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

"it was important for me to have a live healthy baby so I chose a hospital birth" whereas those of us who planned a home birth aren't that bothered about the outcome and it's all about the whale music instead?

I just didn't want the mess at home and I wanted heavy duty drugs. doubt I am alone

Honestly TattyDevine - if your friend was expected to walk to the ambulance then why weren't the HCP's able to walk the other way to her house?

A major report, Birthplace in England, has just been published, and looks in detail at the differing outcomes for hospital births, births in midwife-led units and home births. Broadly speaking, home births are just as safe for low-risk women. If you're high-risk, (e.g. you're obese, have diabetes, have had previously difficult births etc) they tend to like you to come into hospital.

As with everything in life, it's a case of weighing up risks and benefits. In hospital, the care you get is generally less good (e.g. you can be left alone for hours on end, be seen by overworked midwives you've never met, have a monitor stuck on you for no good reason, and women tend to become tense in hospitals which often slows down the labour). On the other hand, if something goes dramatically wrong and it needs an urgent response, then you're better off in a hospital than if the equivalent happens at home.

People often speak of how dangerous birth was before hospital births were introduced. But this is a case of correlation does not prove causation. A large proportion of women died either because they had puerperal fever (which used to be untreatable) or they had an undiagnosed condition like placenta praevia or pre-eclampsia. Modern medicine has all but eliminated deaths from those causes - but that has very little to do with whether you give birth at home or in hospital.

DD (my third) came out blue, and was rushed to SCBU. She pinked up fine, and we were soon reunited. But what if she'd been a home birth? In hospital, she was in SCBU within minutes. What happens at a home birth if there is an unexpected problem with the baby?

I wouldn't have had a home birth for the world. Medical intervention all the way for me.

I actually had a very similar experience with my first baby though to OhDearNigel's friends dd, though my baby did survive and is 12 now but the hospital left me and her in a terrible state.

Sorry benedict I wasn't meaning to criticise those who have home births - of course everyone wants a healthy live baby. I am explaining my reasoning for choosing hospital births.

OneHand. A home birth isn't just a midwife and a pair of gloves you know. They bring full resuscitation equipment as well as a range of drugs designed to deal with unforeseen events. They carry oxygen for resus etc. I think the misconception around home births is huge. It really is a 'delivery room' in your own home.

I had two home births.

No mess. After my hospital birth I was left lying in blood/ mess for an hour while stitching etc happened. At home, the MW scooped up the mats etc and chucked it in a yellow bag.

No risk. In hospital, the medicine and interventions caused my baby to go into distress. At home, I was safer.

It was important to me to have a live, healthy baby, so I chose a home birth.

(I am allergic to Woo. There was no aromatherapy/ whale music/ any hippy stuff. I read and researched, and did the maths. I was safer at home, so were my children.)

It's ok Lesley, I just get a bit cross sometimes about this topic. I love hospital births, they keep me in a job, but I hate the common view that homebirthers are happy to put their child's life at risk for the sake of their own experience. It's just bollocks and makes me see red.

"Broadly speaking, home births are just as safe for low-risk women."

No - this is not true.

Homebirths are just as safe for the BABIES of low-risk women.

But they are LESS SAFE for women themselves.

Unless you're going to fly in the face of reason and research and insist that the near doubling of the rate of major abdominal surgery associated with hospital births has no implications for the health of women.

'A large proportion of women died either because they had puerperal fever (which used to be untreatable)'

As Semmelweiss proved in the 19th Century, this happened in hospitals because Drs were going from dealing with cadavers to attending women in childbirth without washing their hands.

Semmelweiss was vilified for saying this, and died, I believe, as a broken man in a mental hospital. After his death it was realised that he had been right and he got the recognition he deserved.

shagmund isn't that the wrong way round?

I considered it, and then decided on MLU (on same site as labour ward but on different floor). Although the risks are very low, and although there are risks with hospital birth (I have friends with severely brain damaged DD from hospital blunder), and although would have been nicer at home etc I decided that birth is unpredictable and on balance better to be in hospital.

