why are homebirth rate so low

[McHappyPants2012]

www.walesonline.co.uk/showbiz-and-lifestyle/health-and-beauty-in-wales/2011/02/05/wales-delivers-on-home-birth-rates-91466-28109298/

after watching 'call the midwife' it seems to me homebirth was quite common in the 1950.

when did hospital birth become a common

there are some small scale studies on higher risk women, and the Birthplace study did collect evidence on a minority of high-risk women choosing HB (disincluded from main body stats, obv) i didn't see the actual results bit on that though...

high risk women choosing home birth are a small self-selecting minority (more so than HBirthers in general!) so it is very hard to compare data on them accurately.

"But she is misinformed if has been led to believe that it's true. Because for healthy women it's not. In fact the evidence points to hospital births putting women at risk of avoidable surgery."

It's a shame though that 'avoidable surgery' is not yet a valid birth choice, and seen only in terms of a horror to be avoided at all costs. I have opted for an elcs for DD2 (currently 6mo pg), which is technically 'avoidable surgery'; however, I have researched all the options available and am happiest with an elcs.

Am I misinformed? Or is my choice as valid as someone who chooses a homebirth?

Tethersend it's one thing if you weigh up all the options and decide that an ELCS is right for you. It's quite another if it wasn't the mother's choice and could have been avoided.

I don't think a home birth is a superior birth and I'm surprised tethersend that sane person is saying that.

I looked at my situation - increasingly rapid labors, no car, no one close to call for to look after per-existing toddlers - decided a home birth was better bet than giving birth on way to hospital possibly by myself or with entire family, DH two toddlers in tow.

It would have been nice if MW had accepted that we could make informed choices - instead of denying that rapid labors ever happened. She wasn't the only MW with that odd view - young hospital MW next day said we must be wrong labour couldn't be that fast thankfully a much more experienced MW told her to shut the fuckup she was incorrect as she'd seen a few.

Thethers I would categorise an ELCS as a very different thing to an EMCS which is what Shagmund is referring to.

Some women opt for or are advised that an ELCS. It should be an informed choice and is by no means unnecessary surgery. But I very much doubt anyone actively plans an EMCS as the ending to a long labour! The issue is why so many low risk women end up with an EMCS as a direct result of giving birth in a CLU.

what i think is being said is if pre birth counselling went a bit like this..

you can have clu, access to epidural (most likely though there are reasons x, y, z why one might not happen, increased risk to you of forceps or c/s delivery
or you can have mLU....most likely you have to transfer for epidural, decreased risk of c/s and forceps,
or you can have HB - first time there is a very slight +0.4% (but still safe) increase in 'adverse outcomes' as listed but still reduced risk of intervention, forceps, c/s to you with the knock-on effects on subsequent births that that entails... or second time your baby is slightly safer than CLU and you are much safer also..but again you will need to transfer if you want epidural...

then maybe many more mothers would know there was a choice, and be better informed when making it. currently most people just think HB and even MLU is 'dangerous' in any and all cases.

This is one of these First World Ishoo things where you believe you are having a "back to nature" experience, but can't see that it only happens because of an army of high tech support services is behind the scenes.

And again with the patronising bollocks. I don't feel like this at all but I have lovely easy births is all, why would I leave home? You wonder why someone who post something hostile about you when you make crass statements like this? How the Hell would you know, you have never had a homebirth or wanted one.

No one is suggesting an ELCS is not a valid choice. Having to have a CS from mismanagement of your labour is not the same as making a choice to do that electively. If yu want one, have one, legislation is being passed to make that possible so I cannot see where there is an argument in this.

I would want to avoid surgery if I could, if you want to have it for whatever reason then that is your business, you just sound so defensive. As long as you are happy I am happy. What the poster was saying was that people should be aware that being in hospital does actually increase the likelihood of surgery which could be unavoidable not that you cannot choose to have a CS - your birth is your business.

