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

"And why not a good homebirth service given that it's what many women want"

Where is the evidence that more women would want to give birth at home if the homebirth service was good sigmund?

kayano - Because apparently we are all misguided and making decisions that are not in our best interest - according to sigmund

Kayano, was that directed at me? I didn't mean my last point to you, that was for bobbledunk. I was questioning why she thinks "some people are more concerned about being cut open if they are in hospital regardless of the outcome for the baby", when I hoped this thread had demonstrated otherwise. I have already mentioned my support for more MLU's (plus better staffing!)

No it wasn't it was for shagmund who quoted me earlier x

Kayano - I appreciate it's what you want for yourself, but health policy should be made in light of the evidence. The evidence points to free standing midwife led units having the best health outcomes for mums and babies, therefore it's reasonable - I think - to argue that there should be more of them if the demand for them by women is not currently being met.

Kayano - good you go where you are happiest. If you think you're safest in hospital - fine. It's just there is no evidence mmthat being in a alongside MLU is associated with better outcomes compared to giving birth in a freestanding midwife led unit.

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

Actually, I am. I am considered high risk. I am planning a homebirth, with the support of the community midwifery team and rather interestingly I haven't had to fight or have my reasons for that questioned. High risk covers SO many different things - if the risk in my case was to do with first or second stage of labour then I might very well have made a different choice, but personally my high risk stage is the third stage (chance of PPH and retained placenta)

If a high risk mother wants a homebirth and understands those risks and the reasons for it, why not advocate the provision of a homebirth for her?

But then equally I am happy to advocate hospital births for low risk mothers who choose them or for caesarean sections on request WITHOUT QUESTION for any woman who chooses to have one - all of these are valid options, provided that the mother has the risks and benefits of her choice compared to the other options available made clear to her, in honest terms, using the facts. If we're going to have choice then it should be a bloody real choice.

I know that but I am happy with that happy medium and really it will save the NHS money surely having more units in hospitals?

No need for 2 seperate sites and less transfers etc ?

thinks about £

This thread is bonkers, the only reason that the supporters of homebirth are getting so annoyed and defensive is because (and I paraphrase) various posters keep accusing them of not caring whether baby lives or dies as long as they get to listen to whale music . When actually they all appear well informed about their decision to give birth at home based on very good research.

Those that choose to give birth in hospital seem to somehow regard other peoples decision to birth at home as a personal insult to the choice they made. They don't want to feel criticised for their choice yet feel free to do the same to others.

Surely, what we should all be advocating is better choice and better care for all women giving birth, whether it be in a CLU, MLU or at home? Do people seriously think that the personal decision they made as to where to give birth is so right that everyone else should have to do what they did?

furry yy I think it also comes down to consistency of care. I have not given birth yet, but I fear being in a hospital and having to 'argue my corner' about epidurals etc with every new staff member who comes on shift. You see so many stories about women getting worn down.

I think a major advantage of a HB is having consistent care throughout the labour, even if the MW is unknown to you before. If this could be guaranteed in MLUs or even CLUs it might change my feelings, but right now that seems unlikely.

RevoltingPeasant, it is undeniable that far too many women receive terrible care. Prepare for the worst, hope for the best, and choose what you want, whether that's home, MLU, ELCS.

But sometimes no-one pressures you. I was in labour for 5 days, in a hospital, and I wasn't pressured to have an epidural. One doctor explained why she would recommend it, and the anaesthetist came and explained the risks and benefits of it on day 1 or 2. I said no. They said "okay, but if you change your mind, tell us".

Lots of shift changes over that time, and the subject was never brought up by a doctor or midwife again. I felt safe and secure the whole time there, and reassured by the presence of kind, reassuring, sympathetic men and women.

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.

Human childbirth is risky, hospitals make it safer, the only reason it is now as safe at home is due to massive first world infrastructure and dedicated staff and resources at home

For babies. Better for mothers. re First bitrths at home..

Counterfcat - latest British study (2011) shows at least 2 x higher death rates for home births. Mothers who heal quicker and more daed babies is not a beter outcome.

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

Actually, there is a nmajor 2011 US study of all the recent studies in US, UK, Holland, Scandinavia etc shows it is probably 3x worse.

I think you are picking and choosing the research to prove your point, cleaving to that which agrees with you and rubbishing that which does not.

And why not a good homebirth service given that it's what many women want

Given that its about 2% of women who use it in the UK, I think the word "many" rather overplays it. "A tiny minority" is probably far more accurate.

