Home births are irresponsible

[LadyShapes]

Did anyone see the start of Lorraine at about 8.30? They were talking about what's in the news and one of the stories was about how more women should have home births. The delighful guest they had on to talk about it said that she thought home births were irresponsible and dangerous. She also said she thought natural births were a load of rubbish and she just wanted to be in hospital and have medical intervention (paraphrasing). Oh and she wouldn't have a home birth because she has cream carpets. The other guest just agreed with her, so the that was the extent of the discussion.

Is it me? AIBU to think they shouldn't discuss news stories unless the guests have some kind of informed opinion (I mean, all the infomation I have had from my midwife tells me about the benefits of home births and a natural birth as well as the risks), or they should have read more than just the headline. Or AIBU to be watching Lorraine and hoping for some kind of balanced discussion.

oh bollocks, bolding fail.

sorry Tangle, hope you can spot your quotes in " " in between my responses.

But my point is Hairy that "The Government" has never tried to persuade me to have a HB. The people who are promoting them as far as I am concerned are the MWs, and not for reasons of cost.

And do you think that midwives aren't told to push home births? They have targets to meet in Wales. I'm sure some midwives are passionate about them. But I doubt they have much choice as to whether they push them or not at women with low risk pregnancies.

Hairy - there is evidence that continuity of caregiver is linked to better birth outcomes. It's one of those things - most women don't get it and don't know what they're missing. So when there have been surveys asking women what they want in maternity services, they've rarely flagged the issue up. Unless they've had experience of being cared for by a caseloading midwife, (ie - one midwife providing all the care in pregnancy, birth and postnatally) in which case they usually become completely evangelical about how much better it is than seeing a different person every time and being cared for by a stranger in labour.

"The people who are promoting them as far as I am concerned are the MWs"

The government is committed to basing recommendations regarding maternity care on good quality medical evidence.

There are really clear benefits for women and for babies in having a homebirth. Women tend to be happier and healthier after a home delivery. Midwives promote them because they know that women are more likely to have uncomplicated labours, and because they are better able to do their job - which is to focus entirely on the mother and baby, and not be worrying about institutional pressures.

Yes I'm sure that every time governments have made either direct or backhanded cuts in the nhs they have done so for the good of everyones health .

There are benefits for SOME women having a home birth. I don't think it would be of benefit to force women who don't want one to have one. You seem to think that all women with low risk pregnancies should have a home birth. I disagree.

I maybe don't know what I was missing by having 'strange' midwives at my births. What was it? As I said my antenatal midwife was pretty much a stranger too. I probably knew people I saw at the bus stop on the way to work better.

I would have been on paper a good candidate for a home birth - I actually had my dc in hospital and thank goodness I did, because late in labour I had complications and had to be rushed into have a caesarian. I have no idea what the outcome would have been if we had been in a situation where we were calling an ambulance and waiting.... as it was although I lost a lot of blood both me and my dc were fine.

In my personal but limited experience they don't push it as such but are just very enthusiastic when you ask for it. Perhaps it's all a clever psychological ploy.

I'm on the UK homebirth egroup and there certainly seem to be plenty of MWs around who aren't pro-HB/pushing it - in fact if you go and hang around on MN's childbirth pages for a while there are usually plenty of people having to fight for a HB (or there were when I was planning DD's birth three years ago).

In fact when DD was born my HB was called off at the last moment due to staffing issues - so clearly not of desperate importance to the MWs at the hospital (or they could have got temporary cover).

I have never personally heard of anyone being forced to book a HB who didn't want one.

Re stranger MWs ... With DD I had a different MW/GP for every appointment then moved 200 miles and saw a couple more then had a complete stranger during the birth itself. Was fine.

This time I have seen the same MW every single time and she's promised she's going to try to come out when I go into labour. I actually feel slightly weird about someone I "know" staring at my fanjo!

Thing is for me is that if anything went wrong with my baby would I choose to have a HB I could not forgive myself. Because I would not be able to ask myself if things would have gone better if had been in a hospital.
I don't care if people have HB. I just want to go with the option I am happy with.

I actually feel slightly weird about someone I "know" staring at my fanjo!

Which gets even worse when they look like George Clooney. You'd think it would be a dream come true, but actually it was very disconcerting.

Scans were nice though, it was like being on ER, but in the flesh, dubbed into Italian.

"There are benefits for SOME women having a home birth".

Yes - and benefits for some women having hospital births: those mothers with complex pregnancies and those who want an epidural.

But there is no proof that having a baby in hospital is associated with any clinical benefits to healthy women or their babies.

That said, I don't think it would be of benefit to force women who don't want a one to have one. You seem to think that all women with low risk pregnancies should have a home birth. I disagree."

