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

But this is all something of a red herring here. That person was a very high risk - most of the time here we have been discussing the situation for 'low risk' women and what is right for them.

No, Shaggy treated it the same as a low risk game, no other poster there came anywhere near her in advice - everyone else was in the (sane) "no way" camp.

Clear evidence of ideological blindness, and dangerous at that.

Whatme, I thought you supported women making their own choice about where to give birth? You obviously think she is wrong in that choice though.
Why should someone elses choice bother you?

Can I also point out that an epidurial is often considered intervention. Yet because epidurials are not offered at home, or in most MLC if a low risk mother wants an epidurial she has to go to a hospital, therefore skewing the results. I am hoping to just use gas and air, but also want the option of an epidurial so that woudl be another reason I would choose a hospital birth. If I do end up getting an epidurial then I will oviously be considered a low risk birth that use dintervention, yet the hospital was not the reason for the intervention, the availability intervention was the reason I chose the hospital if that makes sense.

kelly2000 An epidural was definitely considered an intervention in the Place of Birth study.

As far as I can tell from the reports, women planning an epidural on medical grounds were omitted from the study because that put them into the high risk category, but those like yourself who wanted the option of an epidural were still considered low risk and eligible to be included. So in that sense the results wouldn't be skewed by including high risk cases.

Whatme, I thought you supported women making their own choice about where to give birth? You obviously think she is wrong in that choice though. Why should someone elses choice bother you?

Absolutely make their own choice, but if you read that thread you would see that advising a high risk woman with all sorts of complications to have a home birth is irresponsble and dangerous.

It is clear that Shagismund is blinded by ideology, she was the only person not saying "no way", the "Nobody can tell you whether you should or shouldn't - it's such an intensely personal decision. We all have our comfort zones around risk-taking when it comes to birth." was completely unsafe advice.

I think you have to ignore anything she says on this subject, really - her ideological blindness means she is unsafe and dangerous in her opinions.

And she even knows it - her excuse on this thread whwn I called her on it was that the woman would be correctly advised by the medics anyway.

Now that in my opinion is something to be ashamed of.

hand up

I didn't say 'no way' - I too agreed that the OP on that thread had to make the decision for herself.

I don't think the line you've quoted is unsafe advice. It is true. No one can tell her whether she should or shouldn't - they can tell her it's not advisable, but ultimately it is a personal decision, to be made with information and support from her medical team.

What would be unsafe would be to say "You're an ideal candidate for a home birth, so do it anyway and don't listen to anyone who says otherwise because they are all just WRONG" or "If you want a homebirth, then just freebirth, don't let anyone mess with you because that's BAD" - that's not what was said though,

Whilst even I might not plan a HB myself with those particular risks, I am not the OP there, and wherever she chooses to have her baby, I don't see why her decision shouldn't be respected - even if it's not one I would agree with.

I think Shags advice is perfectly reasonable and actually probably more helpful than everybody telling her what she has to do.

I think that what I feel, and what others who I have discussed it with feel, boils down to this:
If I was in hospital and something catastrophic happened, at least I (or my family) would have the comfort of knowing that I was in the place which had the most doctors and medical facilities, and there really was nothing else that could have been done. If I had been had at and something awful happened, we would have no such comfort and would always be thinking, 'what if I was in hospital?'

"It is clear that Shagismund is blinded by ideology, she was the only person not saying "no way", the "Nobody can tell you whether you should or shouldn't - it's such an intensely personal decision. We all have our comfort zones around risk-taking when it comes to birth." was completely unsafe advice."

Advice: definition of 'advice' is to suggest a course of action.

I have deliberately not given 'advice' to the OP because I don't consider myself qualified to do so.

Unlike everyone else on the thread who clearly feels like they have a good handle on what risks the OP might have to take into account and are quite happy to tell her what she should do.

