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

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

I don't like those odds."

The latest research found an increased risk of death for babies born to first time mothers at home, but not to subsequent babies.

The researchers have admitted they don't understand the reason for this.

The interesting thing is that the death rates for babies born to first time mums in free-standing midwifery units, where there are no doctors, no operating theatres, and transfer is necessary in the event of things going wrong, was no different to babies born in hospital. And this is despite the fact that the average transfer distance for free standing midwifery led units is 17 miles.

To me that suggests that the problem with first time mothers giving birth at home is a lack of expertise among midwives delivering this group of women in that particular environment. Doesn't surprise me to be honest, given that some midwives attending homebirths are not experienced with giving this type of care, homebirth rates in some areas being so incredibly low.

I would like to see some research which compares outcomes for case-loading practices to non-case loading practices, as I suspect it would tell a different story.

My induction wasn't safely avoidable - it wasn't a risk I or DH was willing to take. Every birth is different, and everyone's choice is theirs alone.

I do think there is too little open and honest info given and too few resources.

Fliss

That is exactly how I feel. Yet another topic on which to criticise mothers.

Nope, I have never heard of Dr Amy. I am stating why I would not have a homebirth. I am happy to be corrected if my stats are wrong.

Dont know if anyone posted this, only read the first page and my bath is running!

In the 1970s it was government policy to get 100% of births in hospital because it was believed that hospital was safer. This was untrue, the increase in hospital births coincided with a drop in maternal and fetal death and was thought to be causal.

The government stopped short of making home births illegal, but they did push hospital births to point that home births made up less than 1% of births in the UK and most of those were unplanned HB.

The subsequent campaign to increase HB had to fight against the belief the HB was dangerous. I have a book from Marks and Spencers that was printed in 1981 that said "You might want to give birth in your own cosy home, but is the life of your baby worth your own comfort?" Also, many of the women who wanted HBs in the 90's had their own mothers telling them it was dangerous, as they had been brainwashed into believing that during their own ante natal care.

I had 5 in hospital and 1 at home. I was better attended and better cared for with the HB than in hospital.

I think that allowing women to assess the risks and making their own decisions about where they give birth is a positive thing.

I choose an elective caesarean. In a hospital.

tethersend, i wonder will c-section in the year 5999 be an option to have at home

People can choose to have a HB if they want one. They just don't always get to choose it for free, and why should they?

If people want home births, they can pay a private midwife.

Thats a relief Poorman. I said that because she's strongly publicised a very flawed and inaccurate American study which stated homebirth was 3 times 'deadlier' than hospital birth. I think homebirth in the USA probably is riskier than here.
Please look at the link posted earlier that says homebirths for 1st babies in riskier (twice the likelyhood of an adverse outcome), but there is no more risks for subsequent babies.

Why should they pay? Its cheaper than hospital birth!

home birth or hospital birth...nobody in the uk should have to pay ( NI contributions are there for a reason)

It wouldn't be cheaper if everyone did it.

There is nothing wrong with paying for choice. We should be entitled to good quality maternity care, but we shouldn't have the right to decide where that takes place.

I would never expect everyone to. But just imagine all the money that could be saved from less epidurals/cesareans/sutures/antibiotics/oxytocics/analgesics/ perineal repairs/linen/food/sanitary towels/baby formula
if say, 30% of births were at home?

some hospital don't give out formula milk and sanitary towels

menmedia.co.uk/manchestereveningnews/news/s/1459696_st-marys-hospital-bans-free-formula-milk-to-make-mums-breastfeed-instead

Would you make women pay if they chose to have an epidural or a cesarean IUTMK?

I bet it saves them a packet!

because hospitals try to discourage homebirths, despite what they might say. I had a terrible experience where I fought for a homebirth and was booked for one, only to be told on the phone as I was having contractions three minutes apart, that I had been advised against a homebirth - not true.And then had a bitch of a midwife turn up and do fuck all, except talk stridently and take my temperature and check my urine, and write copious pointless notes and do nothing to support me physically or emotionally, and then fail to stitch me up and get me bluelighted to hospital where alleged postpartum bleedling clearly not an issue as it took more than five hours for anyone to get around to stitching me up.

tbh I think the labour process itself is massively overemphasised i.e. in how you do it. What was important to me was having 4 healthy live babies and a healthy mother. I thought I was more likely to get that in hospital than at home.

I remember hearing somewhere that as soon as a homebirther is rushed to hospital with complications then the birth is categorised as "hospital" which means a lot of negative outcomes re: homebirths aren't being accurately recorded and the NHS are able to give incorrect statistics to expectant mothers to help meet their homebirth targets.

Could be a load of baloney but does anybody know anything about this?

sensitivitychip last years birthplace study used the planned place of birth as the place of birth even if it was different.

So a woman who planned a homebirth, but transferred to hospital for assistance halfway through and gave birth in the hospital STILL came under the homebirth category - she wasn't reclassified as a hospital birth.

Is that what you mean?

When my cousin was taken in Sensitivity, she was categorised as "failed home birth" and the information the hospital gives out is split in to booked hospital, booked home, booked CS, etc and then Actual Hospital, Actual Home etc so it reflects babies booked for hospital that popped out in the car park, EMCS and transferred HBs.

That said, the stats released and how they are compiled probably varies by PCT or hospital though.

Even in areas where there's generally quite good HB support people can be discouraged from it. Our local MLU was shut recently and a friend was quite strongly discouraged from having a HB (they were worried that all the MLU Mums would want HBs). She fought back because a) she's a doctor and was able to stand up to the MWs b) this was her third baby and third planned HB and most importantly c) she reminded them that her second labour was 45 minutes and she probably wouldn't get to the labour ward in time.

An obstetrician (JR, Oxford) told me that it would be so much better if more low risk pregnancies were dealt with at home as it would relieve the enormous pressure on the delivery rooms and subsequently improve the care for everyone.

I expect my hb cost the nhs an awful lot less than my hospital birth. I had one midwife for about 5 hours and the second midwife for about 10 mins. The fact I called on the services of our excellent community midwife team meant that I was one less person to deal with at our incredibly stretched hospital.

Good theory twofalls (and I am a HB advocate) but unfortunately it would just shift the problem.

There is such pressure on maternity units because of a lack of midwives because of money. Putting all low risk births as HBs woiuld mean that there wouldnt be enough MWs in the community, again because of money.

When I had dd4 the MWs who were with me were the ones who were on call for our whole town. There was another mother who was due and who called in about an hour or so before I delivered with contractions (according to DH). If I hadnt delivered when I did then she would have had to go to hospital because the MWs couldnt leave me at that stage.

It would work if there was investment in community MWs and then a push for more HBs but health care change in this country is reactive rather than pro-active so nothing will change :(