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

I should have added to my mammoth post that, in relation to unnecessary intervention - my local hospital has the highest induction rate in Scotland, the lowest 'normal' delivery rate and is in the top few for ELCS, EMCS and assisted deliveries. For all of the above, the hospital is on the wrong side of average. This is despite the fact that it's not a specialist centre, so basically all the units who take the more complex and extremely high risk deliveries fare better than my local district general.

"Comparing health professionals to violent kidnappers or hijackers gives the impression you have lost the plot."

Only if you're determined to interpret everything I say in the worst possible light.

You'll be in company though. With other poster who's insisted that my support for homebirth means I think that all women should reject modern medicine and give birth unattended at home, and another who's insisted that I'm hugely critical of mothers who choose not to have home births.

What I was trying to say was that some women appear to have allied themselves with a system which may have betrayed their interests by failing to provide good quality individualised care. At the very least they are happy to act as apologists for its failings, in a way I can't imagine them acting in relation to any other area of medical practice.

"Doctors and midwives do their best and are caring people."

Well yes - I think this is mostly the case. Although there will always be some who are absolute stinkers. As in any field.

"If you don't know why certain things are suggested, or the alternatives, or the balance of risks and benefits, then most of us (I think) naturally defer to those in authority."

I agree with this in theory. But in practice labouring women are not best placed to make considered and pragmatic choices in labour, particularly when they are being advised one way or another by shroud waving health professionals, who in turn are being pressured to adhere to institutional protocols regarding the management of labour, and within a system which is becoming ever more risk averse, because of a fear of litigation.

In answer to the op -because many women want to be in hospital and have everything single facility available if things should go wrong eg as on OBEM last night.

One wonders if that little girl would have made it if she'd been born at home.

Birth is a risky business,I think women are more informed nowadays and want the safest option.Nothing wrong with that really.I fail to see how anybody can guarantee they're low risk.

My mother nearly lost me and her life in cb,on paper she looked perfect.Thank god she decided to play safe and give birth in hospital,why should anybody question a women's decision to go for the safest option for her baby?

I'd never in a million years give birth in a place that didn't have doctors,SCBU,a theatre and every drug available.It's my choice and not for anybody to question.

in case it needed saying again
last years Birthplace study - with a sample of 60000 mothers, all low-risk, and post-controlled for additional risk factors - concluded

• the safest place for a low risk mother to have a first baby - for the baby - is not a CLU, but an MLU (for both higher and lower-order adverse outcomes, higher-order results were pretty similar )

• the safest place for a low-risk mother to have a second baby - for the baby - is at home (for both higher and lower order adverse outcomes).

the safest place to give birth for the mother (first or otherwise) was at home.

the vast majority of MLUs do not have any kit that is unavailable at a home birth (and in fact transfer time from a freestanding MLU is longer than the average homebirth transfer)

One wonders if that little girl would have made it if she'd been born at home

One wonders if that little girl would have been put in that position had her mother not been induced and encouraged to lie on her bed.

Homebirth midwives can and do deal with shoulder dystocia at home.

We can see from the discussion above that the idea of the 'safest option' is hotly disputed with evidence on both sides. Its not clear cut and black and white that hospital is right or necessary for every pregnant woman.

My mother underwent forceps in hospital for my birth simply because the consultant considered her too short (5 foot) to labour effectively. Two years later she pushed out my brother who was two pounds heavier with no assistance. Medical care has moved on in the last thirty years, more can be detected and treated.

I wasn't unattended, squatting in a pile of patchouli drenched cushions, hair in dreadlocks, communing with nature, whalesong on the stereo and keeping the medical profession at arms length. I am a normal woman with no leanings towards organic woo, magic or crystals. I don't even eat lentils. I don't think you could pick me out of a crowd as a homebirther.

I decided to have a homebirth after it was recommended by a trained medical proffessional and after an enormous amount of reading, thought and discussion. My midwife considered me low risk, I was watched closely and delivered safely. I am glad I did not have my DS in the hospital.

That was my choice and not for anyone to question (or suggest I was being foolish or dangerous or putting my son at risk).

Either you trust the medical professionals who say its safe and fine or you don't. I chose to believe them.

In answer to the op -because many women want to be in hospital and have everything single facility available if things should go wrong

I think a number of posters have a false sense of security about the staff available which in turn governs access to the full facilities.

