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.

"I do think homebirths are a bit irresponsible and i had one. It left dd brain damaged"

I do think you need to point out that you - like me - were not 'low risk' and therefore by normal standards not a suitable candidate for a homebirth.

I wasn't either but I still did it. I was luckier than you Riven.

"How did you 'know' it would be a quick and uncomplicated selivery fatlazymummy?"

You don't know. There will be a tiny number of babies born at home this year who would have been better off being born in hospital because of unusual, last minute problems with the birth which need immediate high-tech medical input to resolve. However, there will also be women who go into hospital to have their babies who'll experience complications in their labour that wouldn't have happened at home and end up with a baby who is very poorly or worse. So it evens out - the outcomes for h/b for low risk mums are similar to those for low risk mums going into hospital. But with about half the number of birth injuries to the mother. So overall h/b comes out pretty well. Maybe that's why the RCOG and the RCM support them as 'safe' and 'offering significant benefits'.

"What she didn't explain was that I would be rushed to hospital at the first sign of anything going wrong and then the mother/child mortality/morbidity statistics are recorded as being from a hospital birth and NOT at home"

No - that's simply wrong.

All the research into place of birth which forms the background to NHS recommendations on the safety of homebirth judges by place of BOOKING, not by place of birth.

So women who book a homebirth but who transfer in labour with problems are included in the homebirth arm of the study.

"Dragon exactly how was putting a monitor on you, or telling you when to push 'treating you badly"

Because NICE guidelines state that CEFM without clinical indication increases CS rates for low risk mothers, without improving outcomes for babies.

And directed pushing results in higher rates of assisted delivery and perineal trauma than spontaneous pushing.

In other words - the midwives weren't following best practice.

Tangle - that's fair enough if there are enough midwives to go around.

To be honest, when I was in labour, I didn't care who was looking after me, as long as they were kind and courteous and listening to me and DH and doing a good job. There was a shift-change at 7.30 am when new midwives arrived. DC3 was born at 8.00 am. New ones were lovely, original ones were lovely. No problems here and the original ones came back to find me on the ward when they came back on shift to see how I'd got on. Don't forget that midwives have their own families and life to get back to.

"Midwives aren't strapping you to a monitor, and advising you that your waters need breaking on a whim"

No - they're often doing it because they're knackered and need a break, or too busy to monitor you intermittently which requires them to actually be in the room with you as it needs to be done every 15 minutes, as recommended by NICE guidelines. Far easier to make you lie on a bed, strap you to the CEFM and go off and do something else. Even though they know that by doing this they're making your labour intolerably painful and putting you at risk of avoidable surgery.

As for breaking your waters - you've got to ask why some midwives do this 10 times more often than other midwives. It's not good practice to do it routinely and often when midwives are doing things like this it's because of impatience, or the fact that their practice is simply out of date.

LeQueen
"Dragon exactly how was putting a monitor on you, or telling you when to push 'treating you badly' "

Forcing treatment on a mentally competent adult in such a way that they do not understand why it is considered necessary/advisable and do not feel able to ask questions is degrading, bordering on abusive and can lead to PTSD.

Yes - we have a fantastic service in comparison to many other countries and I'm grateful for that. But just because we can expect to have a MW when we need one that doesn't mean that we have to bow down and worship the ground that she walks on, and neither does it mean that she gets to act like god and treat us like serfs. Just because what we have as standard is better than many countries wildest dreams doesn't mean our standard couldn't and shouldn't be improved.

I had access to equipment and trained staff. I just had them at home.

Not really like those who have to labour in a favella or shanty town.

This thread will go the way it always does.

So I will leave it with this,,
We choose where we have our babies for the same reasons. Because we think it is best for them and for us.

It is no more selfish to chose home than it is to chose hospital.

Oh my god this has really rattled my cage!!!!
Where do I start my rant???!!!
We have been blessed to have three very happy healthy girls all born at home with no problems and complications.

All MW with patients who are after a home birth carry out a full inspection of the home and consider things like distance from hospital and how high risk the pregnancy is, the home accommodation, how easy it would be for a paramedic team to stretcher the patient out of the property, only if she is satisfied that the birth will not endanger the mother and baby and of course herself in a professional capacity will she agree that it is a safe choice of delivery.

A home birth is cheaper than a hospital birth so money cannot be used as a reason to put women off having home births.

MW carry everything that you would have in your hospital room with them apart of course for an operating theatre!!

Not to mention that many people and babies are picking up infections in hospitals whereas with a home birth you are already immune to the various bugs in your home and pass on that immunity to your baby and are far far less likely to develop post birth infections

And as in a hospital you would be left on your own for long periods of time when you are at home with a midwife with you at all times you are better monitored.

I don't have a problem with hospital births we even considered it with number three, who cares where they are born as long as mother and baby are both healthy at the end of it??

And yes we have cream carpets, god bless tarpaulin!!!

I could go on and on!!

