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

Bit of x-posting here... I don't think that having interventions counts as 'riskier', but that's my opinion. I was glad to have the options available to me right there on the spot!

HorribleDay are you like BadDay 's evil twin?

of course you shouldn't feel invalidated!! I'd like a HB but even without having given birth, know birth plans must be flexible. I'm sure you didn't choose to have increased risk factors! And of course you did the right thing, because you + DS are still with us

But remember as soon as a homebirth gets slightly complicated the mother is transferred to a hospital. So the only people who give birth at home are those who have no problems whatsoever. If a mw thinks intervention is needed the mother is transferred to the hospital, therefore the birth is considered a low risk mother having a hospital birth resulting in intervention. It rather skews the statistics.

Home birth is a safe option, but most women (or partners) just dont fancy it. It is offered as a choice to all healthy women in the area but only 2% go for it. The main reason is that people have been led to believe that hospital birth is the only safe. Its not true, recent research has shown that for 2nd and subsequent babies home is just as safe (first labours still relatively safe but slightly more likely to be problematic than if in mlu or hospital), but women need to feel safe when they give birth and if being in a hospital offers that feeling then thats what theyll go for.

If you're a healthy, low risk mother, you're twice as likely to end up needing an emergency c/s if you choose to give birth in hospital than if you plan a homebirth. And - for second time mums at least - no more likely to come home with a well baby.

Emergency c/s is by far the riskiest way to deliver for mothers.

You are more likely to die following an emergency c/s than after a vaginal birth or a planned c/s.

So as far as I can see the evidence supports my view that giving birth in hospital puts healthy mothers at higher risk of death and serious injury.

I had loads more 1-1 midwife support at my home birth with dd2 than I did at my induced hospital birth with dd1. They are with you and you only, they don't get distracted by other patients and they don't spend as much time on paperwork. I felt safer, more in control and so much calmer at dd2's birth.

And honestly, there was no mess. Not a bit.

I think that different people need different options. In some circumstances homebirth is the safest option and in other circumstances hospital birth is the best option,

DD would have been born in a car if we had opted for hospital birth. As it was we only had one midwife for the birth instead of the two you are supposed to have.

HorribleDay - no-one should be made to feel crap about how their birth went, it is awful that they made you feel that way!

Btw a comment was made about medics not asking permission before episiostomies in labour: I saw an obstetrician regarding the damage caused by my lovely 3rd degree tear (sorry if TMI) and he tutted and said the midwife should have just done an episiostomy without asking because I wouldn't have had anywhere near as much damage (I tore naturally btw)!! I timidly disputed this and he said it was the midwife's job to think like that because women don't always think straight in labour!!

Admittedly he might be right about not thinking straight but I still prefer to know I've got an option about whether I get cut :)

Ha no chance, I have much admiration for MW as Bo way at all I could do it!

Tho I do teach midwifery students about AND, PND and Post party psychosis - and on of the things we discuss is birth expectation, pressure, disappointment and trauma....!

Which may be why despite BP crashing during EMCS to 56/34 (apparently, I was unconscious...!) and losing almost 2 litres of blood - I don't view my birth as traumatic at all. I had no expectations bar wanted me and DS alive. I think it helped :)

"It rather skews the statistics."

No it doesn't. The research looks at outcomes by planned place of birth, not actual place of birth.

So the outcomes for the homebirth arm of the trial included those women who started off at home and ended up transferring in to hospital in labour with complications.

Um post partum psychosis.

Post party psychosis is v v different ....

cerys74 As I've said upthread, intervention is riskier!

Induction increases the chance of CS or instrumental delivery - which is riskier to the mother's health than a vaginal birth.

Interventions increase the chance of PPH and retained placenta (which can lead to or worsen PPH, as well as the risk of infection) requiring for PPH perhaps a transfusion (or if you're lucky a course of iron tablets for several months in some cases) or for the retained placenta, a spinal anaesthetic and manual removal in theatre (both presenting further risks in themselves)

PPH and retained placenta then make every subsequent delivery for that mother high risk automatically, regardless of whether the reasons for them were iatrogenic or not.

I had a hospital induction, and interventions available on the spot. I am far from glad that they were available to me, and wish I'd stuck to my plan of staying at home and waiting for DD to come in her own time.

Possibly more of us now, or our family members, are survivors of a high-risk birth and owe our lives to hospital, so want that backup even if we ourselves are likely to be low-risk birthers?

I owe my life to a manual ventilator. I was considering homebirth and MWs strongly pushed it but a) I had really bad SPD and suspected something might not go smoothly, and b) there was a lovely MLU in the hospital, and I figured I personally would prefer to be in there, pissing and bleeding over their wipe-clean stuff rather than hiding from our builders! I'm also very used to hospitals so don't get that inhibitory fear thing there.
If ds hadn't stopped breathing an hour after birth, I'd be up for a homebirth this time, but as it is I'm going for MLU again.

I would like to see more nice calm MLUs on or next to hospital sites, so more women feel they actually have that choice.

Think I agree with your 'both of us alive and not too battered' birth plan HorribleDay! Forgive my paraphrasing... I had a plan like that and it worked pretty well, didn't end up feeling like I'd 'failed' or anything.

OP - good article.

I would say the answer to your question is that women see hospital as the appropriate place to have a baby, and the safest.

And most are not aware of the mass of evidence linking hospital births to significantly poorer outcomes for women.

In my view there are only 2 good reasons why I'd opt for a hospital birth:

• to have an epidural
• because of medical complications

fliss and other pro-HB people - I think I'm going to have to agree to disagree here, because I remain unconvinced and I'm pretty sure you feel the same... the world would be boring if we all thought the same!

Retiring from thread now, night all :)

The Local Mums Group are generally good at making me feel crap... I don't see them anymore :) (because I am 'abusing' my child by working - that was the camel back breaking straw!!)

Because people don't realise how much medical intervention there is available at a hb. They bring a whole hospital room with them- gas and air, diamorphine, oxygen and neonatal resuscitator, forceps and BIG scissors.

My understanding is that hb triples your chances of your baby dying.

I don't like those odds.

"I had no expectations bar wanted me and DS alive. I think it helped "

I had the expectation that the health professional who was caring for me would not only do everything to help me deliver a healthy baby, but would do his/her utmost not to risk my health by exposing me to avoidable surgery and medication.

And I paid for a private midwife to optimise the chances that my expectations would be met.

I think the reason most people go into hospital it's seen as the usual thing - if your friends tend to be the type of people to stay at home to have babies, or other family members do, then it feels more normal and you are likely to be tempted yourself.

good night cerys.

i just say thank god by medical staff, after seeing so many stories here and in my family. I am just glad i am not a mum in the 1950

My first was in hospital - failed epidural - midwife didn't believe I was labouring - son born in less than 5 hours from first contraction as midwife was about to leave the room!!! I had a further two days of horrendous care - 27yo mum in a ward of teenagers - I was only one BFing and ignored completely.

Second was a homebirth - 58 minutes from first contraction - daughter arrived before the midwives did. Absolutely no mess at all and visitors afterwards thought I had just been for a walk, I looked so relaxed.

All being well this one will also be a HB although my husband hopes the MWs get there in time this time.

Poorman have you been reading 'Dr' Amy's site?

Maybe because although technically women should be able to choose a HB, often they get fobbed off due to staff shortages and it's easier to just go to hospital? (completely anecdotal, based on stories I have read on the UK homebirth website and message board).