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

anniemac I know you were just saying why you personnally wouldn't give birth at home but you did go on to make a bit of a sweeping statement that mothers who choose homebirth do so just so they can have a nice experience. This just isn't true there are women on this thread who felt that their babies were at greater risk due to lack of midwife attention in overly busy hospitals, whereas at home they had the full attention of two midwives, who could if necessary make the call for extra help quicker than during a neglected hospital birth. There are also women who labour very quickly, who think it's better to birth at home with a midwife and a full medical kit than give birth at the side of the road, with just their husbands and a taxi driver for company.

They just made the best decision for them and their babies in the same way you do.

"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"

Yes. I agree! And within this context, homebirth is as safe for the babies of low risk, second/third time mothers, and SAFER for women themselves.

That's ALL I've ever said. I'm glad we're in agreement at last.

"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."

Actually the conclusion of the report was that birth was "safe across all settings". So it's really up to individual women to decide their own comfort zone around what they're happy to do. If I was a first time mum making this decision I'd hope that any advice I was given would encourage me to consider my health and my baby's health not just in relation to the first pregnancy, but in relation to my reproductive life as a whole. Incidentally - if you read the research you'd know that the authors themselves have flagged up concerns about the way 'poor outcomes' have been recorded in the study. The doubling of the rate of 'poor outcomes' doesn't necessarily means 'baby deaths'.

"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."

But that is in systems which have a completely different system of healthcare to our own. I personally prefer to rely on evidence from the UK as this is most relevant to our system of maternity care. I also believe that the most recent study (the 2011) is the most comprehensive and closely examined study of outcomes connected with place of birth to have been published in the UK. As such, I think it's reasonable to accept its findings in preference to research done in other countries.

"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."

The number of women who have a homebirth doesn't necessarily correspond with the numbers who would want one. There is a huge disparity in homebirth rates between different areas: in areas where there are pro-active homebirth midwifery teams and where women are given a real choice, between 10% and 20% of women opt for one. And that's within a culture of misinformation and misunderstanding about its safety and its benefits, such as is evidenced by your posts and the posts of some others on this thread.

I'd like to ask a genuine question to those who gave birth at home. Did you feel confident with your MW's ability to get you to hospital in time if (god forbid) there had been an emergency? Also, did the potential transfer time cause you any anxiety? I say this because surely you'd have to wait for an ambulance, up to 10 mins and get to the hospital etc.

I'm not looking to pick holes, just genuinely curious and having never given birth myself, I have no strong opinions on either a hospital or home birth.

"Its not that I am being insulting its just that I genuinely don't see how it could improve a baby's chances of survival (or a mums) to give birth at home."

Because women who labour at home tend to spend about two hours less - on average - in labour.

Labours which become dysfunctional - slow down or stop, resulting in the need for syntocinon, put babies at risk. This is less likely to happen at home.

I had a homebirth with DS because my midwife (community and on the homebirth team) suggested it and encouraged me to do it.

Not everyone has to push to get one, the NHS and medical professionals offered me one.

I trusted them and took them up on it and it was lovely with very little mess.

I had already experienced a technically perfect hospital birth and got PTSD as a result. DD was absolutely fine and I was physically fine, but the repercussions to my mental health and my relationship with DH and DD from the 'care' that I received in labour/postnatal ward were far reaching. I only received a midwife to myself in the last hour of a 22 hour labour, despite having entered the hospital four hours previously.

Anecdotally I was told by the midwives after DS was born that had i been in hospital they would have encouraged me to have an epidural or other inventions. His labour was long, he was back to back like his sister and I dilated very slowly/irregularly at first and then went from 6 cm to 10 cm in an hour. I avoided it with DD's birth by entering the hospital after 17 hours at home and 8cm dilated as they wouldn't admit me to be examined before then. It was much easier and more encouraging to deal with the long hours of contractions at home rather than in a hospital ward. Additionally I didn't face the hideous slowing down of contractions that happened when I entered the hospital the first time.

The midwives (more than I ever saw in the entireity of DD's labour) brought G&A, absorbent mats, resus equipment, a fetal doppler, thermometers, a sharps bin, baby scales and vials of local anaesthetic for stitches, the placenta injection and a hands off attitude. They also read my whole birth plan and respected my wishes.

They also asked me before injecting me with things and doing vaginal examinations, which they didn't do with DD. When DS was born they took all the soiled linens/shower curtains/pads/bin liners away to be incinerated at the hospital. The rest was put in the washing machine for me.

I read a lot of books about the biology of birth, book like Birth Reborn by Odent, Gaskin's books, waterbirth book, Birth, a history by Cassidy and it made sense to me to be in a calm, warm, dark room where I felt safe and I trusted those around me.

DS's birth was relatively painless, I did not experience any of the pain or panic I felt the first time around, it felt like waves of pressure. I was able to hypnobirth him easily, whereas with DD I lost focus because of the environment I was in and the bloody useless midwife who told me I couldn't push for an hour.

DS was born to 'Ghostbusters', not through choice I have to add.