And technically I am High Risk despite having four easy labours with great results. Because I am 42, because I have thyroid problems and because I had a precipitous labour at 36 weeks. In reality none of these things actually make me high risk and my HCPs are happy too but technically they are attending a high risk birth. I am jolly grateful for the fact that they choose to use their common sense.

This is one of these First World Ishoo things where you believe you are having a "back to nature" experience, but can't see that it only happens because of an army of high tech support services is behind the scenes.

And again with the patronising bollocks. I don't feel like this at all but I have lovely easy births is all, why would I leave home? You wonder why someone who post something hostile about you when you make crass statements like this? How the Hell would you know, you have never had a homebirth or wanted one.

No one is suggesting an ELCS is not a valid choice. Having to have a CS from mismanagement of your labour is not the same as making a choice to do that electively. If yu want one, have one, legislation is being passed to make that possible so I cannot see where there is an argument in this.

I would want to avoid surgery if I could, if you want to have it for whatever reason then that is your business, you just sound so defensive. As long as you are happy I am happy. What the poster was saying was that people should be aware that being in hospital does actually increase the likelihood of surgery which could be unavoidable not that you cannot choose to have a CS - your birth is your business.

And technically I am High Risk despite having four easy labours with great results. Because I am 42, because I have thyroid problems and because I had a precipitous labour at 36 weeks. In reality none of these things actually make me high risk and my HCPs are happy too but technically they are attending a high risk birth. I am jolly grateful for the fact that they choose to use their common sense.

"No one is suggesting an ELCS is not a valid choice."

I am not accusing anyone on this thread of thinking this- I was just pointing out that they are two ends of the spectrum. Legislation is being passed, but this has yet to be applied in most hospitals across the country. Most women are not able to choose an elcs without a medical reason.

The issue is the disregarding of maternal choice, distrust of women to read the stats, evaluate the risks and make a choice. This applies equally to HB and ELCS.

I am opting for avoidable surgery- I just wanted to take issue with that, as I am not certain that the evidence being cited is exclusively EMCS? Please correct me if I'm wrong, but would I not have been counted in the hospital stats as 'low risk' and ending up with 'unnecessary surgery' with DD1 who was undiagnosed breech until 37 weeks?

Perhaps it would be less confusing and emotive to use the terms 'elcs/emcs' instead of 'unnecessary abdominal surgery'?

Have enjoyed the debate thus far, and have been provided with some interesting discussion and links to research. Please don't misinterpret what I'm saying.

But you can request a ELCS for medical or emotional reasons... and I can tell you that is the same for HB too - for the first time (my 5th baby) the consultant actually said to me the other day 'you do not need my permission for a HB' that is because last time she said 'I am happy to give you the green light for a HB' and I said I am not here to seek your permission' and was a,little shirty. Either way it is just as hard. The difference is that with second and subsequent labours the stats are the same safety wise for Hb and hospital birth but the stats for recovery time from CS for VB differ in time and infection rates. It doesn't make it right or wrong but they are trying to save themselves man hours and money by trying to dissuade women from having something they deem unecessary and not medically indicated.

Legislation is being passed, but this has yet to be applied in most hospitals across the country. Most women are not able to choose an elcs without a medical reason.

As an aside - are you referring to NICE guidelines here - because if so this is not legislation and as such hospitals can choose to follow it or not.

I was stoatie, and had no idea that hospitals were not required to adhere to the guidelines. That's even worse.

Completely agree, brandy- we should not have to justify our choices in such a way. The assumption is always that expectant mothers know nothing, and it is this basic premise which must be challenged IMO.

Saving money should not be the driving factor in birth choice.

Yes but in reality all hospitals know if they were formally challenged they would not win. Different consultants see things differently and most people on when referred to someone else can get an ELCS if they want one. The problem is that some medics see it as all very black and white and cannot understand the grey areas which apply to women (as a lot of them are blokes too) - I think they do their best to discourage what they see as unnecessary procedures in the same way that they do their best to discourage home births as they only ever see the arse end of these things when they have gone wrong. It is all black and white for them I think.

in reality it's because hopsitals births were modern and modern meant better.

