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

Whatmeworry
is no compelling reason to do a homebirth

So all the woman who had high risk of rapid labours like I had, and I ended up having, either don't exist in your little world or are better of giving birth at side of roads, back of taxi's or like one of my friends in hospital car park with no MW nearby ?

As for last line - Pot. Kettle. Black.

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.

No, I would say that the reason women don't have home births are:

-many women don't realise that it's an option so don't question a CLU booking
-many women don't realise that the midwives who attend come fully equipped (the OP didn't)
-some women booking a home birth are conned out of it because of staffing issues
-some are worried by the mess (but those of us who have had them can tell them that there isn't much mess)
-many women have a false sense of security about hospital - they don't realise that they can be left unattended for long periods, or that obstetric staff aren't immediately on hand if things go wrong
-many women don't realise that as a multiparous woman a CLU is no safer for the baby, but vastly increases their chance of CS/forceps/episiotomy
-Some women are influenced by those who deliberately misinform them -
"latest British study (2011) shows at least 2 x higher death rates for home births" when it shows that the stillbirth rate was so low that it was insignificant.

Positive reasons to have one:
-safety - one midwife throughout and two for delivery (unless like me the birth happens so quickly, that only one gets there in time)
-no risk of hospital acquired infections
-easier to establish breastfeeding
-own facilities - relaxing afterwards in your own bath instead of sharing possibly dirty,bloodstained facilities with strangers
-vastly reduced chance of CS/forceps/episiotomy

Reasons for a CLUbirth:

• medical factors which make being in an obstetric unit advisable

-early access to an epidural (but hospitals don't always deliver on this)

Sorry shagmundfreud and others - crossposted and said many of the same things.

There is never going to be agreement on this, because women who homebrithed successfully are always going to think that that is the best way.

Personally for me, I wouldnt have a homebirth because I jsut couldnt forgive myself if something went wrong and I couldnt get to the hospital in time. Yes, I am aware that women and babies die in hospitals as well, but if I was already in a hopsital then at least I would know that everything and everyone would have been there and there really would have been nothing more that they could do.

I had a looooong labour (DS was stuck), and for most of the labour it was pretty slow going. However, as soon as they decided that DS was in a tiny bit of distress and it was best to get him out ASAP it was as if the entire hospital turned up and I was in theatre in literally seconds for a forceps delivery.I felt that they doctors did such a fantastic job to get DS here safely, and although I know that is only my hospital is the reason why I will not be having a homebirth next time either.

My mum used to be a midwife and begged me not to have a homebirth (I wasnt really considering it anyway), because she had seen one woman die and several others have a near miss from a PPH after a homebirth.

I have seen on MN in particular (but also in my antenatal yoga class), this idea that labour is all about the mother having this great birth experience . For me, labour is about getting the baby out safely. This really is such a first world problem, we are so lucky to have hospitals in which we can deliver babies safely, why moan about the fact that more women arent shunning this to have a homebirth?

By the way, sorry for the appaling way my post reads, have been ill so my brain is still a bit all over the place!

For DS I was induced in hospital, 15.5 hour labour, me terrified all the way through and SCREAMING all the way to the operating theatre in pain despite G&A, ending up in spinal anaesthetic and forceps delivery (only because I was just lucid enough to refuse C-Section)

When I was pg with DD, the hospital tried to force me into a hosptial birth, as "you had a large 1st baby (8lb 12.75oz ) and you needed assistance. 2nd babies are statistically larger, therefore you are having a hospital birth..."

Erm, no, I don't think so. (Not when your hospital KILLED a woman just after she gave birth, by "accidentally" injecting a large dose of anaesthetic in her arm)

DD was born at home in water pool, doula present, 2 mw's sat having a cuppa with DH, checking on me now and again, 3.5 hour labour, NO pain relief, and a very happy and relaxed baby and mum. DD was 7lb 11oz - larger baby my arse.

I am now pg again and am planning to replicate DD's scenario as much as possible.

I would only consider hospital if it was medically proven throughout the pg that I would definitely need assistance/intervention.

PS, I think homebirth rates are low because it's not well publicised that it's an option, and even when you do decide on it, the NHS do what they can to make you have a hospital birth... see above post.

this idea that labour is all about the mother having this great birth experience . For me, labour is about getting the baby out safely.