I think it should be offered more across the board as a valid alternative, but obviously it won't be a desirable or available option to everyone.

"Did you feel confident with your MW's ability to get you to hospital in time if (god forbid) there had been an emergency? Also, did the potential transfer time cause you any anxiety? I say this because surely you'd have to wait for an ambulance, up to 10 mins and get to the hospital etc."

I called an ambulance during my second labour. It was outside the house within 3 minutes. But then I live very near the hospital.

My hospital has two operating theatres. Sometimes - often - they are both being used at once. So it's not always easy to have a mum on an operating theatre within minutes even if you are in hospital already.

crashdoll - yes I did feel confident in her ability. She had more experience than the midwives I saw in hospital, and vastly more than the junior doctors who were flitting around. I could have been blue-lighted to the hospital within 15 minutes, so I didn't feel that was a problem either.

As it happened my son came into the world very quickly and the midwife only just got there in time. I am glad it was her braving the elements on a winter afternoon, and not me risking giving birth in the car by the side of the road.

R2...

They injected you without asking you?!?!
dies omg rewrites birthplan

crashdoll I trusted my midwives.

My next door neighbour had a homebirth. Towards the end the midwives called for an ambulance. It wasn't used but it was there just in case.

Another friend was transferred towards the end of her labour for failure to progress. The ambulance was there within 5 minutes and she was in hospital in another five where she gave birth to her DD naturally half an hour later.

I used the same midwife team and they answered all of my concerns and querys honestly. During labour my temperature was taken every few hours, the doppler was used regularly and I had a midwife there for half of the labour watching me quietly. Considering that with my first labour I was only checked once a hour in the last four hours of labour (out of 22) and got a midwife to myself only for the last hour I was much more confident in their ability to pick up any problems.

"I said that I think that would be the
Best middle ground IMO as it means that people can be in a mLU which also has a much lower rate of intervention and csec than clu...

But if something did go wrong then you wouldn't be far
From a clu if you did need a csec etc."

It feels like the best middle ground FOR YOU Kayano - because you believe you will be safer.

It's not right for everyone else though.

And as long as there's evidence that homebirth and birth in freestanding midwifery units are

SAFE
and
HAVE BENEFITS

then it's right that they should be supported and that women shouldn't be made to feel unreasonable or irresponsible for making that choice.

Kayano Yes. Twice.

Once for the placenta injection (DH says I wasn't asked, but I was out of it)

Then in the postnatal ward I was dozing when a midwife (not one I had seen before) walked in and said 'right, roll over', pulled up my hospital gown and my pants down to stick the anti-d injection in my buttock. After it was done she said 'your daughter's blood came back as rh-positive. Your midwife will have explained why you need anti-D' and walked out.

It was an extremely busy ward in a very busy teaching hospital.

I have put in my birthplan about my needle phobia and must be asked and DH has been put on alert...

I need needles for antiD too but I with thrash about and panic like hell if they did it without me breathing right, silent tears falling and head buried in DH's fat stomach

Shagmund - do you read before shouting people down. I SAID that it was the best choice for me PERSONALLY about
3 times...

I said I advocate women being able to chose for themselves whatever they want

I said I had additional concerns re: being adopted with no medical history etc

I said that I didn't think it was best
For everyone, I said many women may feel this is a good compromise or middle ground and their should be more mlu in hospitals and there are not that many

So read, get off your soapbox and chill out

Apologies Kayano. I should have used italics or bold for emphasis, instead of capitals, which might be interpreted as shouting.

I think I'm still stinging from a comment you made some pages back calling 'some people' on this thread (referring to me?) 'smug' and 'self righteous'. Made me feel you were being a bit judgy. Especially when a bit further down the thread you started complaining about people name calling.

I said 'there is so much smugness and self righteousness on this thread' that I have been a bit sick in my mouth

Which there has been! From both sides! I never said that in relation to any particular side and I had been watching dodgeball

I have been pretty consistent with the 'can't we agree to disagree' standpoint.

I also take your point about freestanding MLU shagmund, there should be more of those too I mean, more choice the better right.

I didn't think the stats were any different for freestanding mlu than for mlu within a hospital or attached to a hospital

So on balance (in my personal opinion) then one next to a clu would be a better option from and NHS £ perspective and cut down on transfer times etc/ no need to pay for more land etc

"I have been pretty consistent with the 'can't we agree to disagree' standpoint"

I don't think you're that bothered either way, but as someone who's had a homebirth, it's been very irritating and actually quite upsetting for me to have to listen to posters on this thread making inflammatory and inaccurate comments about the safety of out of hospital birth.

"I didn't think the stats were any different for freestanding mlu than for mlu within a hospital or attached to a hospital"

For what it's worth, the figures from the Place of Birth study referred to a lot on this thread do flag up better outcomes for freestanding units, than for alongside units. For healthy first time mums the normal birth rates were as follows:

Consultant led unit: 46.4%
Alongside Midwife led unit: 62.9%
Freestanding Midwife led unit: 71.1%

Forceps rates were also quite a bit lower too. (AMU - 7.8%, FMU - 5.3%)

I think that's quite a significant difference personally.

