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

"the increase in hospital births coincided with a drop in maternal and fetal death and was thought to be causal. "

So what did cause the drop in deaths that coincided with more hospital births?

Better nutrition and housing conditions, the advent of reliable contraceptives and limiting family numbers, antibiotics, the discovery of oxytocic drugs (to stop haemmorhage) and anti-hypertensives, availability of blood transfusions to name few.

badday,
How many midwives carrying out a homebirth can give blood transfusions, or prescribe drugs then and there? If anything looks like it is going wrong, the homebirth is canceled and becomes a hospital birth. How many people would go for a home birht if they were told they would be unable to transfer to a hospital if anything became complicated. It seems unfair to compare hospita births negatively to hbs when people only want a homebirth if everything is uncomplicated and have every intention of transfering to a hospital if anything should crop up. It seems Hbs are only good if you can rely on a hospital for back up.

WSS^^

However, the advent of the Welfare State also played a huge part. If you needed a doctor then you saw a doctor, whereas before that you would need to pay. If you were sick and had no money then you would have to suffer (remind you of anywhere?). Many people saved for the doctor during pg rather than the baby equipment. My great grandparents had to do this, my great grandad said they got twice their monies worth as G.Grandma had (undiagnosed) twins, at home with no pain relief btw.

And after the war it was seen as a womans duty to have babies, and pregnancies were so precious that antenatal care was seen as a neccesity. It wasnt for the good of the mothers admittedly, but better care for the baby was obviously good for the mother and therefore there was a better chance that both would live. Good nutrition and adequate housing were no long seen as "nice if you can get it" but essential to all members of society.

I should add that the increase in hospital births was because women wanted to go into hospital. It meant a good rest for 2 weeks, someone else doing the washing, and it was free. This coincided with the points mentioned above, so for many years it was assumed that the drop in birth related deaths must be because the births were in hopsital when infact it was totally coincidental.

but even today women still get transferred to hospipital if a complication arises whereas before it was tough luck, if you could not pay you stayed at home. So the fact women can get treatment in hospital (c-sections, blood transfusions, oxygen, emergency surgery facilities if they bled too much etc) has increased the survival rate. before hospital births triplets, transverse births (even sometimes breech births), generally long difficult births etc were almost certainly a death sentance for mother or baby if not both.

Well Kelly there certainly îs an arguement for a mother with severe complications to go to hospital. The other arguement is that those cpomplications would not have occurred at home. I know what I am talking about, dc2 was tranverse, face down, if I had had to have her in hospital she would probably have been a csec. I was not tranferred I had her at home. Its a complete croque that you would go from a hb to taking every procedure in hospital. Its a complete croque that some of these births spell death for mother and baby. I did it, and I am a useless lump of shit.

Because many women would rather be in a place of safety and do not want the mess at home. I had a low risk pregnancy but he got stuck and nearly died. Without a crash caesarian and ITU I would be grieving now. My best friend lives round the corner. Ie same distance from hospital and had HB with her first I it went well but might not have done. I feel hsopital is the same choice.

I am sure that is true bogeyface. I think we are just really lucky that the community midwife team are actually pretty well funded in our area. As you say if funding was more proactive with a more strategic aim, I.e., more community midwives to support overall objective of reducing pressure on hospitals then things might turn around.

Chocolate, there was honestly no mess. By the time I came out of the (long,hot) shower dh was cuddling dd2 and the living room was an oasis of calm. My waters had gone in my bedroom hours earlier admittedly but there wasn't any other mess.

As for your emergency c-sec obviously that was a concern but my mw assured me we could be from home to theatre in 20 mins if anything was to go drastically wrong. They also are extremely cautious with regards to transfer and at the first sign of baby in distress would not hesitate to blue light you to hospital. We talked through all the factors that would result in this and I decided on balance, I was confident to be at home. My awful experience at hospital first time around with my second midwife was so bad I was so scared of repeating the experience. Dd1 was back to back and induced - I resisted the constant bullying to have an epidural - if I had I am sure that birth would have resulted in emcs.

Of course its a womans choice whether they homebirth or go to hospital. I would prefer to give birth at a hospital as you have all the medical equipment/professionals there should something go wrong, and more chance that if it does mother and baby will survive. I gave birth to dd in hospital, when i was in labour they were concerned about her heartbeat and was put on a monitor, she stated to go in distress and heart slowed down, the MW pressed a button and a whole team of Drs/nurses were there in seconds, you will not get that at a homebirth. DD was fine, and i had a ventouse delivery but was thankful that i was in the best possible place to give her a chance of life if anything went wrong which it nearly did. That is why I also chose to give birth to ds in hospital too.

