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

[everychildmatters]

Because clearly evidence says otherwise!!

A lot of medical cultures (including US and continental Europe so we don’t have an argument of how superior British practice is - it really isn’t per medical stats) consider it necessary and a natural part - if you go to a gynaecologist you obviously expect him to perform a VE and same with birth. Like, why would you not consent? Consent may be sought formally but it is strange not to provide it.
(and as a side point UK is also pretty unique that women and NHS don’t consider seeing a gynaecologist regularly as medically necessary - which is bizarre frankly).

so if you are conditioned to think that VE is assault and not necessary you will think so. But UK is quite an outlier in this regard as I said above.
A lot of people (not from UK) will perceive this as negligence if a midwife or a doctor would not do VE during birth

A home birth with an experienced midwife (who has extensive experience of home births) in a low risk pregnancy can be a wonderful experience. The issues arise when it’s a first time mum who has had a normal pregnancy, who is birthing with an inexperienced midwife (or a midwife lacking in home birth experience) who perhaps doesn’t flag an issue early enough, or a mum who is too stubborn to accept medical advice because they dream of the perfect home birth.

I’ve got friends who had very succesful
home births with minimal support from
their midwife, and who delivered overnight and the most the midwife really did was a few checks and cleaned up after. I’ve also got a friend who delivered successfully in hospital and then haemorrhaged so severely 3 hours later that they had to have a hysterectomy to stem the bleeding.

I planned to have my son in a midwife lead unit of a main hospital, which au gel was a brilliant compromise between having the relaxed hands off delivery that I wanted but within the confines of a main hospital if support was needed. Thank goodness I did. My contractions stopped at 10cms dilated and my son’s heart rate dropped dangerously low. I was able to be transferred quickly to the main delivery suite and put on a trace to monitor my son. They did a quick hand scan to discover he had moved position between my 36 week check and going into labour and was back to back. I ended up delivering in theatre where he came presented with shoulder Sonia and came out fist first with the cord round his neck so tightly that if they hadn’t been able to do a 4th degree episiotomy his delivery would have lead to possible placenta abruption and him being strangled by his cord. He needed oxygen at birth.

Like I said, there is a place for each option, but unless you are in your second pregnancy and have already had one uncomplicated delivery it shouldn’t be the first option for many ladies. And certainly should be considered very carefully for a first time delivering.

The lady in the papers was failed twice. The first time she delivered by being made to feel that she didn’t have a successful labour and delivery and the second time by the team that didn’t press on her exactly how high risk she was having had a previous post partum haemorrhage

Unfortunately I'm not shocked by that part of it having come across (via NMC work I previously did) many midwives who failed to resuscitate a baby born in poor condition - meaning hypoxia often until paramedics arrive who tend to be quite good at airways.

Resuscitation is much much more effective in hospital with neonatologists and supportive medicine if needed, intubation etc, but even at home a MW should know how to do compressions and airway management. Unfortunately many are deskilled having leaned it years ago and never putting it into practice. HB midwives are I'm sure very good when nothing goes wrong as that's the situation they fave most of the time.

I wish there were more birthing units

Halfway between home and hospital births and with hospitals accessible if there is a problem

And you're not put in a noisy ward with mums, babies and partners afterwards, you get your own room

They’re still in some cases a way away from a hospital though. My friend booked into a rural unit to have her first baby, and although it wasn’t a life/death scenario and they were both ok, she had to wait an hour stuck at 10cm for an ambulance and then a 30 minute drive to the hospital. I don’t see any reason why we can’t just improve maternity units in general so they have a homely feel, pool access etc but the doctors just upstairs.

'My last baby was a home birth and far, far safer.' Because nothing went wrong with your HB fortunately. Had something gone wrong you'd be safer in hospital. You keep ignoring this point.

I can't tell if you are being purposely obtuse but the general consensus on here is that a home birth isn't any likelier to have complications than a hospital birth, unless it is a first time mum.

What the majority of us have been saying is, if something were to go wrong you and your baby would be at greater risk of death or injury if you were at home.

Where would you rather be haemorrhaging to death, in your living room or a hospital?

The NHS backs this up and it's plain common sense.

@Goldwren1923 Are you US? If so I can guess your views on bedsharing too...

@AshKeys1 But what you need to question here is why things go wrong in the first place. How often is it due to Cascade of Intervention, for example?

An estimated 10 - 15% of births involve a cascade due to unnecessary invention according to AI. This isn't wholly reliable when you look at how it was broken down.

Around half of births have an intervention which ranges from episiotomy 10-15% to C section 38.9% of that half. The overwhelming majority of interventions are deemed necessary.

A woman has the right to refuse medical intervention whether she is in hospital or not. I personally would refuse a stretch and sweep or an induction for the sake of it.

This doesn't change the fact women and babies are at greater risk if something goes wrong during a home birth, meaning hospital is a generally safer place to be giving birth.

@AshKeys1 Do you mean half of hospital births have an intervention? That's a lot. And "deemed necessary" by whom?

