To be fed up of the "home birth is risky" misinformation?

[everychildmatters]

Because clearly evidence says otherwise!!

No they don't. Try getting a doctor to see you to discuss a c-section if you are classified as 'low risk'.

The original "Hospital = Safe" idea came from the late 60's/early 70's when the death/injury rates for both mother and child dropped dramatically at a time when hospital birth rates shot up.

So the logical conclusion was that this must be causal when in fact it has been shown that it was more to do with increased understanding of infection control, better and cleaner homes with running water, pest control etc There was a campaign that all births should happen in hospital and it was floated that homes births be banned altogether. The home birth rate dropped to less than 1% in the 1970's and 80's as women who wanted one were simply ignored and forced into hospital.

Various studies have been done the back up the claims that home births in the right circumstances are safer than hospital, but the sad fact is that home births are more expensive to the NHS with two midwives per labouring woman. They would rather have those two midwives overseeing 8 women on a delivery ward, so discourage it.

The issue is that maternity care in this country is patchy at best and appalling at worst. I believe the research indicates that midwife-led births, conducted by experienced midwives with minimal medical intervention, are optimal and possible for most women. However, 'home birth' can mean many things...from a carefully planned, experienced midwife-led, risk-assessed birth to a woman with an inexperienced birthing partner doing it alone in an unsuitable environment. The reality is that we do not have the resources to provide every woman with an optimal home birth experience, or even a midwife-led birthing centre equivalent. Quite often there are not enough midwives to cover hospital births, and certainly not available midwives to be on-call for home births. There is also the reality that any birth can suddenly become a medical emergency, for a variety of reasons. Until we get to grips with funding and resourcing proper maternity provision, it is not the case that home births are 'safer' or 'as safe as' hospital births. I think a lot of people who have positive home birth experiences forget the number of women and children who died in childbirth before the advent of medicated intervention as standard.

The problem with giving birth is that it is completely unpredictable. So some women won't have any particular risks, but still develop devastating complications. Others may be high risk and sail through birth easily. We just don't know which women are going to develop complications, all we can do is put them in a low or high risk category. There will always be women who would have been better off not giving birth at home, but no one would have thought so beforehand.

I do understand women who don't want to give birth in hospital because maternity care is awful. I gave birth in hospital twice and in my experience the problem with hospitals is the impatience, lack of empathy, and fear of litigation of the staff who work there. The midwives I encountered were mostly in a rush to get it over with, they just weren't interested in letting things progress naturally. There is also a general attitude of arrogance and disdain for women - basically just everyday misogyny, which is particularly painful in such an intimate setting.
I am not having any more children and I am so glad I won't need maternity care ever again.

I had a very long normal labour and then would have bled to death had I not been whisked into theatre. They literally got me in in less than 5 minutes and I wasn’t even knocked out before they started operating on me it was that bad. I would have just died on my own living room floor if I had had a home birth.

But how do you know how high risk your birth will be until it happens? I was categorised as low risk my whole first pregnancy, not a single concern, I was encouraged by my NCT leader and midwives to try home birth or midwife-led birth centre. But I chose a hospital birth and thank God I did. My labour was terrible, my baby became distressed and I needed a crash C section to save both our lives. You can't always predict which births will be safe to happen at home. My baby would have died!

The issue with "my baby would have died" is that you have no proof of that.

Midwives in home birth situations stay with the mother the whole time, pick up far earlier on issues and will always err on the side of caution. In hospital women are left to labour alone and issues are often not picked up on until they are emergencies, when earlier intervention may mean that they would never have become emergencies at all.

You dont know that you would have needed a crash C section if you had had an attentive midwife with you the whole time. If your monitoring had been done by an experienced hands on professional and not one midwife watching 8 different monitors on a screen in a different room.

You cant say with any level of certaintly that your baby would have died at home, simply that you both almost died despite being in hospital.

@Bearlionfalcon I wouldn't have chosen a home birth for my first as slightly increased risk. For low-risk subsequent pregnancies the risk is the same, with some clear advantages of labouring at home (see Cascade of Interventions).
The answer to your question is that experienced midwives are trained to spot any issue when it starts to first become a potential problem and address it accordingly. Also remember that there is always at least one 1-1 midwife present at all times at home, and two 1-1 when labour has progressed.
Can the same be said of hospitals? I know it wasn't the case for my middle child who suffers from permanent hearing damage as i was left either completely alone or with just a student midwife working in isolation who made some appalling decisions without my informed consent.
We need to look at the research here which suoports the fact that for low-risk subsequent pregnancies there is no increased risk and many advantages of s home birth.

@PyongyangKipperbang I 100% agree with you on this one.

That's not true. Hospital births are riskier because they are not a good environment to give birth. They stifle oxytocin levels and interrupt labour. Then you get the interventions which lead to more traumatic births. A good midwife will know when to transfer a home birth to hospital to get extra care. The stats just don't bare out what you are saying.