I think I was just trying to provide some balance that a highly medical, intervention heavy birth isn't always a bad or unnecessary thing, or isn't always perceived as such. I believe 100% that my medical and MW team had my best interests at heart, and were not merely acting according to protocol or due to risk aversiveness.

I am also aware that this is not the case for every woman.

But I also don't think doctors are racing round CLU's waving scalpels and forceps desperate to intervene. I do see how the cascade of intervention works.

But I also don't think doctors are racing round CLU's waving scalpels and forceps desperate to intervene.

I am sure that they aren?t consciously but maybe it?s something that they do without fully reflecting on their practice?

I followed through the boobmeister's link on the previous page about promoting normal birth and read the link to casestudy 2 about Luton and Dunstable hospital. Within 1 year they were able to reduce their C Section rate from 31% to 22%. The leaflet explains how the hospital has done this ?through top to bottom cultural change and a commitment to normalising births.? ? The trust introduced a midwife lead for normality, to champion normal birth with staff and pregnant women and developed a birth option clinic for women who had previously had a c-section." This is an enormous drop and does beg the question whether all of the previous 31% were necessary? At a rate of 5,500 births per year it means that 495 avoided a C Section. I would agree that it's no good going for a drop in CS rates unless you are going to put the facilities in place to ensure that women have a good normal birth.

Sounds like that was a disproportionately high rate in first place so excellent it's down to what I think is the national average ish?

I agree that there may be units where it's culture for MW to become deskilled and defer to doctors who are pushed for time and go for what they perceive as the least risky option (c sec often). Unit I was in was nothing like that, which was lucky - they were fantastic.

I'm not (contrary to how it may seem) pro medical birth any more than I am anti HB. I am pro choice (about everything ;) ) and believ womb should feel their birth, however it goes, was valid and as 'good' as any other type of delivery. For this to happen I thin there 100% needs better, more individualised and respectful care - and for this there needs to be more investment and more midwife posts.

For this to happen I thin there 100% needs better, more individualised and respectful care - and for this there needs to be more investment and more midwife posts.

100% in agreement.

Womb? Women- but great Freudian auto correct there!!

We can see from the discussion above that the idea of the 'safest option' is hotly disputed with evidence on both sides.

Yes, and while that is the case, and things are not clear cut, I am going to take my chances with the place that has the doctors and the drugs

Another thing I think (and again this is what I have also gleaned from my friends) is that I really dont think I could relax and labour at home knowing I was planning to give birth there! I think that in the back of my mind I would always be worrying that something could go wrong and I was quite far from hospital and that would ruin the experience for me and probably slow down labour. Again, this is only the opinion of a few (and it really does depend on how you feel about hospitals etc), but I wonder if other women feel like this?

One thing I will admit is that whilst Ihave seen many women on Mumsnet discuss their awful hospital birth experience, I have never seen a woman say that she regreted her homebirth.

I was in hospital for a total of 6 hours, I had the medical backup if required and still got home with the baby in time for dinner.

"squatting in a pile of patchouli drenched cushions"

"I was just trying to provide some balance that a highly medical, intervention heavy birth isn't always a bad or unnecessary thing"

I think you may find that even the most ardent natural birth supporter will support you in that statement because it's stating the bleeding obvious

"One wonders if that little girl would have made it if she'd been born at home."

I experienced a shoulder dystocia with ds2, who was born at home weighing 11lbs. Midwives dealt with it very skillfully. Ds born onto the bed, white and motionless. They bagged and masked him there and then and I watched him take his first breath and pink up. It was astonishing. I honestly don't think a doctor would have done any better at getting him out.

But it's not all that obvious on occasion on this thread...

There does seem to be a massive misunderstanding about what MW in a HB situation can do.

Alot of people think that unless the HB is the mum wandering around in a perfumed haze, occasionally leaning on her DH and doula for a mild contraction, maybe having a bath sprinkled with rose petals and then 2 coughs and the baby is out, then it should be in hospital!

As Shagmund showed, a massive amount can be done at home. I have had 5 in hospital and one at home and the only difference for me was that the care at home was far more...well...caring! 2 of my hospital babies and the B baby had lower Apgars than were ideal and both had delayed first breath (they didnt need oxygen) and the MW at home were far better with it. They talked to me, told me what the were doing and helped DD to take her first breath. In hospital I was snapped at when I asked what was happening and told to be quiet and let them work!