Doctors then took over a lot of the roles of midwives. which lead to a lot more intervention and thus more of a need for hospitals.

HBs are great if there are no complications.

"would I not have been counted in the hospital stats as 'low risk' and ending up with 'unnecessary surgery' with DD1 who was undiagnosed breech until 37 weeks?"

No. equally women who go overdue and wind up with inductions were also disincluded. you had to present to hospital/ be attended by a MW in your home in labour as a low-risk case to be included..if at that point you were noted to be high risk (so, if it was a breech discovered in labour) on the other hand...you would still be included as HB/ CLU low-risk.
interestingly 0.4% of home births were breech, versus 0.2 of CLU...

Edless that is interesting about breeches actually. Personally I would be still having a crack as delivering at home if mine was breech (as long as super trusted Midwife was happy with that) - at a push I would go into hospital but I would not opt for a ELCS if my baby was breech.

Thanks Edless, interesting indeed... So I would not have been counted? That's good.

brandy, there is no way I would ever have considered a vaginal birth, either at home or in hospital with a breech baby; but there you go- both of us would assess the risks and come to different conclusions. It doesn't mean that one of us is naive or wrong.

well, as half of all breech is undiagnosed prior to labour - and some prior to delivery - all maternity HCP attendees should know how to birth a breech so they don't panic..

No. equally women who go overdue and wind up with inductions were also disincluded
Gosh, is that so? I assumed that the higher adverse outcomes to the mother in CLUs was probably due to failed inductions leading to CS.

IMHO the argument shouldn't be about whether home birth is safe or not, it should be about why CLUs are failing women?

well quite.

if your labour stalls (having been admitted in labour) and you have an induction though, then you are included, just to make that clear...
there were more inductions in the CLU group.

No. Not at all. There is no research comparing outcomes of anything other than low risk pregnancies in out of hospital settings.

Good. In that case then, there is absolutely no significant evidence at all that a home birth has a superior outcome to a hospital birth. Every other study basically says that someone who is not going to have a problem is probably not going to have a problem wherever they are....unless they are one of the unfortunate few who do have a problem and the low risk goes sour. In which case, where do you want to be?

So therefore the question becomes a "why would you do something which has no advantage, and has the disadvantage of a poorer outcome if things go bad".

Please read it Whatme. It would really help

Funnily enough, I have read a lot of the studies. The difference seems to be that I see they say that things are at best inconclusive. IMO many here are approaching this with preconceived want-to-believes.

And again with the patronising bollocks. I don't feel like this at all but I have lovely easy births is all, why would I leave home? You wonder why someone who post something hostile about you when you make crass statements like this? How the Hell would you know, you have never had a homebirth or wanted one.

Its not patronising bollocks, it's the facts, and facts cannot be crass, albeit they may be inconvenient.

If you read even more widely on the subject, you would see that the myth of the superiority of home birthing is shown the minute you take away the support of the first world medical infrastructure that props it up, as then the outcomes get a lot worse i.e. it's first world medicine that is achieving the benefits, not the location.

Well if location isn't important, why are you so bothered about people who are provided with access to good medicine in their own home giving birth there?

Whatme, I really don't get what your point is: obviously HBs take place in the context of first world medicine, obviously they are administered by trained NHS personnel Who said otherwise?

I think you have some idea in your head that people think HBs are 'natural', whereas if you read the comments of practically everyone on this thread who's had one, that is not the impetus.

In that case then, there is absolutely no significant evidence at all that a home birth has a superior outcome to a hospital birth.

From the Place of Birth study:
For multiparous women, birth in a non-obstetric unit setting significantly and substantially reduced the odds of having an intrapartum caesarean section, instrumental delivery or episiotomy

Well, each to their own, but in my book that's a pretty superior outcome.

So therefore the question becomes a "why would you do something which has no advantage, and has the disadvantage of a poorer outcome if things go bad".

HB does has advantages- less morbidity for the mother. Where does it say outcomes are poorer 'if things go bad'? Midwives manage emergencies at home the same as they would at the hospital.

And comparing birth here to the third world is a moot point.