Counterfcat - latest British study (2011) shows at least 2 x higher death rates for home births. Mothers who heal quicker and more daed babies is not a beter outcome.

To counter that No it doesn't show that - what it does show is:

For nulliparous women, there were 9.3 adverse perinatal outcome events per 1000 planned home births compared with 5.3 per 1000 births for births planned in obstetric units, and this finding was statistically significant.

It does not say that these are deaths - some were problems which were resolved but doesn't give sufficient detail. This is an area which needs more research.

Actually, there is a nmajor 2011 US study of all the recent studies in US, UK, Holland, Scandinavia etc shows it is probably 3x worse.

Which study was this please? If it was the Wax study I believed that their methodology had been roundly criticised. The Place of Birth study was rigorous.

I think you are picking and choosing the research to prove your point, cleaving to that which agrees with you and rubbishing that which does not.

The same could be said of you.

'And why not a good homebirth service given that it's what many women want'

Given that its about 2% of women who use it in the UK, I think the word "many" rather overplays it. "A tiny minority" is probably far more accurate.

I don't think anyone knows what the true demand would be. Most women don't realise it's an option. If you read the link supplied by the original poster you can see that homebirth rates are quite high in parts of Wales. I believe Torquay used to have a high rate of home births (I don't know what the recent figures are.) I believe that if there is a decent home birth service a lot more women would use it, particularly for second and subsequent births.

Human childbirth is risky, hospitals make it safer

Hospitals are only as good as the staff in them and if they are too busy to attend you, you won't have access to the facilities whether you need them or not.

the only reason it is now as safe at home is due to massive first world infrastructure and dedicated staff and resources at home

I am not sure why you have a problem with this. As has been suggested before, are you confusing home birth with unassisted birth?

"hospitals make it safer, the only reason it is now as safe at home is due to massive first world infrastructure and dedicated staff and resources at home"

So you do agree its safe at home? Aren't we lucky we live in this country in an age where medical back up is available and accessable to all!

"latest British study (2011) shows at least 2 x higher death rates for home births. Mothers who heal quicker and more daed babies is not a beter outcome."

No, it doesn't, it shows there is an increased risk of an 'adverse outcome' with first babies born at home. This does just mean 'death', it includes things like meconium aspiration sydrome, HIE, Erbs palsys. 2nd and subsequent babies born at home are at no greater risk. If you double a small risk, it is still a small risk.

"Actually, there is a nmajor 2011 US study of all the recent studies in US, UK, Holland, Scandinavia etc shows it is probably 3x worse."

Yeah, its a study that has largely been ignored my because the methodology of the study was crap and deeply flawed.

"I think you are picking and choosing the research to prove your point, cleaving to that which agrees with you and rubbishing that which does not."

Anyone can read a bit of research, but it can be difficult to critically appraise research if you don't understand the methodology and how good qualitiy research is done, flaws and inaccuracies can be missed and you won't recognise you're reading a load of tosh.

"Given that its about 2% of women who use it in the UK, I think the word "many" rather overplays it. "A tiny minority" is probably far more accurate."

How many is many? If its 2% thats at least 15000 women every year wanting a home birth. There are many more women who would want a homebirth but for one reason or another been denied it.

I find it ironic that you can say 'double a small risk is still a small risk' when talking about your own argument. It 100% increase of the small risk...

Yet someone upthread was shouting about a 50% increase in a small risk when referring to hospitals...

I do get an impression of picking and choosing stats here... Why can't you all just agree to disagree and leave women to make their own choices

(this is to both sides as I am tired)

So, the argument (such as it is) from Pro Homebirthers revolves around rubbishing any data that disagrees with their position, heartily recommending any that does, glossing over the documented risks if things go wrong, and claiming that far more women than the current 2% would use it if only their lizard brains were correctly informed.

Besides, hospitals are nasty places.

And anyone advancing a counter argument is to be howled down as shamefully wanting to risk children's lives.

*doesn't just mean death.

whatmeworry the words pot kettle and black spring to mind here.

Why are you so bothered anyway? No one is forcing you to have a homebirth.

No whatmeworry Pro Homebirthers are not rubbishing any data that disagrees with their position. One thing we are saying is that the recently published and rigourous Place of Birth survey shows that this is a safe choice. It does highlight that for first time mothers the risks to the baby are higher - still low, but higher, and this is something that needs to be considered.

