospital to have treatment to reduce the risk of brain damage. If we had been at home he wouldn't have survived.

I am thankful every day that my DH's caution meant we were in hospital, I can't actually let my mind go to where we would be if I hadn't taken his feelings into consideration.

I wanted a home birth after my very uncomplicated first birth in a midwife led unit, the only reason I changed my mind is our renovations weren’t finished in time. Lucky for me and DD2, as I had a placental abruption during labour and because I was in the midwife unit at a major hospital, I was transferred to the labour unit, no time for an epidural so had a crash c-section in about 8 mins. All I know from my experience is I am really glad I wasn’t a 15 min car ride away from a hospital.

Thank you for the support - I think I'm the 'silly' one and the 'home birth activist'. Ironically, I have never had a home birth - I planned one, and then happily changed plans and had a hospital birth when things changed and it was no longer the safest option for me and the baby. That was my second birth - my first I didn't even consider home birth as I felt the chances of transfer were too high. I am absolutely not some sort of pro home birth zealot.

I have never, and would never, claim that home birth is appropriate in all cases, that it would always be a safer option or that it is without risk. However, it is simply not true to say that it is always safer to give birth in a hospital, and despite what the poster who thinks I'm 'silly' says, it is not proven medical fact. Her 'common sense' doesn't trump the outcome of multiple medical studies which are used as the evidence base by NICE. These are the actual facts, which I have not 'gravely misunderstood'.

Well what complications do you think the hospital would actually cause?

I’m sorry to hear that :(

It would be more or less impossible to work out the statistics but I’d love to see how many of the people who “works have died in a home birth” had complications DUE to the fact they were in hospital. Obviously the quality of care can vary wildly but I’ve heard way more horror stories about being totally neglected Oar being forced to have interventions, in hospital.

i get it that people want to be near emergency measures just in case but so many don’t take into account that labour can stall / become much more complicated when you’re trying to give birth in a hostile environment (bright light, strange place, unknown people) when we are all mammals who would naturally find a quiet dark private place to birth in.

I don’t understand what you want from this thread. It’s different for every woman. How on earth could you know what’s best for any birth experience other than your own? Or are you a midwife or obstetrician struggling to convince women to choose an alternative care pathway to leave space free for more high risk pregnancies?

If something does go wrong, a home birth is definitely riskier than being in hospital, no argument. There are several reasons for this:

• Limited staff: Often, only one midwife is available, and they’re usually on call. This means they’ll need to travel from home/another visit or their office, which can take time. Until they arrive, you’re essentially on your own without any professional support.
• Delays in backup: If complications arise, that midwife will need to call for a second midwife, who is also likely at home or on another call/in the office. Again, could easily take 30 minutes or more for to arrive, and in an emergency, that’s a long time.
• Limited equipment and emergency support: If you experience a haemorrhage, a cord prolapse, or another emergency, an ambulance will be needed. Midwives attending home births generally have very limited equipment to manage severe complications, so you’d be waiting for paramedics and ambulance response times are not quick. During that wait, even the most skilled midwives can do very little without the necessary equipment or support team.
• Doulas: It’s worth noting that doulas don’t need any formal medical training or qualifications to practise - the only ‘requirement’ is having given birth themselves. While some are wonderful and supportive, many I’ve met have given dangerous or inappropriate advice during labour when medical help was needed.
• Access to pain relief: At home, options are limited. In hospital, you have access to epidurals, stronger analgesia, and anaesthetists if needed.
• Monitoring: Continuous monitoring of the baby’s heart rate and your vital signs is much easier and more reliable in a hospital setting, which can help catch early warning signs before they become emergencies.
• Emergency facilities: In hospital, if something suddenly goes wrong, you’re seconds away from obstetricians, surgeons, and full resuscitation equipment. At home, you have none of this.
• Unpredictability: Even the most low-risk pregnancies can develop unexpected complications during labour, which require immediate intervention.

So yes, the fact of the matter is home births are riskier than hospital births. The very sad story in which the mother and baby died recently is devastating, but this woman was told the risks of a home birth and advised against it. She chose to ignore this advice.

Yes, I agree.
i don’t think the doctors can be blamed here.
Re warning about risk if death - damned if you do, damned if you don’t.

Im sure however she listened to someone like the OP or some untrained “doulas” peddling the garbage that home birth is always safer and hospitals medicate births “unnecessarily”. There are lots of “crunchy” woo-woo communities which peddle this crap

My friend's daughter had her first baby at home and had to be blue lighted to hospital after the birth due to a post-partum haemorrhage.

Birth is always unpredictable, particularly for first babies, so I would deem a home birth for a first baby to be more risky than a hospital birth. Subsequent pregnancies when the first pregnancy and birth were unproblematic and straightforward could possibly be safer than a hospital birth if planned well and as long as the expectant mother lived near enough to a hospital to be able to get there in time if an emergency situation arises.

I personally wouldn't have risked one as I had complications in my second and third pregnancies after an unproblematic first pregnancy.

How far are you from your local hospital?

I had an emergency c section and we both could have died earlier this year.
My second child after a perfect birth with my first child, I was fit, healthy, age and bmi both 24. In fact I was lead to believe baby would fly out after being told a thousand times “second babies come out a lot quicker”

To be fair you can have both - I did. I fully accept the things that happened which were unforeseeable, and that nobody could’ve prevented them. But I also received very negligent ‘care’ to the extent my entire labour went unnoticed (for 12 hours) on an induction ward (I posted story upthread).

My first delivery I felt cared for and always privately wondered if those slating ‘poor care’ were blaming unforeseeable events on the doctors and midwives because it’s easier than facing the fact their body hadn’t done what they wanted it to do. But now I feel humbled as I experienced first hand just how appallingly negligent and inattentive some hospitals can be with my second child.

An 8hr 2nd stage? At home? That's negligent, I'm sorry. After 3hrs (absolute max), she should have been transferred to a Maternity Unit. As an ex-Midwife I'm appalled at that standard of care.

You've got irritated that you felt somebody shouted at you and I can understand that. But talking about somebody in the third person and saying they are 'silly' is really rude and belittling. This is clearly a highly emotive issue for women who have had either terrifying births or horrible dehumanising experiences in hospital, or both. You can take a purely statistical stance if you're planning maternity services. Maybe you've had your own horrible experience that makes you do that. But birth is a human experience as well as - often - a medical one. It is never a statistical one. Calling another woman silly is really out of order.