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.

fastweb - OK, I think I get it ( - been very slow, I do apologise).

1. IMO, the Dutch system is not pulled out as an example that we should try to emulate in the UK in every detail. Its pulled out as an example of a country with a HB rate an order of magnitude higher than ours with pretty good results, which highlights the point that HB is not intrinsically dangerous. The study in Rotterdam has raised a number of issues that should be subject to further examination but does not, in and of itself, disprove the basic premise.

2. The existing system in the UK is very different to that in The Netherlands. All UK MWs are governed by the NMC, and her held personally accountable for their professional actions. Their best defence is to have followed the policy of their local PCT and/or NICE guidelines to the letter, as this is the standard that the NMC will hold them to. If a MW in the UK were to recommend/pressure a woman into having no scans or other ante-natal tests and things went wrong, that MW could be hung out to dry. No consolation to that individual mother, but a check to keep the overall system reasonably consistent.

Whatever happens with place of birth, I do not see the likelihood of huge changes to the current system of regulation - which would make it difficult for more radical MWs to "coerce" women to follow their model of care against UK standards (although if a woman was that way inclined she may seek out such a MW of her own volition to avoid feeling pressure into antenatal tests she did not want).

This is no deviating a little, but this attitude does concern me in some respects - at the point a MW takes a woman into her care she assumes the role of the woman's advocate. From that point, her first duty of care is to support the woman and THEN to follow the guidelines as far as possible. If a woman refuses VEs it would be assault for a MW to perform them, for example. But there have been cases where a MW has been destroyed by the NMC for supporting a woman's wishes where they went against guidelines - and even the woman turning up in court to support the MW by stating that these procedures weren't performed because she, the mother, declined them hasn't made a difference.

If we want MWs to support women in their choices (even if those choices do not follow policy), the MWs themselves need to feel supported by their employer and by their governing body. At the moment I'm not convinced this happens - and it makes me even more in awe of those MWs who continue to practice.

3. Being in hospital is no guarantee of good midwifery care - as your own example highlights. I think there is scope to improve care by encouraging all MWs to spend more time listening and less time assuming, such that all women had better care and a better experience - whatever the environment.

4. If the government wishes to shift a significant %age of births into a more community based setting then they have a major re-training exercise on their hands. IMO (and this is an opinion I've also seen from experienced MWs) whilst any midwife should have similar core competencies, the experiences gained in a busy labour ward do not necessarily translate to a MW who will be competent and confident in a home/MLU environment and vice versa. This needs to be addressed, especially in light of (2), IMO.

5. Would these changes reduce choice by preventing women who want to birth in a consultant led unit from being able to access it and possibly force them to go private? I don't know. That is an angle that I hadn't really considered.

I do think that there are a number of women who would automatically choose a hospital birth if asked today who are doing so on the basis of assumptions that aren't necessarily born out by the facts - and that by increasing accessibility to the facts, and providing better support, more women might actively choose to birth in other locations. I do think that there is merit in the argument that a smaller number of better staffed and equipped consultant led units could deliver better care (especially for those women with higher risk pregnancies) than the status quo. I do think that the current model is reaching the point where it is costing a huge amount to provide an inferior service.

But I also fundamentally believe that women should be supported to birth in the location of their choice.

How you reconcile the pressure to improve choice, improve results, improve care and provide a cost effective service is a question I'm quite glad that I, personally, don't have to find an answer to!

But I also fundamentally believe that women should be supported to birth in the location of their choice

I agree, problem is that I don't think the purse string holders give a bugger about where women want to give birth. Just as long as it is cheaper and works within a longer term plan to dismantle the NHS bit by bit.

IF a push to improve maternity services came with..

1. the stated intent to first produce additional investment and then reinvest part of any savings in recruitment and training to expand the home birth specialist midwives.

2. the stated intent to invest part of the savings into improving the staffing levels and professionalism on maternity wards.

Then I'd be less pessimistic.

How you reconcile the pressure to improve choice, improve results, improve care and provide a cost effective service is a question I'm quite glad that I, personally, don't have to find an answer to!

Me too.

Perhaps what we need to do is provide some significant motivation to those that do have to reconcile the above. By forming a hacking great big unified multi generational group of women determined to get choice and quality care for all, be it home birth, epis on demand, elective c-sections and all that lies between.

All roaring around the houses of parliament (I'd prefer Brussels, but beggars can't be choosers) scaring the knickers of politicos cos there would be so many votes at stake and the possibility to conquer and divide got taken off the table.

Bet the magic money tree would be more productive upon being shaken then.

Ps it wasn't you being slow, it took several posts for me to fully formulate the niggling sensation in my head.

Hello everyone, I just stumbled on this thread as I'm researching my own decision re home birth. I would just like to make one comment - I think it's absolutely right that every woman should get to choose to do whatever they want re birth place, but...
IMHO not many women know the enough about home birth to make an informed choice. I have about 10 friends with babies and not a SINGLE ONE had them at home. They were all uninformed and found the idea of home birth 'scary'. 90% ended up having CS, or ventouse, or some kind of scary time at hospital.
I have 4 pregnant friends at the moment, and none of them are having home birth either. why? 'too scary'.