Did you miss the bit where I said that women have do do what they feel is best and safest for them? Nobody's talking about compulsion to have their baby out of hospital.

" I maybe don't know what I was missing by having 'strange' midwives at my births. What was it?"

Well - whatever it is, when women experience it they want it again for their next pregnancy!

I never met the MW who got me when I came to hospital, but I am bloody grateful to her for getting senior midwife when she became suspicious things were not going to plan. I wanted a professional not a friend.
Don't get me wrong, she was very kind and supportive and that's why I want the same experience again next time. Not the Emercgency CS bit, but the feeling that I was surrounded by professional people who did not hesitate to refer to others when they thought something was off.

I've found that sometimes on MN that people that have had homebirths seem to be its a homebirth or nothing. Personally for me I will have a homebirth every time now unless there is a medical reason I can't.

But saying that I don't care if Mrs A has a homebirth, Mrs B has a water birth in a MLU, Mrs C has a VB with every form of pain relief going and Mrs D chooses to have a CS.

Surely it should all be down to the mothers personal preference. As I said before I will not have an epidural, I can only just manage blood tests without freaking out. But if someone else has one then good for them and I hope it helps.

If someone was to come to me to talk about wanting a homebirth then I would tell them my story and how I felt much more looked after than I did with my first birth. I won't ever try to push them towards one though.

No matter how many statistics etc are posted it won't make any difference to someone that doesn't want a homebirth and vice versa does want a homebirth.

DialM you're assuming that things only go wrong because you're at home. Things could equally go wrong because you were at hospital eg contracting an infection or spiralling medicalisation.

I don't think all low risk women should have a hb but I do think it's a shame more don't even consider it (and that, as someone mentioned above, so many people think it's the same as freebirthing!).

fastweb I completely misread that as having a fanjo that looked like George Clooney (I'm thinking kind of bristly and jowly, not far off tbh)

Oh and with DS1 I had never seen the MW that delivered him before I went in. She was really really nice. With DS2 it was the MW I had been seeing since I had my first appointment. But TBH when I am in labour it could be the Queen for all I care [hgrin]

I completely misread that as having a fanjo that looked like George Clooney

Oh I don't think Dh would like that very much

you're assuming that things only go wrong because you're at home.
No not at all, but after being told I was low risk and in theory I could have done it and seeing how critical things were, I guess I am wary.
I know things can go pear shape in hospital too, I don't see hospitals as a guarantee that things will automatically go well.

Homebirths should not be touted as the safe option or hospitals as a guaranteed safety choice either.

Birth is a risk.

What should be emphasised is a woman's right to make choices. I ahve little truck with women who go against medical advice to deliver in hospital and I sadly ditched my planned HB with ds3 on medical advice. but it should be treated as an equal option to hospital when the mother is suited.

It is obvious that people who are of the mindset to opt for a home birth would be more likely, barring catastrophe, to make the same decision the second time around. A pp has even said that she would make the same decision again after her home birth ended in tragedy (sorry I couldn't find the post to quote directly). I don't think that repeat home births are necessarily an indicator of a high quality experience first time around. More an indicator of the personality and values of the parents which are unlikely to have changed between births. You could equally say that people who have only ever birthed at home 'don't know what they're missing' with hospital births.

Believe me Harry I have had the delights of both, I know what I'd be missing...my personality and values are such that I like to minimise the risks to mine and DC safety. After the F*ck up that was the hospital birth of my second child (if the Mw shift hadnt changed when it did I dont think she'd have survived), I chose to have a home birth with my 3rd.

Your comment is pretty patronising IMO...if it's all down to 'personality and values' why do these supposedly change to encourage a home birth but not vice versa??

HairyFrotter
"A pp has even said that she would make the same decision again after her home birth ended in tragedy (sorry I couldn't find the post to quote directly)"

I think you're probably talking about me, although the tragedy had nothing to do with the fact we'd planned a HB. Our baby died in utero at 8 months after I developed swine flu with complications. We had made an informed decision to decline the SF vaccination. It is possible that vaccination would have saved our baby's life, in which case you could argue she died as a direct result of our decision. We'll never know.

From stories I've read, it is not uncommon for women to opt for a HB (sometimes with an IM) for a 2nd baby after receiving very substandard care in an NHS hospital 1st time round, as illustrated by jugglingmug.