It highlights that for women having a second or subsequent baby, CLUs don't offer a better outcome for the baby, but do offer a higher risk of CS, forceps, episiotomy.

There are pros and cons to all the options. This is all useful data to have when making a choice about where to have a baby. This is much more nuanced than the 'homebirth bad, hospital good' stance that you seem to be taking.

furry probably because of the glossing over of stats that don't fit their argument and the fact that whatme has been called some horrible names on here just
For not agreeing.

She must be a lizard brained man... That may be why she is bothered by...

Then you all sit back and 'what are you so upset about?' as if the sun shines out of your ass and name calling is acceptable?

Maybe?

Why the bunfight?

If you want a homebirth, have a homebirth. If you want a hospital birth, have a hospital birth. Why does your way have to better than someone else's way? Why can't it just be your way? That is a generic 'you' by the way - not addressing any particular poster.

The whole point about choice is that women need to be relaxed and comfortable in order to labour as well as they can. Being where they want to be will make them more comfortable. So homebirth isn't intrinsically better than hospital birth, or vice-versa - it depends on what a woman wants. There is no point a nervous woman being persuaded to have a homebirth on the basis that she is less likely to need a c-section as that is only true if she isn't constantly panicking about things going wrong. And there is no point forcing someone who hates hospitals to have a hospital birth on the basis of better outcomes as that is only true if she isn't hugely distressed and uptight about being somewhere she is not comfortable.

I have had a hospital birth and a homebirth. Both rapid deliveries and very straightforward. I preferred the homebirth and would plan another one if I had another baby. I did the research before making the decision - although there wasn't really a huge amount of option given the speed of the deliveries - and attended a very helpful homebirth session where some experienced community midwives dealt with the "what if something goes wrong" question very thoroughly. They went through the timeframes involved in the most common problems - getting a theatre ready, getting someone prepped for surgery etc. The reality of the situation is that unless you are a substantial distance from the hospital, you are unlikely to get help any slower as the preparations for dealing with the problem will be made while you are on your way, rather than being made while you are waiting in the hospital. The midwives said that unfortunately most of the really catastrophic problems would not be averted even if they happened while you were standing in front of the most senior obstetric consultant in the hospital at the exact moment they happened.

kungfupanda exactly

Ok so I haven't read whole thread yet, need to get dd from nursery, but I wanted to put my tuppence worth in :)

2 hospital births, 1 MLU birth and 1 home birth under my belt, the home birth was the only one that had complications. DS had shoulder dystocia (sp?) and was stuck for a bit. The midwives however, were very experienced and started trying all the different techniques available to dislodge. Bearing in mind an ambulance was on standby for me should I require, from the minute I phoned my midwife and told her I was in labour.

I am not having any more children, but if I was, I would take homebirth every time.

I strongly suspect that had I been in hospital when DS got stuck, he would have been cut out of me by default, rather than what happened in my master bedroom, minus the whale music

Absolutely my opinion though and I in no way negate or judge anyone else's view on this.

Oh and I had no whale music. I did try to listen to my ipod but accidentally played Tenacious D, couldn't turn it off and finished up throwing it across the room.

Kayano Whatmeworry has been being incredibly rude to people in favour of homebirth since her first post on this thread and will happily gloss over as many stats as she likes.

I don't know where you're getting the impression that homebirthers think the 'sunshines out of their arse from' they are just defending their position from people accusing them of being reckless for choosing to give birth at home, when they aren't actually being reckless. Just because most births take place in hospital doesn't automatically make it the best option for everyone. You have said yourself that you've looked at your options and made a choice you think is most appropriate for you. Why are you so uppity about others doing the same.

You seem to think that pointing out that low risk women are more at risk of intervention in a CLU means that homebirthers think women are stupid for wanting to give birth there. They don't they are pointing out that the facts don't back up the perception that birth in CLU is the safest option. For what it's worth I gave birth in a CLU, it was the best choice given my circumstances at the time, I knew I was at risk of more intervention by choosing this option, but I took that risk as at the time my instinct told me it was the best option (I'd already been in hospital 2 days trying to be induced with minimal intervention which meant I could stay in the MLU). In the end DS was a ventouse delivery that I'm about 90% sure could have been avoided had the delivery been managed in a slightly different way. So this time unless circumstances conspire to make it the best choice again, I will endeavour to either birth in my MLU (which just happens to be in a hospital, but that's not why I'd go there it's just close to my house) or at home.