Homebirth - should any woman be allowed the choice?

I am so shocked that hospitals still get away with telling women what to do when actually they have no right to do this. Of course drs and midwives can advise, but no more. Pregnant women do seem to be regarded as either a/nothing more than vessels for their babies or b/giant overgrown children themselves.

wahey, excellent discussion

Mears, there was an editorial headline in the BMJ 2 weeks ago, 'Denying patients choices is patient abuse' (from memory, probably not exact).

This is exactly how I feel. ANY patient should always be given choices and allowed to come to a decision that suits them. Of course, there is always a cohort of patients who cannot make decisions or prefer their physician/midwife to make the decision for them.

Pregnant women are tremendously vulnerable and when you couple that with an increasingly litiginous society and an NHS that practices defensive, rather than sensible, medicine.....well, you get the picture. For women who want to take responsibility for their pregnancy/birth etc, then they should be allowed to, as long their is a full and frank discussion of the worst-case scenario and how the women would feel afterwards eg no point in sueing the NHS if a homebirth went wrong, it was the woman's decision.

I personally feel really strongly about this and very, very angry in my case. I have MVP and was told that I cannot be under the care of a midwife at my healthcentre. I was also told that I would have to have continual monitoring during the birth. I would have 'no choice, that's the rules'. Get this........ this was even though I told her that, as a cardiologist, my husband stated that there was absolutely no risk to my health during pregnancy. Midwife was unwavering, so I stated that I would rather have a section than be pinned to a bed giving birth in an uncomfortable position with the risk of tearing. 'Oh no, there's no need for that' she said.
Jeez........

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I think there are 3 types of women who go for homebirth:
Camp A) Just think it would be nicer than hospital. Safer too, probably.
Camp B) Had previous bad experience in hospital and don't want to go near the place again.
Camp C) Have deep-seated strong feelings not based on previous experience, but have strong anti-establishment feelings, surgery phobia, etc.

The media focus on extreme cases of C, the Camp B crowd can be me most strident, but I'm pretty sure most would-be homebirthers are in Camp A). Willing to work hard for a homebirth, but not absolutely set on it. The thing is, I think most of us make parenting choices that at least one other person thinks is crazy and all-wrong, maybe it's like that with homebirth. Whether it be smacking, leaving child alone in the car for 5 minutes, working full time when you don't need to or homebirth in a situation that someone else might label as WAY too risky. I try not to judge.

Even if you've had three babies at home before (I'd have thought you'd be pretty used to it by then, wouldn't you?)?

"under2, I must say that you have summed up exaclty how I felt in that article. All that stuff about going to a cave....crazy. And counter productive to the 'immage' of hb as a rational decision, made by woment who are quite sane and 'normal'...IYSWIM.

Death is inevetable, but that doesnt mean that we have to ruch to meet it halfway

I also think that ultimately it should be the woman's choice. Nobody of sound mental health should be forced into hospital, and I'd guess that someone who has placenta previa and refuses to have a cs in hospital would probably end up being sectioned under the mental health act.
I have been advised by various people against home births for both of mine. For my first home birth I went the independent mw route, second time round I had a great community midwife who was completely supportive (but then I did have a panic attack during an antenatal just thinking about going into hospital ). One of the other community mws on the team was very unsupportive though and miffed that I refused to go and see my consultant for 'permission' . She also made me sign a waiver (personally, I think women should be informed of the risks of giving birth in hospital). I wasn't bothered about her opinion to be honest - she had no experience of home births and had worked in hospital until recently, whereas my cmw was very experienced.
I just read the article on SK's site - I must say I found the woman's stance of death being the inevitable end result of certain conditions somewhat freaky (and not indicative of her being in good mental health). Would she refuse antibiotic treatment for herself or her child should she/he have pneumonia, for instance?

OK so we are talking about minor pregnancy complications here

I'm still not too clear what these might be, your original post said

"I have been asked to list why women who are condsidered not to have normal pregnancies should be 'allowed' a homebirth if they want it"

What exactly do you mean by "not to have normal pregnancies"?

It sounds to me like Levanna's midwife got it spot on, which I think is what you are referring to mears, giving support so that the woman will go into hospital if things do become serious.

I've been thinking about this. (I had a lousy first birth and a very straightforward second birth, at home. The pressure on me was from DP and his mum (who kept saying I was far, far, far too old and that look what happened last time); none whatsoever from the professionals who totally supported me in my choice.)

I think this links up with the thread on which women are discussing hospital care. A lot of us opt for a home birth because hospital is so very horrible to be in. It is also the right place to be in for many women - but what I'm saying is that our choices get skewed by the awfulness of hospital.

Not being very coherent, am I

I think it's up the the mid-wives to if they feel comfortable assiting the home birth. I know mid-wives who won't do home-births at all because they know everything which can happen and how quickly.
I personally think it's a bit of a gamble to let firt-time mums have home-births. You have no idea what your birth will be like. A lot of women write the most wonderful optimistic birth-plans and don't even think of the possibility that something might not go according to plan. I think second-time mums with easy first-births are the best candidates for home births.

I think in the main it should be the mothers choice, but, at the same time she should listen to what the 'professionals' are saying.

