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

"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..."

Oh my goodness, you're tying yourself up in knots in desparation trying to salvage something of your argument.

"If you read even more widely on the subject, it's first world medicine that is achieving the benefits, not the location."

In what sense can 'first world medicine' be responsible for the fact that fewer women's labours go tits up at home?

"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"

Sorry - what 'myth' is this you're talking about? Who is saying this? Not anone on this thread as far as I'm aware.

OK - so you're not talking about 'home birth' in the sense that the rest of us are talking about 'home birth' - ie, women giving birth in an out of hospital setting, attended to by trained midwives, and with good transfer arrangements for high tech medical care should they need it. You're talking about 'unassisted birth'. Would you like to start a different thread about that, because that's not what we're discussing here?

As I said, give up. You're shaming yourself.

Doesn't the study fall down in that while it compares women who are low risk, same socio-economic group etc etc the very fact that some of those women opted for a homebirth rather than a MLU might be the crucial difference.

I would be willing to hazard a guess that women who opt for a homebirth have probably done more research than your average pregnant woman. They may well be more confident in their own abilities - even getting a homebirth can involve a woman being a bit pushy. They probably have a very supportive partner. These are all things that would be outside the scope of the study but may be the reason why these women have a better outcome rather than location.

I'm not sure that anyone can find a way of controlling for attitude.

Not sure also whether sheer confidence on the part of the mother can account for the 50% reduction in c/s rate in homebirth mothers.

So informed, confident, pushy women have supportive partners and straight forward labours? Who knew?

There is so much smugness and self righteousness on this thread that I've just been sick a bit in my mouth

chills out and rubs bump

It has however made me confident In my own decision so thanks for that

We're talking statistics here aren't we? So while not all homebirthers will have the circumstances I've suggested I'd bet a significant number do. Enough to make a difference.

The only way to control for attititude would be to randomly assign low risk women to having a homebirth or attending a MLU which is clearly never going to happen.

Who said homebirths were straight forward? It's about less intervention isn't it? The homebirth argument seems to be that you are less likely to require the sorts of intervention in a homebirth that are routinely used in hospital. It doesn't mean that everyone who gives birth at home has a straight forward labour.

I find the section rate something difficult to get my head round becuase where I am you can't opt for CLU. You can choose homebirth or MLU. You only end up in a CLU if you are deemed high risk. Both the MLU and the CLU are in the same building so transfer from one to the other is quick if necessary.

I wonder if the location of these places would also influence women? I mean lots of women have mentioned the distance from a hopsital being a factor in their decision as to where to give birth.

As I said, give up. You're shaming yourself.

So, to summarise, in my shame - you are essentially advocating an approach that so far demonstrably:

1. Is less effective than hospitals without developed world medicine underpinning it.
2. Gives worse outcomes for all except low risk pregnancies
3. Gives worse outcomes for first births of low risk pregnancies
4. Gives at best the same outcome for subsequent births of low risk pregnancies....
5. ...except when they go wrong, when outcomes are likely to be worse.

And for daring to point this out I am supposed to be (let me list your insults so far - a man, who has a lizard brain, doesn't care about a baby's safety, and am shaming myself). Not bad, I can't wait to see what's next.

IMO the real question coming out of this thread is what can hospitals do to be nicer places to have babies in, rather than risking home births.

Whatmeworry

The answer is in the Newcastle Rvi birthing centre ;D lol
takes virtual tour

Hospital births would be rather dangerous without 'first world medicine' underpinning them though.

I don't get your point - birth ANYWHERE without medical support (and that includes midwives, which you get at a homebirth) can be dangerous. I've not seen anyone here advocate birth without access to trained, professional help on hand

Whatme, er, what are you talking about. Your post is not reflective of what has been posted on this thread. Where are you getting your information?

Because there is a lack of correct information between health professionals and women. In the usa women are basically educated that the medical model is best - and in some circumstances that is the case. However, it can't be denied that statistics show that, in one of the most affluent countries in the world, one is statistically safer giving birth in less affluent countries than in the Usa....perhaps the same is true in the UK?

OBEM USA is significantly shitter than our OBEM though

It's 'go in, lie on your back with monitor, drugs, epidural, intervention, out'

It's like a train of shit intervention. I honestly think there should be more mlu within hospitals as a happy medium.

"you are essentially advocating an approach that so far demonstrably:

1. Is less effective than hospitals without developed world medicine underpinning it."

Sorry - I'm lost as to your point about developed world medicine. I support home birth attended by trained midwives with the back up of medical services should mother and baby need it.

"2. Gives worse outcomes for all except low risk pregnancies"

I'm not advocating the provision of a homebirth service for mothers who are not low risk. Nobody here is.

"3. Gives worse outcomes for first births of low risk pregnancies"

For babies. Better for mothers. And of course the outcomes for women AND babies going to free-standing MLU's are better. I'm sure you are aware that these birth centres have no facilities for medical input that are not also available at a homebirth - in other words, no doctors on site, no operating theatres, and a necessity for transfer in the event of a mother or baby experiencing problems.