I don't think those of us putting the case for homebirth have been primarily arguing about the great birth experience. Most of us have been arguing that it actually was safer for us. Being unattended in hospital, giving birth in the car, having an intervention which could have been avoided are all the sorts of things we have been discussing.

However, I do think that labour is more than getting the baby out safely - the mother's health is important too and this rather seems to have been lost sight of.

For what it's worth - I had a CLU birth and a home birth. They were both great birth experiences. I always suspected that I would have avoided having forceps if I hadn't gone to the CLU, but I will never know.

samstown what exactly is wrong with hoping for a good experience during labour and delivery? Who in their right mind would hope for a traumatic unnecessarily interventionist birth?

LaVolcan cross posts slightly I also gave birth in a CLU and had a ventouse (also possibly avoidable) but it wasn't a bad experience either because I was lucky enough to have one to one midwife care (giving birth 5 minutes before her shift ended probably helped with that one though ) and a medical team who understood how important it was to make sure they communicated properly with me & DH.

To argue that nothing that happens pre-birth is important as long as the baby is alive is just wrong on so many levels and allows poor treatment of women in labour to be excused as acceptable.

Like I said, people's views on this are always going to be coloured by their own experiences. I just think that we are actually lucky to have hospitals to actually give birth in and that the vast majority of babies in this country are deleivered safely, regardless of how that happens in terms of interventions etc.

Beleive me, I was screaming on my way to the theatre, and I was begging them to just give me a c-section and just get him out! However, I now look back on the whole labour with fond memories because I know that ultimately I was looked after so well and my son came out unscathed. That is just my experience.

I am also wondering how you know that these interventions were 'possibly avoidable'. I dont really understand this notion that consultants pace around hospitals, wielding forceps and ventouses just chomping at the bit to get to use them .

Look, if someone wants to have a homebirth for whatever reason, then that is great and your choice. However, I just dont think that a campaign for more homebirths is something that we need to be worrying about at the moment

I am also wondering how you know that these interventions were 'possibly avoidable'. I dont really understand this notion that consultants pace around hospitals, wielding forceps and ventouses just chomping at the bit to get to use them hmm.

We don't know for certain but the statistics from the Place of Birth study show:

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%)

The argument is usually that CLUs have lower normal birth rates because they are dealing with a higher risk population but it doesn't apply with this study because they were matching like for like - for factors such as parity, age, etc. From this, it's not unreasonable to wonder whether your forceps/ventouse would have been avoided if you hadn't gone to the CLU.

I keep quoting the Place of Birth study because it is recent, had a high sample population and was rigourous - in short it's the best we have for now. It doesn't mean it's perfect - there are questions that could be answered - one of which is why CLUs have significantly lower rates of normal birth?

Samstown- some hospital procedures can lead to further intervention, I have seen it referred to as a 'cascade of intervention'.

My midwife encouraged me to lie down on my back on the bed, which is the worst possible place to labour with a back to back baby and I hopped right off. If I had had to have monitoring then I wouldn't have been able to hop off and I am wondering if then I could have coped with the pain without asking for an epidural. Having an epidural increases the chance of an instrumental delivery, it interferes with the flow of birthing hormones and requires a woman to lie still and not move. I moved constantly during my labours, shifting and walking around into positions that felt 'right'.

A woman who does not dilate as fast as the midwives think she should may be offered medication to speed up the labour, which often comes with an epidural as the pains get more intense. I was told by my midwives that had I been in hospital then this is something they would have suggested to me.

My contractions with my first child slowed right down when I entered the hospital, I was in an unfamiliar place, bright, busy and somewhere I associated with illness. I let them put me in a wheelchair and wheel me the thirty seconds to the delivery room even though I had walked in happily. I was put in a bright, unfamiliar room with a bed and encouraged to lie on it. A hospital gown was put on the bed and it was suggested that I might like to wear it. I couldn't walk around freely anymore. After a couple of hours my contractions ramped right up to an intensity I found almost unbearable, I lost my focus, I was frightened and felt abandoned by the midwives. When I got a midwife she didn't touch me once, just told me to stop pushing as I'd kill my baby (not true I found out later, I was ready to push). That was the point I started screaming for an epidural, whereas when I reached that point with DS I screamed for a few minutes as he went through my pelvis/past a possible cervical lip and then regained my focus because I felt safe. In hospital I was a patient, a nuisance. In my own home I was in charge and in control of what the midwives could do to me.