Scholes34 - Research shows that continuity of care and having one to one care results in better clinical outcomes for mums. I appreciate midwives have their own life, but when I was in labour the only person whose welfare I was interested in was my own and my baby's. That's as it should be.

Spud - and continuity of care can come with a good handover. As, I said, there was a change of shift half an hour before DC3 was born and it didn't cause me any problems. Perhaps, in hindsight, I should have insisted the very tired midwife should have stayed with me until DC3 was born, though there was no knowing at the time how long that might take.

I'll note that for future reference.

"and continuity of care can come with a good handover"

Yes, but it's in no way comparable to actually KNOWING and trusting your midwife before you go into labour.

And I think midwives are AMAZING and BRILLIANT on the whole. But at the moment they're working in very difficult conditions, and this often impacts on the care they're able to provide women.

"in hindsight, I should have insisted the very tired midwife should have stayed with me until DC3 was born, though there was no knowing at the time how long that might take"

You're being defensive and silly. No one is saying what you as an individual should have done.

We're talking about the basic tenets of a good and effective midwifery service.

spudulika I did know. I had previous experience and the support of an extremely experienced midwife, who I would trust over some random 'expert' on TV or the internet. And I was proved right, it was much safer for my child to be delivered at home with 2 midwives than in the back of a car in the middle of a traffic jam.

"I've researched this all on the Internet and I know my body best."

Le Queen - have a look at the Royal College of Midwives website. They currently have a campaign to increase the number of births that happen without complications and interventions. They have a 10 point recommendation for midwives to improve their practice in relation to this.

Here they are:

1. Wait and see
2. Build her a nest
3. Get her off the bed
4. Justify intervention
5. Listen to her
6. Keep a diary
7. Trust your intuition
8. Be a role model
9. Be Positive

10. Promote skin-to-skin contact

Note number 5 - "Listen to Her":
"Women themselves are the best source of information about what they need. However, a medicalised culture of 'knowing best' (where the deferential 'patient' is examined mutely) means that we are not good at asking her. We are also losing our skills in being able to read her non-verbal signals: her body language, gesture, expression, noises and so on. What we need to do is to get to know her, listen to her, understand her, talk to her and think about how we are contributing to her sense of achievement."

So you see - the experts agree that women know their bodies best too.......

Scholes34
That's what I find so depressing. Experienced MWs are leaving the NHS because they can no longer cope with the workload and/or no longer feel able to provide the level of care to individual women that they feel is fundamental to midwifery. A small minority turn to Independent practice. Some choose to emigrate and work in countries where conditions are less harsh. Many are lost to the profession.

Colleges are still over-subscribed with people who would love to train as a MW, yet newly qualified MWs are unable to find work as PCTs are not recruiting at that skill level.

We used IMs because, for us, the case-loading model seemed much more appropriate and sensible. IMs do have their own homes and families, but they've chosen to put themselves in the situation of being on call 24/7 around their women's due dates as they believe in continuity of care. To mitigate that they tend to take on a far smaller number of clients than their NHS counterparts. Sadly for the majority of women in the UK, using IMs is the only way to achieve this model of "One Woman, One Midwife", even though it is often held up as the gold standard of maternity care.

With DD2 I had to have a hospital birth. The MWs were as good as they could have been - but we didn't have the background and the relationship, so they had to ask questions. They did listen and they did respect our wishes as far as possible - but with DD1 I could just drift away and let my body get on with giving birth in a way that wasn't possible at hospital as I had to maintain much more mental presence and communication ability.

The UK, as a nation, has a glut of MWs at all levels of training. Our health service has chosen to employ the smallest possible number it can get away with. Women and babies are suffering through lack of continuity of care (and sometimes sheer lack of care), and MWs are suffering through over work, and through lack of job satisfaction. I'm unconvinced that cutting the number of MWs leads to overall cost savings, as it will increase the number of interventions and operative births and so increase the length of hospital stay for those women.

fatlazymamma - you can't guarantee ANYTHING when it comes to birth. There are some unpredicatable events like cord prolapse or placental abruption which have, on the rare occasion, happened to someone giving birth at home, and have been a disaster.

But I still support homebirth and think it's as safe as hospital birth (which is why I had my second baby at home too!). Go figure!

Waiting for Le Queen to come back and sneer at the Royal College of Midwives for being a bunch of touchy-feely loons.....

spudulika better a cord prolapse/placental abruption happen at home with 2 midwives present than in the back of a car surely?

Agreeing with lequeen. Theres too much emphasis on the womans experience. Im sorry, the safety of the baby is the most impostant thing. My daughetr was brain damaged because it was a homebirth. There was a placental abruption. She was born with an apgar of 0. There were 3 midwives present the entire time.
The 20 minutes in the ambulance sealed her fate.

Any home birth advocates wish to explain to dd why she is quadriplegic and talk about homebirth with her? I doubt it.

I agree it isn't all about the womans 'experience'. It is about balancing the medical advice and assessing the risks.