I wanted a home birth with my first but due to midwife shortages I was told it wasn't an option, but opted for the MLU within the hospital and had a great experience despite a posterior presentation - lovely NCT approved natural birth (brainwashed!).. With DD2 again text book pregnancy, was 90% sure I was going for a home birth but changed my mind in the end as our building work wasn't complete - lucky for me! Ended up with a crash c-section due to a placental abruption, fairly rare and not predictable and can be fatal for both mother and baby. It took 20 mins from "uh ho this is bad" to baby in DHs arms and even with the fastest transfer that would have been at least doubled if I had been at home. After that I know with certainty that I will not consider a non-hospital birth because I honestly thought I wa going to die and I was so grateful that the midwives picked up the drop in fhr so quickly. Next time I am having a nice planned section thank you very much!!

Just to point out, that with my two homebirths, something did go wrong, both times. And each time the midwives used their expertise to deal with it.

With my first home birth, the baby was in a very difficult position. The two midwives present (with approx.40 years experience between them) turned the baby and got her out. The cord was twice around dd2's neck, and the midwives dealt with this. I bled a lot and again, the midwives dealt with it.

With my second home birth, I bled very suddenly very heavily (a pph) about an hour after the birth. The two midwives acted within seconds because they were both right there beside me, with all the equipment needed.

I felt far more looked after then in my first birth, a hospital birth.

I have just given birth to ds in hospital, and a lovely experienced MW sat with us comforting and reassuring us all the way through she was fab, as was the other mW at the hospital. For me personally the hospital is right for us.

Add message | Report | Message poster theturdpolisher Mon 06-Feb-12 02:56:48 I know what I am talking about, dc2 was tranverse, face down, if I had had to have her in hospital she would probably have been a csec. I was not tranferred I had her at home. Its a complete croque that you would go from a hb to taking every procedure in hospital. Its a complete croque that some of these births spell death for mother and baby. I did it, and I am a useless lump of shit.

I also had a transverse lie, in hospital which ended in a cord prolapse and an emcs under general. The baby needed resuscitating and intubating but luckily was fine

My mums friend had a transverse lie at home, she was having a hospital birth but hadn't left yet, she had a cord prolapse and the baby died, she had a mw with her but getting into hospital and to theatre took too long

Hardly a croque some do die

"It took 20 mins from "uh ho this is bad" to baby in DHs arms and even with the fastest transfer that would have been at least doubled if I had been at home."

You are absolutely right that some babies will be better off born in hospital. And we can't predict which babies these will be. Some women will be unlucky and have a cord prolapse/placental abruption at home and those women will probably have worse outcomes than had they been in hospital.

HOWEVER, the fact that the neonatal outcomes for everyone except first time mums are comparable means that some babies must be having their well-being compromised by being born in hospital. It must be the case, otherwise you'd see higher deaths at homebirths than in hospital births.

Interventions in labour (which are more likely to happen in hospital) are helpful to a small number of babies. For the rest of the mothers and babies who receive them they disrupt labour and put the health of both at risk. Luckily for those mothers though, there are doctors at hand to 'fix' the problems that giving birth in hospital causes to labouring women and babies.

FWIW - it's very sobering to look at the c-section and maternal death rates from the 1950's, because it tells a very different story than the one people imagine. The c/s rate in the 1950's was 3%. And the maternal death rate was slightly less than one in a thousand. And that includes all the deaths from botched abortions and thrombo-embolisms (probably more common in the days when women were made to have 10 days complete bed rest following birth).

For me this suggests that the VAST majority of women now who are having sections for 'failure to progress' would have had a vaginal birth back in the 1950's. In other words, very few babies are truly 'undeliverable' vaginally, even in a population which probably had higher rates of skeletal abnormalities (many women delivering in the 1950's would have been born in the 1920's and 1930's, when childhood malnutrition was much, much more common than today).

The neonatal mortality rate has gone down from about 2 or 3 in a hundred to 1 in 200 in that time, which is a very big fall, but it's hard to work out how much of that is due to advances in diagnostic techniques, so that far fewer babies now are born with congenital abnormalities with a very poor prognosis.

I think it's unfair for HB advocates to be annoyed about people making assumptions then make massive assumptions about hospital births.

I have had two hospital births. I had a midwife and student with me the majority of the time. I had an episiotomy the first time due to baby being distressed. Second time I had my waters broken to induce labour and midwife was very keen to give me chance to go it alone before introducing syntocin (which I didnt need), she also encouraged me not to have an epidural as I was progressing well and helped me find a comfortable position to deliver. I needed no intervention. Not all hospital births involve being left alone with an occasional check from a frantic midwife and intervention.

I don't think we can compare home births today with home births in the 50s.

Shagmund interesting you mention the 1950s as a date there. It appears that the 50s was when research into 'progression rates' was first undertaken, and the 1cm p/h was eventually brought in as the ideal in the 70s (and a graph plotting progress was drawn up for all women to follow) and women not following this path then have intervention to augment their labour.

So women who in the 50s may have laboured slowly but naturally were able to deliver vaginally to a healthy baby with no intervention, 20 years later would have been encouraged to have intervention because they weren't following 'the line' which then leads to an increased likelihood of CS for failure to progress.

Essentially someone drew a graph, said "this is what should happen" and then all women were expected to conform to that line, except the flaw in the plan is that no-one told women's bodies that the rules had changed!