Gives at best the same outcome for subsequent births of low risk pregnancies....

No - there are considerable health benefits for low risk mothers for subsequent births. This is very clear from the latest study.

"Except when they go wrong, when outcomes are likely to be worse".

Luckily they don't go wrong as often as hospital births, which is why there is a parity of outcomes for babies when comparing all but first time mums, and continued improved outcomes for women. (were you aware that the likelihood of needing admittence to HDU or ITU appeared to be twice as high for low risk mums giving birth in a CLU, compared to those giving birth in a freestanding midwife led unit - average transfer distance 17 miles......)

"IMO the real question coming out of this thread is what can hospitals do to be nicer places to have babies in, rather than risking home births."

I'm sure there's lots to be done to make hospitals 'nicer'. But healthy women who give birth at home aren't taking additional risks, according to all current good quality research.

Incidentally - are you also against freestanding midwife led units? Because they have no medical facilities and no doctors. So that just like at a homebirth, women and babies needing doctor input have to transfer to a CLU by ambulance? Would you have these places closed down?

'Lizard brain' wasn't an insult by the way. It's a way of talking about the role of hormones, and of instinctive behaviours in labour.

I honestly think there should be more mlu within hospitals as a happy medium.

Yes, coupled with much, much better staffing.

"I honestly think there should be more mlu within hospitals as a happy medium."

Why not more MLU outside hospitals, given their excellent safety record and good outcomes?

And why not a good homebirth service given that it's what many women want, and is also associated with excellent outcomes for healthy mothers?

Or is it just that you have a theoretical problem with birth away from hospital? One that doesn't take into account what ACTUALLY happens, and is simply based on assumptions about what's safe and what's not?

Yep, thats what all the research has been pointing towards for years. This model, including caseload midwifery has persistantly been shown to have the best outcomes and in the most economical way. I'll never understand this false economy of shutting these units and forcing women into vast 'super centres' of birth where care is impersonal, sometimes sub-optimal and ultimately more expensive.

Or is it just that you have a theoretical problem with birth away from hospital? One that doesn't take into account what actually happens, and is simply based on assumptions about what's safe and what's not?

I think it is based on assumtions. Most peoples ideas of things 'going wrong' involve a catastrophic event requiring immediate cesarean, which admittedly can't be done at home and is indeed a rare event, and if its a true catastrophe, sometimes being in hospital won't guarantee a good outcome, which people are lead to believe. With the more common emergencies (pph, shoulder dystocia, baby requiring resusciatation) people do not realise that midwives deal and manage with theses all the time, and manage the same way as in hospital.

"But healthy women who give birth at home aren't taking additional risks, according to all current good quality research."

And many of us feel that we are minimising our risks by staying at home by avoiding:
risks of routine intervention, because it's 'protocol' not because it's indicated for health reasons,
of having to share one midwife between 2-3 other labouring women, so effectively being unattended for much of the time (but being criticised for being selfish!),
of being completely unknown to the staff attending you, cue much scrabbling through your notes to find anything out about you,(although you could get someone unknown to you at home)
of people barging in and out of your delivery room for god knows what purpose, but not helping you in any way
of exposure to hospital bugs.

Those are some reasons.

trustissues - You really can't use the USA stats imo to argue either way in terms of safety of birth. In the USA you have pregnant poor women who have very little access to neo natal care, who if they are suffering from illnesses such as diabetes may not be able to afford all their meds and so go without and who may be homeless. The level of poverty of some people e.g. in the south is more shocking than in many many much poorer countries imo.

Most people just want to get out alive with a healthy, live baby. Those chances are maximised when surrounded by qualified medical professionals with access to advanced technology in case anything goes wrong, as it often does.

Only a small minority are interested in birth as a spiritual experience or fear medical intervention more than the death of a baby.

Bobbledunk, its a shame you've not read the thread because you would then realise the inaccuracies in your post.

I have read the thread and some people are more concerned about being cut open if they are in hospital regardless of the outcome for the baby. That's the shame.

Shagmund... I think more
Mlu in the hospitals because if something did go wrong then you wouldn't have as far to go for interventions. I'm just having my first baby and feel reassured to be in a
Mlu but if I need an epidural or a csec I only have to nip upstairs as opposed to travelling further

I'm happy with that middle ground

Could you point out to me where you see that please? I must have missed that bit.

Why do you need to constant question and berate anyone who would prefer to be closer to a hospital in case they need it. I'm low risk but this being my first it is an unknown quantity and I am happy with my decision and do not
Like the implication that I am making assumptions and not looking at research. I am a big girl and will do/ go where I feel comfortable.

and I feel comfortable with a full delivery suite and theatre upstairs if I need it but otherwise have minimal intervention in the mlu