So the outcome for the babies was the same but theoutcome for me was far better with the HB and being treated like a human being with needs and fears should never be underestimated, especially at such a vulnerable time. I just wish I had had the strength to insist on the HBs I wanted each other time instead of allowing myself to be talked out of them.

Oh and for the record, DC1 was 8 hours labour with them getting shorter until DC5 was induced and still only took 3 hours start to finish. DC6 was my HB and took 14 hours (thanks for that DD!), had the cord around her neck and my placenta didnt want to come. And it was still the best birth out of all of them :)

I was booked in for a HB for my DS1 last year, and got all sorts of judgy comments about it, generally of the "ooh, you're brave" type, meaning ooh you're naive/stupid/mad as a box of frogs. My sister had her DS2 and DS3 at home, and I'd discussed it all at length with DH/MW, I was low risk and happy to do as told by the highly experienced MW. As it turned out, DS turned up a month early so I ended up on the labour ward anyway with a fantastic MW, minimal intervention, happy ending.
If I manage to go full term next time, I would seriously consider HB as I had a normal labour and now know what to expect! If I go full term that is...
MWs are highly skilled professionals, and I suspect the ones out 'in the field' as such behave differently to the ones with a whole team of colleagues on the other side of the door. The very fact that they're in your home means they are capable of handling the situation, whether that means dealing with it themselves or transfer to hospital.

samstown I know of one poster on MN who regrets her homebirth (and iirc she has said as much but I apologise if I am off the mark here).

Doesn't stop me planning one for myself though.

", I have never seen a woman say that she regreted her homebirth."

Riven had a homebirth that went badly wrong. She is the mumsnetter who has a little girl with severe cerabral palsy who has met David Cameron.

www.bbc.co.uk/news/uk-england-bristol-12237100

I imagine the experience is so painful for her that she stays away from homebirth threads.

I think that the best thing we can do is pray for a postive outcome wherever people choose or end up giving birth.

Oh yes, I have seen Riven discuss that before actually

Yes I would imagine that she always wants to stay away from these sorts of threads.

Sam I think your point about being able to relax is a really good one.

I think (think!) that I will try for a HB when the time comes (hopefully next year ).

This is because in the last year I have had the following experiences at my local hospital-

• them forgetting to book me a bed when I was due to have surgery
• them forgetting to show the consultant a scan, so he nearly operate on me without seeing it
• the OOH dr telling me to go home and take paracetamol when I was in serious pain after surgery (had to be readmitted as emergency case hours later)
• them failing to respond to repeated phone calls/ messages when I had distressing symptoms post-surgery
• them telling me to remain in positions that really hurt because it was 'hospital policy'
• one of their HCAs encouraging me to eat and drink hours before a GA

If I have to go into hospital I will, and will try to be chilled about it - but with some hospitals, they are just not that brilliant, and surely you can see that some women feel tense there and will therefore just not labour as well?

I had a homebirth last time, hoping to have another this time.

I also have a very dear friend whose birth at home went very very horribly wrong indeed

Thing is, afterwards there was a post-mortem where it was concluded that the outcome would have been the same in hospital. I mean, it literally happened out of the blue with no warning of something amiss before or during labour. These things are very rare, thank god, and even with all of our technology they may happen equally in hospital or at home.

Which is why it irritated me that the Daily Mail picked up on that pro-home birth lady who died at home. Why didn't they write a story about the 32 pro-hospital women who died in hospital? Or even better, treat the subject with the respect and thoughtfulness it deserves and just not write a story at all?

Oh yes RevoltingPeasant I totally understand that some women will feel the opposite of me and therefore might go for a homebirth. In fact my two friends who wanted to have a homebirth chose to do so for this very reason - unfortuntately both resulted in a transfer to hospital and c section in the end due to lack of progress and babies getting distressed.

I was just thinking about the original question and wondering how many women felt like me and therefore would just feel happier in hospital.

unfortuntately both resulted in a transfer to hospital and c section in the end due to lack of progress and babies getting distressed.

Is that unfortunate or is that the system working well? They needed help and they got it.

I'm with as goodasgold.
Have had both and far prefer homebirth. Our midwives were fantastic, I was far more carefully monitored than with first birth on a busy labour ward. I did end up getting transferred into the hospital afterwards as I was loosing too much blood but again this was managed brilliantly with extremely prompt responses from paramedic back up. The midwives always err on the side of caution.