I take your point (although I guess I probably know my birth better than yours, and my 'proof' is that the doctor who delivered my baby literally told me this was the case, so I think I'm probably correct) but I definitely don't accept that home birth midwives "stay with the mother the whole time, pick up far earlier on issues and will always err on the side of caution" - maybe in an ideal world, fine, but not the world I live in! In my area, the home births team is very popular, but is as stretched as any other part of the NHS, and stories abound of the midwives in the home births team not turning up until the last minute, especially for first babies where they never seem to believe the women who say they are in established labour. My neighbour opted for a home birth and her midwife did not arrive until the head was out, she ended up giving birth terrified in her shower clutching her mobile phone to her face, it sounded horrendous.

You said "my labour was terrible" - so you would have been transferred in in any case/

@everychildmatters I'm so sorry you had such a poor experience, and about your child's hearing damage, that's awful. I've heard of many bad experiences about home births too though tragically, including terrible outcomes for the babies involved. The system is simply too stretched.

The midwife who was sat there with me didn't think my labour was terrible, she thought everything was fine. It went terribly in the sense that I wasn't progressing but she kept saying there was no cause for concern. As soon as a doctor saw me he identified that the baby was in distress, which she'd missed, and that my baby needed to be born immediately. I was wheeled into theatre and my baby was out within six minutes. I could see the doctor was furious with the midwife

But that is conflating two issues.

The state of midwifery services in this country is appalling, no one is arguing that. However, that in your area there are not enough home birth midwives (ironically probably because the hospitals are so understaffed that women are opting for home to try and guarantee getting a midwife) doesnt alter the facts that home birth in a low risk pregnancies is safer, with fewer post birth infections and less likely to end in interventions such as c sections etc.

There is a big issue around how many emergencies are caused by being in hospital. In some cases we have no way of knowing, but the stats bear out the fact that many are indeed caused by being there in the first place.

Well, I personally wouldn't choose to have a major operation at home so by the same token I wouldn't want to give birth at home. Giving birth is dangerous. It's fair to say that hospitals can (and do) screw up but if anything goes wrong unexpectedly I think mother and baby have got a better chance than if they're an hour away with no doctors or medical equipment etc.

The problem with birth is it can all be going perfectly until it isn’t. You can only transfer in by ambulance, and lord knows there’s not enough of those and due to sheer weight of traffic at all times these days, getting one to you is always a struggle.

my first birth was going along nicely until my baby turned sideways at 9cm and refused to turn the ‘right way’. Thank goodness, because after my EMCS the doctor said to me he’d never come out naturally due to size! I have a teeny pelvis and they said they could guarantee shoulder dystocia with my baby and due to how big he was, a crash section (pushing him back up) would have been the only chance of saving him. I still shiver thinking about it.

Well, infection and sepsis in my case. Caused by so many unconsented vaginal examinations as was basically admitted in my birth notes.

I was coerced into unnecessary medical interventions by consultants and had such a horrendous birth that ended with an emcs, ptsd and pnd.

Homebirth gives women like me the chance to labour naturally without fear and the stress from feeling unsafe by brutal medical staff during a very vulnerable time.

Its very strange how so many women are 'my body, my choice' when it comes to abortion, but when it comes to birth, we are told to unquestioningly rely on 'the experts' to the detriment of our physical and mental health. Maternity care is not women centered, and much of what is done is to get women in and out as fast as possible, like an assembly line at an abbatoir.

Yes misinformation of all kinds is bad.

But many women want decent pain relief which can only be accessed in hospital. The advantage of the epidural, for example, is that you have effective pain relief while maintaining mental clarity.

I was under a caseload team - they see you in the community, which was fantastic, all antenatal appointments in your living room. You have the choice to have a home birth or hospital birth and the midwife assigned to you (same one who does your antenatal appointments) will attend your labour and delivery whether at home or hospital. It really was an amazing service and I was so lucky to have access to it.
BUT there was a definite undercurrent of home births being better/superior much like the pressure to breast feed. I just let it wash over me.
I definitely didn’t want to have a home birth but didn’t want to stick around in hospital for too long afterwards either, so I do sympathise with the discomfort and stress of being in hospital versus being at home.

I think the reason it is so divisive is experiences. If you have had a hospital birth and been traumatised you can't compare it to a home birth where you were traumatised. Assuming the grass is greener clearly is working both ways on this thread. My issue with that is that it is far less likely you will be bleeding out in a hospital due to something suddenly happening, as it often does, unexpectedly.

If we were safer doing this at home we'd be having a lot more push from NHS as they want to save £££! Believe me the first thing they'd be doing is pushing us to stay at home and save millions!

They want you to birth at home

Home births increasing would actually cost the NHS more due to the fact that one woman needs one and usually two midwives with her. Two midwives can cover several women at once in hospital.

I very much doubt that they would encourage anything that costs more than what is currently being spent.

The point with the statistics is low risk births with little likelihood of medical intervention are at least as safe in hospital, but high risk births with medical intervention are much safer at hospital.

But the disadantage of epidural (especially the older types) is that it limits mobility, increasing the likelihood of unfavourable presentation, increasing the likelihood of baby going into distress, increasing the likelihood of delivery via foresceps ventouse or c section, increasing the likelihood of a heavy bleed and infection.

Its called the Cascade of Intervention for a reason. This is exactly the sort of issue that can be caused by being in hospital in the first place.