Lavolcan,
But that would skew the results for low risk women, I, and other low risk women, who go to hospital intending to make use of epidurials (apparently it is the most common requested pain relief), will be considered to have interventions and the study will include us in low risk births that took place in hospital that ended in intervention. Yet it is not the fault of the hospital we had the intervention, we chose the hospital because we intended to have the intervention. Huge amounts of low risk women want an epidurial, or at least the option of one, but these are not available at home births or MLC.

Although I have disagreed with shags attitude about women who are low risk having a hospital birht, I do not think the advice that chosing a homebirth was a personal decision was bad advice. I would probably have included a "if I was you", but at the end of the day it is a personal choice and no law exists to make someone have their baby in a particular place.

Also, from reading this thread I think I must live in some wonderful parallell universe because I had a hospital birth:

I was advised that a homebirth was an option to me at my antenatal appointments. During labour I had CFM, but was still allowed (and encouraged) to stand up, walk around etc. It took 36 hours of (exhausting!) contractions and only getting to 4cm before any 'cascade of intervention' happened. This involved an induction drip and epidural (because I was so tired), then epidural wearing off, then 2 and a half hours of pushing in EVERY conceivable position, then DS getting into a bit of distress so all systems go to go down to theatre (me begging for a c-section by this point!), for a top and and forceps delivery. At no point did I feel like the doctors were just gagging to use their interventions and I really felt like the midwives totally allowed me to get into positions that were comfortable for me (and I am not a particualrly 'I am in charge of my own body sort of person!). I cant be alone in this kind of experience?

"Can I also point out that an epidurial is often considered intervention. Yet because epidurials are not offered at home, or in most MLC if a low risk mother wants an epidurial she has to go to a hospital, therefore skewing the results."

Epidural use was just one aspect they looked at.

Of course women who want an epidural will opt for a hospital birth, therefore you'd expect to see higher rates of epidural use in the hospital arm of the study.

But epidural use isn't associated with higher rates of c/s. It's the significantly higher rates of emergency c/s in the hospital arm of the study that are most concerning, not the higher rates of epidural use, which is to be expected.

"That person was a very high risk - most of the time here we have been discussing the situation for 'low risk' women and what is right for them."

How do you know that the OP was 'very' high risk?

Are you a midwife?

Medically qualified in any way?

No?

How do you feel qualified to comment on her level of risk?

And whatmeworry - would you have said the same to me when I was contemplating a homebirth following a diagnosis of gestational diabetes, polyhydramnios and macrosomia (big baby to you)? Said 'I was 'mad' to consider a homebirth?

And yet I had support from an experienced independent midwife and from a consultant midwife from a large teaching hospital.

I know women who've had homebirths following 2 c/s, someone who had a homebirth with twins, breech homebirth, someone who has type 1 diabetes, and someone who'd had THREE previous c/s. All of these women managed to obtain support from their healthcare professionals (NHS and private) and went on to have normal births at home.

Really - the issues surrounding risk and risk assessment aren't as clear cut as you'd like to think. Not among people who are involved in the business of birth.

Samstown- if you had been at home for those first 36 hours you may have had a better outcome. Going into hospital/ changing environment increases adrenaline and halts/ slows progress.

reallytired - It sounds like you saw people for a lot of the time. In our hospitalits often too busy I think. I got their at midnight they filled water pool and then saw a midwife half way through for 15 minutes and then at 6am my husbnd rang the bell 3 times and the midwife came for last ten mins.They just havent got the midwives now cause its a busy time I dont think. HV sys its often like that at busy periods she told me that a couple of weeks ago.

shag,
but about 45% percent of low risk women who have a hb end up being transferred to hospital because intervention is needed. So 45% of home births end in intervention, and more serious intervention than epidurials.
and remember a lot fo women in hospital who are having a very long labour may well ask for a c-section (an emergency c-section just means an unplanned one, not someone being rushed into theatre in a life or death situation), I know people who have done this. If they had been at home they would not have had this option until it became a life or death situation. Again for me that is another reason I want a hospital birth - if things are taking too long I want the option of being able to get a c-section quickly. It would be interesting to have a study done looking at the wishes of the women before birth - I suspect those requesting hospital birth even if low risk are going to be more prone for pushing for intervention like epidurials, or c-sections. You also need to know the reason for the unplanned c-section - was it because of a life or death situation or was it to avoid a situation becoming life or death?

