[quote AliceAll]@Lifeisnteasy "What do you think would happen if home birth became the norm among high risk or first time mothers?"
For FTMs I would expect to see a massive drop in emergency Caesareans (I think the rate is around 15% when it ought to be around 3%), episiotomies and bad tears, postpartum haemorrhage, birth trauma, postpartum depression, and birth complications leading to women being classified as high-risk for all future pregnancies. According to Birthplace cost analysis, increasing homebirths would save the NHS loads of money. I'd also expect to see a massive increase in babies being born vaginally, being breastfed and a reduction in babies being born instrumentally, admitted to neonatal units, and exposed to antibiotics in early life. All of which would then result in reduced infant mortality and morbidity, reduced hospitalisation for infection, reduced allergies/asthma and may even result in health benefits lasting into adulthood. As a trade off for this there may be a slight increase in perinatal mortality - although further research is needed into why this is only seen in one uk study and not replicated in other similar health systems and whether it would still be the case were homebirth for FTMs to be normalised and not-treated as inherently risky.
In the case specifically of high-risk pregnancies it's not as clear cut - the Birthplace further analyses surprisingly found that homebirth significantly reduced serious harm to the baby for high risk pregnancy. These results are difficult to interpret - they didn't have enough data to separate out the many types of high-risk so there are a lot of confounding variables although they tried to account for these. When they looked only at the most serious outcomes, home was slightly higher than hospital but this was insignificant, whereas overall home was safer for the baby. I'm not sure how much weight you can place on this but it definitely implies that we should be much more individualised and open-minded about what is actually high-risk and what is increased risk but not necessarily prohibitively high-risk.
For example borderline low iron is enough to classify someone as high risk and they are recommended not to birth at home when moderately low iron does not increase the risk of PPH, does not increase the risk to the baby, and only increases the chance that you will need a transfusion if you have a PPH. Given homebirth is known to reduce the risk of PPH, informed consent should involve women having this explained to them and being allowed to choose their place of birth not being told (and I quote my midwife) "unless your iron is above the threshold by 38weeks, you won't be allowed to have a homebirth".
I do see advice on the group to ignore classification as high-risk and choose to birth at home anyway. The birthplace study would seem to agree with this advice - although I would personally be uncomfortable with drawing this conclusion from the data. I think where there are elevated risk factors the actual statistics should be given to the women to enable her to make as informed a decision as possible about place and mode of birth.
Since that is a million miles from the current situation it isn't surprising that occasionally people go to the opposite extreme when trying to fight against what is usually needless intervention. It doesn't make it right, and it doesn't mean that it won't occasionally result in a dangerous outcome, but it does make it likely that the groups do more good than harm. Which cannot be said of current obstetric units. I'm definitely not in favour of spreading misinformation. But I'm also in favour of free speech. And I'm very in favour of informing women of their rights and encouraging them to question their HCPs in situations where they are not being given the information needed or the even the opportunity to give informed consent. That doesn't mean the best choice might not be what the HCP recommended in the first place. But it does mean the woman should be given the numerical risks of the different options where that is available, the best guesses of the relative risks otherwise, and then allowed to make an actual informed choice. Since that isn't happening by default, it is on the whole helpful for other people to question whether listening to the medical professionals is truly the safest course of action.[/quote]
That is an incredibly assertive essay given it lacks any factual support.
Can you please tell me why homebirth as a standard would be so great for first time mums, given half of women would need to transfer (I’m guessing an emergency ambulance ride wouldn’t do much for their mental state or birth trauma?).
Why would homebirth make tearing & haemorrhage less likely? These are unforeseeable events, and the latter is a common reason for homebirth transfers as it is.
How do you know intervention is usually needless, as opposed to sometimes needless?
What would you do if you were me out of interest? I’m a type 1 diabetic with a previous VB. Would you consider me suitable for a homebirth despite guidance?