Of course a healthy baby is an important thing, but I could see and was told by my midwives that a homebirth was a safe and desirable thing for both of us, whereas from my perspective the hospital was safe for the baby only. Negating the woman's experience ignores the effect of PTSD, PND and trouble bonding which can have much longer term effects-in my case it took three and a half years before I stopped shaking at the thought of pregnancy and birth and I still had panic attacks when I went to 12 and 20 week scans with DS. And I had a normal birth with just G&A and TENS, healthy baby at the end, small tear which required stitches. I really struggled to bond with DD, it took a year before I really felt I loved her, I feel like I lost a whole year of her life.

"Like I said, people's views on this are always going to be coloured by their own experiences."

Very true. Women are generally very loyal to their birth choices, whatever they are.

But women who book homebirths overall are more likely to be happy with their birth experience. According to the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives:

"There is ample evidence showing that labouring at home increases a woman's likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.1-3" (joint statement on home birth from the two Royal Colleges last year)

And they should know shouldn't they?

"I just think that we are actually lucky to have hospitals to actually give birth in and that the vast majority of babies in this country are deleivered safely, regardless of how that happens in terms of interventions etc."

Given that women are significantly more likely to die following an emergency c/s than following a normal vaginal birth, I for one don't think the doubling of the numbers of c/s associated with hospital birth, for healthy, low risk mothers, is something to dismiss as a minor detail. Particularly when it's not accompanied by lower neonatal mortality rates.

"However, I just dont think that a campaign for more homebirths is something that we need to be worrying about at the moment"

I don't know. Given that the emergency c/s rate in some UK hospitals is now 1 in 5 of all labours, we need to be looking at ways of bringing it down. Homebirth and birth outside hospital (in free-standing midwife led units) is part of the answer to the problem of high c/s rates. (and there are others like increasing numbers of midwives and more consultant cover on CLU's, that would also help to bring it down).

shag,
It is ignorant in itself to declare that women who do not want to give birth at home are only doing so because they are ignorant and misinformed. It comes across as saying that homebirth is the best way and anyone who feels differently is stupid. If hospitals are so bad for low risk women, then they are free to have homebirths, and to tell their midwives that under no circumstances should they be taken to hospital.
Homebirths are more likely to not need interventue because if intervention is required the homebirth ends and it becomes a hospital birth. Only low isk women can give birth at home, meaning those more likely to be needing intervention are going to be at hospital also skews the results. The same goes for midwife led units which (at least in my area) will transfer you to the CLU as soon as intervention is required even if the mother was condsidered low risk, meaning that the results for "natural" birth compared to birth with intervention are skewed against consultant led units.
And the antenatal care and health of the mother also needs to be taken into consideration when looking at whethe ror not the intervention rates have increased as there are now more older, and more overweight women, and more vunerable women (such as immigrants who do not speak English and understand the care available to them whilst they are pregnant), and multiple births due to IVF than there was thirty years ago, all of which lead to an increase in risk and need for intervention.

Also lets not forget that intervention has been used for thousands of years. the ancient romans were found to have used physical interventions to increase the birth, and the ancient Egyptions have been found to have used medicines (more akin to what we wuld call natural remedies) to try to speed births along.

Homebirths are more likely to not need interventue because if intervention is required the homebirth ends and it becomes a hospital birth

No, that's not the case - the births which started out as home births still show up in the stats as such even if the woman transferred to hospital.

Only low isk women can give birth at home, meaning those more likely to be needing intervention are going to be at hospital also skews the results.

Anyone can give birth at home and undoubtedly some women 'high risk' women do - either by accident or design.

The same goes for midwife led units which (at least in my area) will transfer you to the CLU as soon as intervention is required even if the mother was condsidered low risk, meaning that the results for "natural" birth compared to birth with intervention are skewed against consultant led units.

And both of these will still show up in the homebirth/MLU stats - this is why the stats can record CS births for both these categories even though the CS didn't take place there.