How do you know that the OP was 'very' high risk?

...umm, she said so? Bit of a giveaway, that.

Not hard, is it?

For those that aren't far up their own ideological spout, anyway.

will be considered to have interventions and the study will include us in low risk births that took place in hospital that ended in intervention. Yet it is not the fault of the hospital we had the intervention, we chose the hospital because we intended to have the intervention.

kelly2000 Yes, I take your point - it's one area where the stats are a bit crude IMO - we need to have figures to show where it was an active choice. ( I hope you see what I mean - I don't think I am expressing myself too well.) To counter that -there is an argument that some women who feel they will need an epidural find that with good support they don't need one.

shagmund How do you know that the OP was 'very' high risk? I don't know - I don't know her and no I am not a midwife, just someone who wanted a home birth and made sure I was well informed. I was taking her word for it - she said Oh yes and I have a bicornuate uterus, as well as my previous cs, so no chance of me being classed as anything other than high risk.

OK, I could have cut out the word 'very'. I was agreeing with you. I thought you gave her some sensible advice - talk to your midwife and you also explained how you dealt with a high risk pregnancy.

Sorry should have said, I had to be in hospital because I had Group B strep (diagnosed at about 32 weeks) and a suspected water breakage (long story!). My mum (ex midwife) said that she knew when I failed to progress that he must have been in a bad position, and it turned out he was, but I guess we will never know. I had had about 12 hours of very irregular contractions at home before suspected water leakage, if anything the contractions sped up when I was in hospital, but still no progress!

But I have to say, even if I had not been diagnosed with GBS, homebirth would still not have been a consideration for me.

samstown the unfortunate thing is that not all women have your experience, which is what the real problem is. Of course it's wrong to generalise that intervention automatically makes a birth a bad experience for a women, but do you not find the shear number of births requiring forceps, ventouse or EMCS and the rate at which these interventions seem to increase alarming?

For what it's worth my doctor decided on ventouse and that's the course of action that was taken, I'd have loved to have got out of the stirrups and off my back to try push in a more optimal position, I think the probability of that working just as well is really high (although of course we'd never know but DS was on his way and in the right position), but I didn't get to find out. Incidentally, it's not for my own sake that this bothers me, but for my DS as he spent the first few days of his life with a massive painful bruise on his head.

Yes, the number of interventions is increasing, but the number of perinatal deaths is the lowest it has ever been. Doctors just dont want to take the risk these days I guess and want to get babies out as quickly and safely as possible, rather than waiting and hoping that they will come out in their own time safely.

There is no point in saying if you gave birth at X place then you would have had a different outcome. We cannot go back in time. All our experiences and opinons are valid.

I feel that the fear that many women have causes the cascade of intervention rather than the hospital. Women tense up when they are scared which makes labour difficult.

I think that good ante natal care should manage expectations. Horror stories do happen, but they are rare. Women need to be encouraged to be optimic and believe that the chances of having a good birth experience is high. I also think that women need to let go of a the myth that they have any real control. You might need drugs or you might not. Having pain relief does not make someone a failure.

I find it interesting that in the 1950s all the women gave birth on their backs, there were very few c sections. I think the big difference is that they put their TRUST in health professionals. They did not stress so much.

Childbirth is a bit of a lottery. Different women need different care options. I think women do better when they put their faith in a trusted health professional who has studied for years and let them do the worrying.

RT you speak a lot of sense. And look at that girl from obem the other week (Disney couple) she said ignorance is bliss, knew nothing about birth and just totally breathed baby out. Maybe my mil is right, perhaps we do have too much info about everything these days!