That being said I hate anything medical unless really necessary and had I not had access to the MLU in a big London teaching hospital I would have homebirth. I would not have gone to standalone MLU as can't see the advantage over homebirth.

re: all these comments about "hairy births and I would have died" - unlikely, as homebirth midwifes very cautious monitor you really carefully (much more carefully than in hospital) and would transfer you at the first sign of trouble and can call ahead such that theatre is ready etc.

In the end we got to MLU with DS2 at 4am with me saying I didn't think I was really in labour..... we were left on our own. At 6.45am I asked DH to get the midwife (as I thought it was getting imminent) who came in had a quick chat and said I was fine she'd rather not fill the pool yet as it was early and I was doing so well (I was uber calm), she stood up to leave the room, my waters broke and DS2 was born within a couple of minutes! It would have been fine at home too, but not much supervision in hospital and no time to fill pool!

It's difficult because no two labours are the same- even 'low risk' ones. I was classified as low risk when pg with DD1, but she turned out to be breech and I had a cs.

I am just having difficulty in extrapolating causation from the evidence of increased cs/intervention in hospital.

I mean, more people are ill and die in hospital than perhaps anywhere else; this does not mean that going to hospital increases your risk of illness and death, so why does that logic apply to births?

Or am I missing something? Am quite prepared to be told that I am, BTW- statistics aren't my strong point

Should add, that none of this research factors in the risks to subsequent babies, born to mothers who've had previous abdominal surgery.

Pregnancies following c/s are more prone to both placenta praevia and placenta accreta/percreta - both of which can be very dangerous to mothers and to babies.

Low risk mothers making their choice as to where they're going to have their baby should be encouraged to take into account not just the present risk to themselves presented by higher rates of surgery associated with hospital births, but the future risks in subsequent pregnancies and births.

Revolting I think so

Tethers- the recent study took low risk pregnancies and assessed them based on planed place of birth. So, take a mother who plans a homebirth, but does not progress, transfers and has an EMCS, she's still a stat in the homebirth group. Likewise if on the day she says 'bugger this, I'm going into hospital', at the first contraction, she's a homebirth stat.

So what the figures seemed to be saying is: take two groups of low risk women and work out where they plan to give birth. Weed out any who have complications along the way pre-labour. Now see what happens to those women on the day.

Does that help explain the causation point at all? As near as possible, these were the same women with the same profiles, but different outcomes.

Of course, what it couldn't account for was things like whether fear of birth led to people choosing hospital, which in turn led to less positive reaction, which in turn led to intervention. You can't really randomly assign and double blind a birth study!

"so why does that logic apply to births?"

Because the research looks at outcomes by planned place of birth, not by actual place of birth, and only looks at mothers deemed low risk at the start of labour.

So - take 100 healthy, low risk women planning a hospital birth. Match them with 100 healthy, low risk women planning a home birth. Match them for age and social class and anything else which might possibly impact on their birth outcome.

Next step: compare their birth outcomes.

Out of these 100 women who'd planned a homebirth, who'd been categorised as 'low risk' at the start of labour, approximately 5 (say) would end up having an emergency c/s. Obviously they would have transferred into hospital to have this done.
Out of these 100 women who'd planned a hospital birth, who'd been categorised as 'low risk' at the start of labour, 10 (say) would have had an emergency c/s.
Neonatal outcomes the same for both groups.

So we say 'hospital birth and homebirth have similar neonatal outcomes, but hospital birth is associated with a doubling of the rate of emergency c/s'.

Simplified HUGELY of course!

"shagmund isn't that the wrong way round? "

Yes!

The replies on this thread answer the op...home birth rates are so low because of peoples perceptions of home births

"Honestly TattyDevine - if your friend was expected to walk to the ambulance then why weren't the HCP's able to walk the other way to her house?"

Well, they could, I suppose, except she needed to go to the hospital, not her house. Do you mean so they could put her on a strecher and wheel it up to the ambulance? I can only imagine that was also very difficult so the most logical solution was to see if she could just walk up there, which she could.

Thanks Sleep, that helps a lot. Do you have a link to the recent study? Sorry if it's already been linked...

I just wonder if the stats are open to interpretation, and can be used in order to back up either side of the argument IYSWIM?

Tethers - this one, I think.

Hi TattyDevine - I was really musing about why the midwife wasn't able to get in if your friend was able to get out.