Shagmund that's really interesting as I'd been pondering whether there was a difference. The night I gave birth I heard that all women in the MLU had been transferred into the CLU and I wondered whether this might just have been one of those nights or indicative of a wider trend. Do they give reasons?

I know I was induced so am not a good example and I didn't start in a MLU, but I do have my suspicions ventouse delivery could have been avoided, and wonder if the doctor having made the decision just carried on with that course of action. Letting me out of the stirrups and letting me have some help from gravity when pushing could have been an option as much he was very well positioned and crowning by the time they suckered him out. So I guess my point is that in a similar situation a midwife without a doctor on hand my have had a different solution to getting DS to make a necessarily fast appearance, whereas in a MLU in a hospital the same team of doctors would most likely have appeared in my MLU room to do the same thing they did in the CLU.

I shouldn't complain too much though DS arrived safely allbeit with a big bruise on his head and despite it being a bit hectic at the end it wasn't actually a bad experience, I'd just prefer it to be a bit different next time.

jessie again with the posts a million miles apart - thanks, I know two women who have given/ are about to give birth at my local hospital. But both are v high risk as one is tiny and pretty much had CS on demand, and the other had a crash section with her first birth, so their treatment may not be representative.

freestanding midwife led units tend to be in rural areas where transfer times from home to hospital are also very long...also they are not more expensive to run.

women choosing them may live say, 2 hours from the CLU, but only one from the FMU..IYSWIM.

one of the benefits noted in the report was there was not the same competition over resources and confusion over staff -responsibility boundaries in FMU settings (as opposed to alongside MLUS)

thefurryone, I suspect that freestanding MLU's attract a particular kind of midwife: one who's absolutely passionate about supporting physiological birth, and has the courage to go with her convictions. I don't know how their staffing is organised. Maybe they have more case loading midwives, which would account for their better results (there's evidence that having the same midwife for pregnancy, birth and after is associated with the best clinical outcomes). Got a visit planned to the Barkantine birth centre in London in a few weeks time, so I'm excited to find out more about how they do things! nice!

"latest British study (2011) shows at least 2 x higher death rates for home births

no it didn't - it actually concluded that stillbirth levels were so low in all settings studied that no statistically valid conclusion could be drawn about that.

The orginal question was "why are homebirth rate so low"

It is very clear from all the research evidence that the reason is that there is no compelling reason to do a homebirth, and some significant risks if things go wrong.

What fascinates me is the pro homebirthers seem to howl anyone down for saying just that.

"It is very clear from all the research evidence that the reason is that there is no compelling reason to do a homebirth, and some significant risks if things go wrong."

What - apart from a big reduction in c/s and other interventions rates among homebirth mothers and mothers giving birth in freestanding midwifery led units? Without any impact on neonatal outcomes, except for first time mothers?

I'd say that's a fairly major advantage wouldn't you?

The BMJ would!

(from the BMJ):
"multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes".

Previous large scale studies also indicate the following benefits for homebirth:
lower rates of postnatal depression
higher rates of successful breastfeeding
higher rates of satisfaction with birth
lower likelihood of poor apgar scores at birth and likelihood of baby being admitted to SCBU.

BTW - I asked you WAY back on the thread how you felt about free-standing midwife led units, as in the latest study these are associated with the best neonatal and maternal outcomes of all (better than homebirth). These are units with no doctors on site, with no operating theatres, and where women need to transfer by ambulance from if they have difficulties. There are no medical facilities available at these units that are not also available to mothers giving birth at home. The neonatal outcomes for first time mums at these units was just as good as for first time mums giving birth in a CLU (and they had less than half the number of c/sections). Would you care to respond?

"What fascinates me is the pro homebirthers seem to howl anyone down for saying just that."

No - they just howl down people talking bollocks about unassisted births, and ignoring the good, solid evidence that NHS recommendations on place of birth are made on, in favour of dodgy studies from other countries which appear to support their case.

Provided mothers are aware of their options and midwives are supportive then I don't see a problem with a low take up of homebirth.

The only issue I would have would be if the homebirth service was scrapped because of low take up. A small minority of women cannot have a hospital birth because their labours are so quick. These women have a right to proper midwify care and if they cant get to the hospital then its only fair the midwife comes to them. We need a good homebirth service to cater for women with fast labours and midwives need to keep up their skills.

What is interesting is why homebirth rates vary so much around the country. For example Torquay has a 20% homebirth rate yet the UK average is roughly 2%. www.thegoodbirth.co.uk/home_birth#lowrates

It would be interesting to know why rates vary so much round the UK and the impact it has on mothers and babies. In someways its a bit pointless looking at other countries as they do not have the same intrastructure as us.

With statistics people will always choose data that suits themselves. If you want to find data that supports homebirth its possible and conversely the same studies can be malipulated to make homebirth look dangerous.

"The orginal question was "why are homebirth rate so low"

And actually your latest response sort of answers that:

Because there is so much misinformation and ignorant prejudice about out of hospital birth.