"I think it's unfair for HB advocates to be annoyed about people making assumptions then make massive assumptions about hospital births"

When people say they don't like the idea of homebirth because they think it's too 'risky', they are doing so on the ASSUMPTION that giving birth at home puts them and their baby at increased risk.

It's an ASSUMPTION because it's not based on fact.

When someone says 'I wouldn't want to give birth in hospital because you're more likely to end up being left on your own in labour, and end up having a caesarean section, they may be basing their view on an assumption, but they also have the facts to back them up: you ARE less likely to get one to one care in hospital. You ARE more likely to end up having a caesarean. A lot more likely.

Of course most women have good care in hospital. Nobody is saying all women are having substandard care, only that some are.

"I don't think we can compare home births today with home births in the 50s."

I think this is reasonable. Midwives attending homebirths in the 1950's were generally vastly more experienced at delivering babies in an out of hospital setting than community midwives today. They delivered breech babies at home and twins for a start. And they had the back up of a gp who would have been highly experienced at delivering babies, who would come out to home births which had become complicated.

So yes - difficult to compare in some ways. But I still think it's interesting that 97% of women managed to deliver vaginally in those days.

The average age of women having babies is older now than in the 1950s as well, so that is likely to lead to more complications. You'd have to look at data for comparable age/socioeconomic groups to make sense of it all.

On the other hand, we now have paramedics rather than just ambulance drivers, so this makes transfers to hospital safer than they used to be as well, as women can receive medical attention en route. Plus women are better nourished, better cared for antenatally, and more affluent generally, which helps too.

Where I think we do fall down is postnatal care. Midwives and mothers are all exhausted by current procedures and practices, and I really do wonder if it would be more appropriate to bring back local, small scale cottage hospitals, rather than squeeze more and more women into a limited number of comparatively distant large maternity units full of infection, run by consultants who only experience a limited smorgasbord of birth types during their training (i.e. normal, forceps/ventouse, or CS), and which institutionalise what is essentially a family event.

Frilly, I didn't make an assumption about hospital births and I can't see anyone else doing that either. My hospital experience was pretty bad and most likely would have ended in a emcs had I elected to have an epidural as the midwife was bullying me to. She finally called a consultant to "talk some sense into me" who asked the mw what on earth I was doing on my back for an op labour. She got me into a better position and dd1 was born 30 mins later.

I am not making any assumptions that that is everyone's experience. Some of my friends had a great experience in the same hospital. It very much depends on your midwife.

For those people who are anti hb, do you also feel the same about mlu, because there is no difference between a homebirth and a mlu as far as I know. Unless of course mlu is on a hospital site.

Flisspaps - love the name!

From my POV, moving labouring women into a big, busy institution full of sick people, exposing them to strangers, routinely and regularly subjecting them to vaginal examinations, and making them lie on a bed is 'intervention' enough to make lots of labours go pear shaped.

Just because people's civilised consciousness perceives this to be a 'normal' and 'safe' response to the onset of labour, it doesn't mean that their lizard brain (which is responsible for oxytocin release) is not responding negatively.

We know well enough not to subject other labouring mammals to this degree of routine interference. Why can't we apply the same sensitivity to humans?

"I really do wonder if it would be more appropriate to bring back local, small scale cottage hospitals"

The recent place of birth study seems to provide a good evidence base for free standing midwife led units for healthy mothers. The outcomes for these units really are very, very good compared to hospitals.

And yet birth centres are still closing around the country.

Shagmund - I don't know why we apply this to other mammals and not humans. Everyone leaves the cat alone to birth in the airing cupboard in the warm and the dark and the private, they don't all tell her she's doing something dangerous and must go to the vet right now just in case something goes wrong

But then some women choose a hospital with the bright lights, unfamiliar environment, beds, routine VEs and they are happy with this and that's great. If that's what they want, and that's what makes them feel safest then I am right behind them because it's about what each of us feels comfortable and safe with.

I tried the hospital route and for me, it was one of 'those' births with lots of bells, whistles, machines, drugs and doctors. It's not for me. Just wish I had an airing cupboard, I'd be in there like a shot this time

"But then some women choose a hospital with the bright lights, unfamiliar environment, beds, routine VEs and they are happy with this and that's great."

But it's generally chosen in the mistaken belief that it's the safest place for them to have their baby.

There is no evidence this is the case - at least for healthy mothers.

And so much evidence that going to hospital in labour increases the likelihood of needing abdominal surgery.

I can't imaging the public being so accepting of such wide scale iatrogenic harm being done to any other sector of the population.

Why is it ok that literally 1000's of women are having avoidable major surgery every year?

Having had an emergency caesarean for my first child and natural birth with the second I know how different a labour can be. My first child had to be got out straight away or he may have died or been brain damaged. I am very glad I was in hospital. I also had a natural birth in hospital where I needed no intervention but knowing that I was there and they could intervene if necessary helped me feel confident in having a natural birth. Yes, the midwives can get you transferred to hospital but could the ambulance get their quick enough in an unforseen emergency situation - I don't think so. Nothing is worth the risk in my opinion.