I wonder why more people don't investigate the choice more before making the decision, or aren't given the literature to help them decide?

The more I read about it the more I find hospital birth FAR more scary than home birth...

I completely agree lippy - it seems to be seen as a real woo option and most people I've mentioned it to won't even consider it. I completely agree that it should be an individual's choice but it seems a shame to dismiss it out of hand.

I'd never consider a hospital birth unless something was wrong with me or the baby but then, I'd never consider cream carpets!

Totally unreasonable to have cream carpets.

Perhaps they couldn't get a sensible guest for the show.

Funny, isn't it lippy? Although it is less common for first timers, we and the other two couples who toured the maternity dept at Kings College Hospital in 2000 all decided there and then we would have home births. It was dirty, there were broken chairs, two bathrooms at the end of the corridor and only a couple of rooms which shared a bathroom between them, there was blood on the curtains and there was only one (tiny) room we could be shown because it was full almost to capacity.
We were being 'midwifed' by a community team and were given the choice throughout of hospital or home birth. I had always thought hospital was the norm for 1st births but that visit put me off completely. In the end I got dragged in because of meconium, though I would actually have been fine at home. The other two mums had their home births.
Kings has a lovely shiny maternity unit now, opened two or three years after that, but I still chose to have ds at home in a pool and it was lovely.

I am considering a home birth for baby number 4. I think the drain you mention may be there but it will be less than me in a delivery suite and then on a ward for a day surely????? Only a couple of hours at home and I will (hopefully) be all done, much better for the NHS I think.......

YABU to watch Lorraine and expect any level of balanced discussion. Breastfeeding and homebirths seem particularly bizarre and freakish to Lorraine or her production team. Needless to say they are thick as pigshit and have no concept of the real world.................... If you live in the middle of nowhere, home births are a pretty good idea as the alternative is being born in the back of an ambulance in a layby or farm gate!!!

Old thread alert , I remember this one.
If a safe delivery could be guaranteed fine, but it can't.

I've never been eligible foe one luckily , as the cord prolapsed with ds3 and the 5 min drive from home to the hospital would have killed him

I preferred hospital births so that someone else made me tea and toast.

Sorry if I offend anyone , I really don't know a lot about home births, but isn't having a home birth putting your baby in unnecessary risk?

I had a hospital birth with DS and it was an awful experience, I'd like to have my next child at home as I hated being at hospital and think that my birth experience would have been far more relaxed, but I'm terrified of something going wrong, would the only option in that case be calling an ambulance and hope that it gets there quickly?

Expecting dc1 in March, and went to look round our local hospital maternity unit yesterday. I planned a hospital birth mainly as a precaution, just in case - I would be closer to experts if anything went wrong, and this is my first. I am classed as low risk (so far - I am aware this can change).

Whilst i believed that birth environment would have an impact on length of labour, difficulty, likelihood of intervention etc, i did not believe that hospitals were as bad as they were painted.

Then I arrived. It was an organised tour, and we got the usual spiel (she'd said it often enough that it sounded rehearsed. I don't say this to criticise, but to show that this is what they think everyone should be told). We were all told:

1. that we would be assessed over the phone when in labour, and would be told to come in for an assessment once we were having 2 contractions within 10 miutes. Anything less and we would be sent home immediately.
2. If our waters broke we were to come in and be induced within 24 hours maximum - not an option, but as the routine procedure.
3. if labour did not progress within 6 hours of our being admitted, we would be induced
4. if labour did not progress to established labour within 12 hours of our being induced, we would have an EMCS
5. No meals or snacks provided, and partners have to leave you to go to the vending machine in the waiting room for you. No food other than provided within the hospital allowed, in case someone else has an allergy. (no problem with them not providing snacks, although wonder what they do for single people with no birth partner)
6. you will be monitored during most of labour so that they can tell remotely if something is wrong. When pressed, she said that was because we would be on our own apart from occasional/regular checks. I asked whether this would stop you walking around, and she said that you wouldn't want to walk around anyway!
7. After birth, you are left in the labour room for long enough to get cleaned up, then moved to the postnatal ward immediately, regardless of the time of day/night. This is a shared room. I understand this is to free up the labour rooms, but it means no-one in the postnatal room gets any sleep, with people coming in and out all night, and everyone has their baby with them. It means you start trying to nurse your baby in a busy room.
8. partners can only stay with you during visitor times once you are in the postnatal room. 11am-8pm. That's all. But then, there is no space for them anyway... Again, no food from home.
9. You "have" to stay until you have fed your baby. I pressed her, and she admitted they cannot stop you leaving if you want to.
10. Minor issue, but every room was tiny and extremely dark, with one plastic chair plus a very high bed that I already would not be able to get on and off on my own at 27w.
11. 25% infection rate. How?! Maybe the dirty floors? It looked grubby.

On the way out I saw they have an award for excellence on the wall in the waiting area. If it is a choice between there and home birth, I'm asking for plastic sheets for Christmas!

I was chilled about birth until yesterday. Last night I couldn't sleep for panicking. This is the only set of options available to me here. If this is the only hospital option here, then I cannot believe home birth would be worse. I would panic so much there that it could only impede a natural delivery.