When I had my booking visit with my community midwife for pregnancy number 2 (ds), she asked what type of birth I wanted. I told her that I wanted to give birth in hospital, her response was 'Why don't you want a home birth, you are allowed you know' even though I'd had a difficult birth with dd1. I'm glad I stuck with my decision as ds was born with the cord tight around his neck and had to be revived, his shoulders also got stuck.

In my 3rd pregnancy I wasn't given a choice, my ante-natal care was basically taken out of my hands due to an uncontrolled overactive thyroid. This birth ended up with an emergency cs, apparently I should have been offered one before I went into labour, but wasn't. The Consultant on duty wasn't very happy that it hadn't been discussed with me. When I first arrived on the labour ward, the midwife examined me (she asked first) and told me that I was ONLY 2cm dilated and said that I should go back home. Both dh and I said no way, we'd woken MIL up to come and look after dd1 and ds, and, we both knew that it was real and not a false alarm. She gave in and let us stay, at this point it was about 3am. I didn't sleep at all, contractions etc. By the time the next midwife came in to check on me (thankfully there'd been a shift change) I was 6cm, allowed to have breakfast then transferred to the delivery suite.

Have talked to dh and don't think it was that case BUT he was involved in one where the mother had pre-eclampsia, refused treatment and had to be sectioned and given a c-section and sued for assault.

interesting point, mears, that often women in labour instinctly know what is right for them. I was dead set on a home birth and had very supportive pro home birth midwives. Easy labour up to 10 cms and relaxed, coping well with pain etc. After a lot of pushing, baby was just too big and not coming down birth canal easily at all. Suddenly I just knew I wasn?t going to do it on my own. The mws didn?t hint or say anything, I just knew I had to go in and quickly - I wasn?t pannicked or saying I couldn?t cope with the pain, I just knew that I needed more help. Sure enough, afterwards my mws and the doctors agreed that it was a very good job I had gone in when I had as there could have been major problems if I had stayed at home. The mws knew the ambulance ride at 10 cms and pushing wasn?t such a great idea and were all for trying an extra half hour but I am so glad I called it a day when I did - by the time I was in hospital the baby was in a lot of distress very quickly and it did get rather scary.
Saying that, my mws were fantastic and I have so much respect and gratitude for the work and kindness they showed me. It was just one of those instinctive things.

I totally agree with what you originally posted, mears.
I had a hospital birth last time, and I'm planning a home birth this time. My sister decided to have a homebirth with her child, when she was 18. She lives in a very rural area, and her hospital has an awful record of patient care. She was initially adamant that no matter what, she would not go into hospital, at any time. But due mainly to a very understanding, supportive and non judgemental midwife, my sister came to trust that if this lady asked her to be admitted at any point, it would be for a very good reason. If her midwife had at any time made light of my sisters concerns about going to hospital, I feel sure she would have lost that trust, and not complied.
It's ultimately the mothers decision, but information and support has to be provided to achieve the safest outcome, IMO.
(Read that horrific article a while ago )

I recall that case you mention, Mears, and am appalled that there were at least 12 other similar ones of women having a cs forced upon them. I think choice should always be informed, and then if a women is prepared to take responsibility, so be it.

I suppose most people are reasonable about these things. When I had dd I wanted a physiological third stage. I was prepared to go the other route if necessary, but I had complete faith in the MW that she would do her best to comply with my wishes.

It must come down to professionals really listening to what women want, in the end, and then making those wishes and needs happen, if at all possible. It might cost a bit of money to accomodate everyone but there must be savings to be made on less requirement for PND treatment and other stress-type illnesses that women can suffer from after having an unnecessarily traumatic birth.

I do know someone who has had several 'unattended' births, not because the baby arrived too quickly, but because she feels she and her dh know how to deliver a baby and they don't want any interference. I think that it's actually illegal to give birth without calling for help - Mears will put me right on this issue, I'm sure!

Or a footling breech? (which is what ds was) I've seen wamerican sites where women have delived alone with fb....to my mind an insane risk to take.

When I was expecting dd I honestly never thought that I would end up having a section. As it happened I did have an emergency, but in an odd sort of was it seemed to be 'the way it was supposed to be'. That makes me sound a bit odd, and I don't believe in predestination

Ds was a planned section for some very good medical reasons.

I just can't get my head around someone who would risk their child to get the delivery that they want. I do appreciate that some women are deeply traumatised by birth experiences (natural, cs or whatever). And I am not belittling the depth of their feeling. But the birth is only the start.

To avoid medical care, stating that you see life and death as natural does seem to be an extreme case. And what of the life of the child? (another can of worms, I grant you)

Mears what would you do if a woman insisted on a home birth with for eg a placenta praevia?

(that's what my mate who's a doctor calls our Toyota Previa btw )

I must say I am obv in the middle.

I wouldn't make a birth plan on the basis that I would probably be disappointed if it didn't then go to plan, lucky really given what happened. I always thought that situations can change so rapidly and to go in with a flexible approach was probably the best option.

DH was just terrified in general as he sees all the f**k-ups in his job, he was very keen on us following the advice of the Prof.