It is ignorant in itself to declare that women who do not want to give birth at home are only doing so because they are ignorant and misinformed.

Well, I was certainly misinformed with my first - it was an eye opener to find out that there were alternatives which may have been better for me, and I don't think I was alone.

As for last line - Pot. Kettle. Black.

Bah humbug. One more dissenter unleashes yet another 2 pages of howling down.

And the antenatal care and health of the mother also needs to be taken into consideration when looking at whethe ror not the intervention rates have increased as there are now more older, and more overweight women, and more vunerable women (such as immigrants who do not speak English and understand the care available to them whilst they are pregnant), and multiple births due to IVF than there was thirty years ago, all of which lead to an increase in risk and need for intervention.

It depends how far back you go - if you are comparing the 1950s with now you can set against this fewer women smoking now, women more aware of the need to take care of themselves, fewer women having 8, 9, 10 children etc, better housing, not having rickets in childhood, safe abortion, so some risks that used to present themselves have been reduced.

CS rates have rocketed over the last 20 years from 12% and I doubt if antenatal factors were much different in the early nineties than they are now.

Also lets not forget that intervention has been used for thousands of years. the ancient romans were found to have used physical interventions to increase the birth, and the ancient Egyptions have been found to have used medicines (more akin to what we wuld call natural remedies) to try to speed births along.

No one is saying that there shouldn't be interventions - in some cases they are life savers. What is being questioned is interventions which were unecessary.

lavolcan,
It depends where you get the stats from, often studies will make their own definitions of what they class as homebirths.
But it is not fair to say that women who want a hospital birth even if they are low risk are ignorant and misinformed.

On the note about safe abortions, I was wondering how much easier access ot abortions has decreased the maternal and infant mortality rate as now mothers who may not survive a pregnancy can terminate , and they can have terminations if the foetus is unlikely to survive too.

Kelly2000" Only low risk women can give birth at home"

Please stop stating this as it is incorrect, it is the second time you have made this claim on this thread and the second time I have responded.

High risk women can give birth and home, and DO give birth at home.

This afternoon I have spent a lovely 2 hours with a Supervisor of Midwives talking through the management plan for my 'homebirth against guidance' as I am high risk. If only low risk women could give birth at home, there would be no women who have had a previous PPH, retained placenta, 3rd or 4th degree tear or a CS who give birth at home. And there are quite a number who do.

I never considered homebirth as I wanted help there should i need it. As it turned out I had alot of complications; some life threatening.

kelly2000 I was taking most of my stats from the Place of Birth study released in November 2011 because it's up to date and can be considered rigorous.

As far as I can remember, but it's a couple of months since I ploughed through the report, they defined a home-birth as one where it was booked and a health care professional had been out to the woman in labour. So I imagine that someone who was booked for a homebirth but was told to come into hospital because there were no staff would count as a hospital birth. Someone who changed their booking to hospital on health grounds would also be excluded. This is so that they could be sure that they were comparing like with like and not skewing the results.

But it is not fair to say that women who want a hospital birth even if they are low risk are ignorant and misinformed.

I don't think it was me who said that. I am sure that plenty of women are informed and still want a hospital birth. I think there are still plenty who aren't informed about the options. As I said, for me it was an eye-opener - I thought being booked for the CLU meant that you saw a Consultant - not took pot luck on whoever.. and I doubt if I was alone.

I was wondering how much easier access ot abortions has decreased the maternal and infant mortality rate as now mothers who may not survive a pregnancy can terminate , and they can have terminations if the foetus is unlikely to survive too.

This must have made some difference to the stats although I don't have them to hand - perhaps someone else does?

"I never considered homebirth as I wanted help there should i need it."

What do you think midwives are for?

one of the findings of the Birthplace study was a great number of women did not know there was any choice at all but went straight for hospital just because that's what you do.

MLUs that automatically book in low risk mothers got very good levels of usage.

this study supports that as a tactic (being safer for babies and mother first time or otherwise than CLU, therefore the correct medical recommendation)

the study found there were more MLUs at the end of the study period than the beginning.

I had a hb for my ds2 and I had 4 midwives. I regret I did it because I ended up bluelighted to hospital because I was bleeding heavily. I would have given birth to hospital I wouldn't have wasted resources like an ambulance !