Luckily my hospital has a normal ward upstairs and a midwife lead birthing centre downstairs so I am going to the midwife unit.

Sort of meet in the middle because if anything does happen they only have to take me upstairs. As this is my first child I would not like to be at home (I suffer from anxiety anyway) but who knows for te future?

After my experience of box ticking in an mlu first time round am very much considering a hb with dc2 in Spring.

VikingLady, read up on birth, and homebirth, as much as you can and consider your options.

I had the option of King's College Hospital, which is massive and staffed by experts from all over the world, they see thousands of births and deal with every complication under the sun.

I visited, read up on home and hospital births and decided that for me and my son, home birth would be likely to be safer for us both. (Lower risk of infection, he was a single baby, low risk - to him - pregnancy, but I had severe SPD which meant intervention other than CS would put my future mobility at risk. I also felt that sharing a midwife with other labouring women could pose a risk to my baby.)

There are no guarantees, whatever you do. But hospitals are not intrinsically safer than homes.

Yoga relaxation/martial arts training/meditation/hypnobirthing - if any of those appeal, they'll help you wherever you labour.

(I had the homebirth, by the way, laboured for 12 hours before calling the midwife, who attended for 6 hours in total (3 1/2 before, 2 1/2 hours after the birth), and her colleague attended for about 4 hours total. I can see why they're cheaper. It wasn't 'the best experience of my life' but it was the safest way to deliver my child and give him the best start to his life. I think every pregnant woman has to weigh up what's best for their baby and for them.)

I had a lovely homebirth. A terrible generalisation to say all homebirths are dangerous.

Like Mavis said, every pregnant woman has to weigh up whats right for them.

I'm just glad i live in an industrialised country with access to (for the time being) free healthcare.

the coet of hb is being brought up, can anyone tell us the cost of hb vs cost of hoepital birth?

Also, my Dsis was in a busy london hospital and as they faffed her round so much she ended up being in for 4 days - tying up a bed and staff.

my friends 2nd birth was home waterbirth and took 4 hours - she felt it went that way as she was so relaxed.....

Trampoline births are irresponsible.

I was in hospital for 4 days too because of a variety of communication problems between staff, it wasn't until I had left that I found out I could have signed myself out

The longest I've stayed in hospital was 3 weeks, I found out towards the end that if I'd discharged myself earlier, when the time came for ds to come out of nicu they would have put me in one of their special rooms off the unit and dp could have stayed with us, this would have been alot better for my mental and emotional health

And I probably wouldn't have gotten an infection

ihatecbeebies - it very much depends on what goes wrong. There are many birth issues that can be dealt with by a competent MW - and will be dealt with in exactly the same way whether you're at home or hospital. There will be scenario's where the outcome would be better in hospital than at home. There will be scenario's where the outcome should be better in hospital but understaffing mean there's very little in it. There will be scenario's where the outcome would be better at home rather than in hospital.

All we can say is that based on the latest research, for mother's who have had a previous baby and who have a low risk pregnancy, outcomes at home are statistically comparable with outcomes in hospital, although women labouring in hospital are significantly more likely to have interventions (www.bmj.com/content/343/bmj.d7400).

Beyond that it comes down to how you as an individual (family) assess the risks, which will partly depend on the situation in your local area and where you live relative to the hospital (some women see a long journey as a reason to go to hospital, others as a reason to plan a home birth...).

VikingLady - we were put off hospital birth by a similar tour. Having been through it and so gained a bit of confidence, my experience is that if you/your birth partner are prepared to be beligerent assertive enough then hospital birth doesn't have to be a policy driven as it is made out to be (at least regarding your points 2-4 and 6). Fundamentally, you have to consent to any intervention - be it a VE, augmentation, induction or whatever (and if they attempt to perform an intervention against your consent then, technically, they are performing an assault on you). When I wound up being induced in hospital with DC2 we stayed very calm and polite, but made it very clear that we were not planning on saying "yes sir, no sir, 3 bags full sir" and agreeing to everything just because it was written down - and the MW needed very little encouragement to support us such that we felt very much in control of the process. If you haven't come across it, a very useful tool is the phrase "Remember to use your TBRAINS." Which stands for:

Do we have Time to Talk about this?
What are the Benefits?
What are the Risks?
What are the Alternatives?
What does my Instinct / Intuition say?
What happens if we do Nothing for now?
Smile!

Moomins - a point of semantics, but in the UK the only way you can be compelled to give birth in hospital is if you have been committed under the Mental Health Act and a court injunction has been obtained. Your personal circumstances may have meant that you did not meet your PCT's criteria for which a planned home birth would be accepted without argument, and it may not have been medically advisable for you to challenge it - but as a mentally competent adult there is no issue of "eligibility".

(Sorry - just one of my pet hates is women being told by authority figures that they're "not allowed" to do something or they "have" to do something else. I'll get off my soapbox now )

I really hope your DS recovered well and is doing OK now :)

TiggyD - couldn't agree more :o

Thank you, Tangle. We're going to discuss the options in depth over the weekend.