I've experienced both home and hospital birth. At home I had MWs who I'd got to know, who knew me, could put how I was labouring into the context of what they knew about me and could therefore support me very effectively - without having to ask me to communicate with them. At hospital I had MWs who I met prior to induction, who didn't know me from Eve, who didn't have the capacity to stay with me during labour and who required me to communicate to give consent for every VE and blood test. I truly believe that the hospital MWs did the best they possibly could given the environment they were in, and they were absolutely lovely - but to me there was still a huge benefit to knowing my MWs (and yes - 8, 10 minutes appointments isn't enough to achieve that. Which is one reason why we've just booked IMs again - each appointment tends to last at least an hour and there tend to be more appointments than under the NHS, especially when you're a multip).

fastweb - I think I agree with most of what you say, although I'm not sure I agree with the finer detail of your conclusions! It would seem that The Netherlands does have room for improvement in the way it provides antenatal care - and that if those improvements were made birth safety could be improved. The risk that a move away from hospital birth may lead to a move away from antenatal screening is one that the UK should be aware of - but I still don't see it as a huge incipient problem.

Not least because unless the government can come up with a very effective public health message that dispels some of the fears many women have regarding birth outside of a big hospital, the HB rate will never rise enough for any potential problem to manifest!

I'm having a big :o at your George Clooney-eque fanjo though :o

"I wanted a professional not a friend"

I want both!

And got both.

"I don't think that repeat home births are necessarily an indicator of a high quality experience first time around. More an indicator of the personality and values of the parents which are unlikely to have changed between births."

You need to ask yourself then why the VAST majority of those who have a homebirth have already experienced at least one hospital birth.

Most women who choose to give birth at home opt for it because they've experienced being in hospital and want something better. Actually they show an 'overwhelming preference' for homebirth when they've experienced both. (quoting from MIDIRS leaflet on research around place of birth)

And I'm wondering how you've managed to read all the posts on this thread and elsewhere on mumsnet from mothers who've had homebirths saying how fantastic their births were - and managed to come to the conclusion that they're probably lying, and just saying it because they have an ideological conviction that homebirth is the way to go.

Are you jealous or something?

although I'm not sure I agree with the finer detail of your conclusions!

There aren't conclusions as such, they are more concerns and suspicions.

If the government is attracted to home birth as a longer term cost cutting exercise I can't see them then turning around and investing any savings to cover shortfall elsewhere. I can see them making savage cuts in hospital based L&D care, with further detriment to the quality of care, in order to "incentivize" more women to choose home birth, because that suits their bottom line.

The Dutch model that is so often waggled as the bench mark of excellent maternal care by proponents of natural childbirth and homebirth has two issues in particular that are giving me the heeby geebies.

1. There appears to be no system of oversight to keep a watchful eye out for radicalisation. That probably doesn't look like much of a concern to many. However a combination of having been on the wrong end of natural birth zealots when in labour and being aware of just how insane the thinking can get the further along the spectrum you go, I am extremely leery of that potential aspect being left unchecked with no system to rein it in. I do not believe a government seeking savings would invest in any system of oversight, even if it occurred to them that it might be an issue.

2. Punitive economic sanctions for those who CHOOSE a hospital birth. It took me mere minutes to stumble across that little bit of info. I am extremely concerned that if I found it so fast then people who have studied the Dutch model in depth also saw it, but have consistently failed to criticise that aspect and underline how lack of choice was not an aspect that should be imported, when praising the system over there. Ergo I do not wholly trust those who would seek to improve the lot of people who want natural birth and home birth to actively avoid gaining ground at the expense of women like myself.

And yes I do take that personally. Still. Despite my son being nearly 11.

I'm no longer at the point where I'd like to take a wrecking ball to the ward walls. (proud of self for having recovered a bit of perspective emoticon)

But I'm fairly rigid in my stance that above all other considerations there has to be a keen focus on taking steps to protect the range of choice, especially when trying to improve the conditions and availability of a single option that is being unfairly underfunded or restricted.

Not least because unless the government can come up with a very effective public health message that dispels some of the fears many women have regarding birth outside of a big hospital, the HB rate will never rise enough for any potential problem to manifest!

If they want to increase home birth as a cost cutting exercise then they can manipulate the increase of uptake via further cuts taking place in L&D, to the extent that the quality of care falls further leaving ever more women highly dissatisfied with how their 1st births were handled.

It is a win win for the people holding the purse strings.

Home birth cuts NHS costs

Incentivising women to move over to home birth by creating greater dissatisfaction with the hospital system can be achieved by cutting NHS costs .

Evidence to support hypothesis of cutting costs to increase dissatisfaction with a view to creating greater uptake of (cheaper) home birth ?

Spud: Most women who choose to give birth at home opt for it because they've experienced being in hospital and want something better.

Tangle: From stories I've read, it is not uncommon for women to opt for a HB (sometimes with an IM) for a 2nd baby after receiving very substandard care in an NHS hospital 1st time round, as illustrated by jugglingmug

OK so midwives at home births never make cock ups then? How does that work?