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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

why are homebirth rate so low

536 replies

McHappyPants2012 · 05/02/2012 21:41

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

OP posts:
EasilyBored · 10/02/2012 11:50

I find it really sad that so many people want a hb because of bad experiences in hospital. I think that says more about the hospital care than about the benefits of a hb, iyswim? Maybe I was just lucky but my hospital birth was great (despite it ending up in a forceps delivery and a whole world of stitches). I had 1:1 midwife care and then when it started to wrong there were three midwives, a junior Dr, consultant and two nurses looking after me and my baby. They were all lovely, and I don't think anything different could have been done to avoid the interventions.

I do think people underestimate what a hb midwife does, and the equipment they bring with them, its not as basic as some people seem to think.

Saying that, hb is not for me. I like the reassurance of being in hospital. And I got to choose which hospital I went to too. We would have been using the midwife led unit upstairs (no hospital beds or interventions, lots of low lighting and sofas) but baby's heartrate was borderline high so we were put on the clu, but it was still nice and I was allowed to labour however I wanted (despite being on a monitor).

Maybe it would be better to work on improving the experiences of hospital birth rather than trying to convince more women to have a home birth?

ReallyTired · 10/02/2012 12:25

I agree that hospital care needs to be improved. I think that having choice improves the standard of care for everyone.

We are all different and have different care needs. We need to respect each others decision and celebrate our babies new lives however they come into the world.

theboobmeister · 10/02/2012 12:29

Easilybored I think that is a good point - and a lot is being done to improve hospital birth experiences. But while hospitals are what they are, a small minority of women will quite sensibly decide they're not going to wait around for things to get better at some point in the future Smile

Actually there is barely any campaigning to persuade more women to have a home birth. The campaigning that does happen now (which is not much, and it never gets any publicity) is about protecting womens' right to give birth at home if they want to - a very different thing. Home birth is not even legal in the US and there is sometimes talk of banning it here too.

LaVolcan · 10/02/2012 13:19

Maybe it would be better to work on improving the experiences of hospital birth rather than trying to convince more women to have a home birth?

I haven't seen this thread as being about trying to convince more women to have a home birth.

I have seen it more as partly answering the original question - why don't women have home births now which has led onto a debate about which is the safest place to have a baby?

In the 1950s women used to have homebirths partly because there was a good domiciliary midwifery service and partly because of a shortage of hospital beds. No doubt some women would have chosen to go to hospital but weren't able to. Then in 1970 the Peel Report stated: 'We consider that the resources of modern medicine should be available to all mothers and babies, and we think that sufficient facilities should be provided to allow for 100% hospital delivery. The greater safety of hospital confinement for mother and child justifies this objective.' At around the same time women started to be routinely booked into hospitals, with (from what I gather talking to older women) healthy doses of what Sheila Kitzinger called 'shroud waving' e.g. 'if you don't care for your baby..., a home birth baby is a dead baby' etc.

In 1980 Majorie Tew, a statistician, published some research to show that there was no evidence to back this statement up - she even found that the 'high risk' cases were safer at home. How her research all came about is interesting - she had set her students a task to analyse the statistics to showing why this policy of encouraging hospital births had come into being. When her students found that the statistics didn't show that hospital births were safer she didn't believe that they had done their analysis right and re-examined the stats herself, to find the same conclusion. She published her research and the debate has raged ever since.

The domicilliary service passed from Local Authority control to the health authorities in the mid seventies and who then realised that they didn't actually have to provide a homebirth service, making it difficult in some places to obtain a home birth. Where there are good homebirth services the take-up is high - the OP gives a link showing that in Porthcawl and Pyle, the rate for this was 25% to 30%. This may be a minority taste still, but it's a big majority.

Personally I think they took a wrong turning by concentrating on the place of birth and should have been concentrating on the appropriate quality of care for each woman. Hence the present mess in some places where one midwife is running between two or three women in strong labour, which I don't think is good for anyone - neither the labouring women, nor the midwife run ragged, but the bean counters seem to think it's 'efficient'. At the same time I think we should try to improving the experiences of hospital birth because that will be what a majority want - and I think it comes down to more than splashing some pretty wall paper about and putting a few bean bags and rocking chairs in the delivery suite. Again, I see staffing as the key factor.

(Whew, something of an essay - I am a social scientist who studied this issue at some length.)

BadDayAtTheOrifice · 10/02/2012 16:45

I agree with everything you've said there LaVolcan. Better staffing and increasing the number of midwives is crucial to improve the standard of care in this country. I can't quite believe we've got to this appauling state in maternity services overall.

theboobmeister · 10/02/2012 17:09

I too am loving LaVolcan's essay Smile

They should teach this stuff in history GCSE ...

shagmundfreud · 10/02/2012 17:23

Thank you LaVolcan!

I'm also very interested in the history of childbirth and midwifery. Marjorie Tew is a bit of a heroine in my book!

"I think they took a wrong turning by concentrating on the place of birth and should have been concentrating on the appropriate quality of care for each woman".

My personal feeling as that we should be moving towards a case-loading system everywhere, as this is associated with the best outcomes, and also because it's how most midwives wish to work. It would keep midwives in the profession and give women a better deal.

For me having a midwife I knew and trusted was THE most important aspect of my maternity care. I only had my second at home because the alternative was going into hospital under the care of the hospital midwives. If I could have delivered DS in hospital with my own midwife I would have been happy to do so (I had gestational diabetes and was carrying a massive baby - really not an entirely suitable candidate for a homebirth).

However, I do feel very strongly that whatever happens with care in hospital, it's very important to preserve and advertise home birth as being a valid choice. Something happens to human relationships and behaviour within large, unwieldy institutions that doesn't happen within a domestic setting. I believe that giving birth shifts the power balance in the relationship between health professional and mother in a way which is very healthy and good, when the health professional is providing care within the mother's own home. There is simply no way to replicate this in a hospital setting. I think it's part of the reason why women who give birth at home have such high rates of satisfaction with their birth: it can give you such a powerful sense of control and self-sufficiency.

shagmundfreud · 10/02/2012 17:25

Whoops - should read: "I believe that giving birth at homeshifts the power balance

BadDayAtTheOrifice · 10/02/2012 17:52

Definate yy to caseloading and how about deciding on place of birth at the start of, of during, labour?

shagmundfreud · 10/02/2012 18:13

BadDay,
I seem to remember that was what the Albany midwives London used to do.

BenedictsCumberbitch · 11/02/2012 10:24

The Albany midwives had a high turnover of staff though as the on call commitments are so huge with little remuneration and staff get burnt out very quickly. Having said that NHS staff are exhausted at the minute as well so it is probably worth a shot.

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