Half of all births. Deemed necessary by medical professionals. We have established some interventions may have been unnecessary but the majority are required.

It's a practically an immeasurable thing to determine because you can't really prove whether a Dr is wrong in his/her decision at a specific time.

What you can do as a woman, is take on the information presented to you and try to make an informed decisions from there.

For example, I'm 2 days over. I'm offered an induction, I refuse. vs I'm going to tear from fanny to arse, thank you I will have an episiotomy.

I think she wasn’t in her right mind and reading between the lines was influenced by the online home birthing community.

I was in her form at school and though I’ve not seen her for years (apart from Facebook) I did know her pretty well. She was lovely - warm, kind, chatty, outgoing, thoughtful. The woman I knew is not the woman described by the midwife in the articles - quiet, only speaking to her husband, uncooperative, turning her back when a urine sample was requested, etc. I think she must have been so traumatised from her first birth and in a very impressionable state of mind and had been influenced by home birthers telling her than pph is caused by the stress of being in hospital, etc.

She was always very meticulous and she planned such a beautiful wedding, kept a beautiful home, always hand made things, and I guess she thought that if she planned her perfect birth down to the very last detail then that’s how it would go.

It is devastating and I don’t think enough was done to address her trauma or mental state. Her clinical team should have done more to dissuade her.

Agreed every woman should be able to make their decisions based on fact. However, sometimes women don't appear to be put in a good position re: informed choice.

https://www.mumsnet.com/talk/_chat/5425163-in-labour-need-urgent-advice

How often does this kind of thing happen, I suspect we will never know?

As most of the above, anecdotal evidence doesn't prove anything. Research suggests there is no greater risk. There is no right or wrong and we should support women in their choices, even if it's not the one you would choose personally. Surely we all want a happy outcome for both mother and baby?

Oh gosh @TheBerry it’s both sad and very nice to hear a bit more about her as a person and not just the few words spoken by the midwife at the inquest. She sounds like a very likeable person and it’s easy to just take the case on the bare facts and assume she was a huge risk taker. As I said above I myself was surprised there seemed to be so many medical mistakes at an already high risk situation.

It’s a real issue because honestly I do understand about cascades of intervention and poor hospital care, I’ve been there myself and objectively DS’s birth was as haphazard as it was due to completely undeniable failings by the hospital - as I wrote upthread, I was given a pessary, put in a cubicle (just a bed behind a curtain) and left there for 15 hours, 12 of which I was in active labour and nobody did a thing - just popped in to do obs, said ‘mmm yes hun’ when I was saying how regular and strong my contractions were, and occasionally bringing paracetamol. They only took me to labour ward when I was 10cm, DS’s head was visible and I was vomiting everywhere and clearly in transition. How this was allowed to happen I have no idea, and it transpired one of the midwives had falsified my notes to say I was 1cm dilated at the check the night before when I was actually 4 and I was able to ‘catch her out’ by printing a screenshot of a text I sent at that time to DP telling him to be on standby to come in as I was probably to be taken to labour ward soon. Only then did they apologise and say she had been ‘spoken to’ - spoken to?? There was me thinking falsifying notes to cover up mistakes would be a disciplinary offence. I would be sacked in my job.

I honestly left that hospital feeling midwives were about as useful as a chocolate teapot and frankly beyond a bit of supervision and doling out paracetamol, barely necessary - they could’ve not existed at all and my labour would’ve been no different.

I actually struggle to know what they’re even there for half the time, they don’t listen, are incredibly passive, forget everything you tell them and when they say they’ll be back in a minute they never are (sorry I’ve gone on a tangent now).

I can absolutely see how this lady was as traumatised as she was to make the decisions she did.

We’ll never know.

The only stats we can reference is those from a time when homebirth was the norm - 1940s and 1950s. The issue is at that time the average maternal age was much younger, they were much less likely to be obese, and fewer twin births due to the IVF etc - it’s not comparable really. I remember a comment from a medic on here saying women are sustaining pregnancies now that would never have been sustained 30 or 40 years ago - donor egg, huge amounts of drugs to prop them up etc

Age massively affects how a labour goes for first time mums. A first time mum aged 40 is 3.5 times more likely to have a C-section than a first time mum age under 30 (a study I just found said, anyway).

No I don’t see a VE as assault, I have had them during labours. No issues. I would expect to be offered them. However if they are done without consent it is obviously and undeniably assault- nobody has the right to shove their fingers up somebody’s vagina without getting permission first. Thankfully I think it is rare- there was an NHS case where the woman in labour told the consultant to stop and he didn’t. The midwives present helped her report to the police afterwards, but I don’t think they really knew how to deal with it because it was such a rare complaint they had not come across.

Same with other interventions. There was a case in the USA where the dr said something along the lines of ‘I’m going to perform as episiotomy’ but the woman in labour said ‘no’- he ignored her and did it anyway. Her birth partner was recording and the dr ended up getting prosecuted after for not having her consent.

The bottom line is that many women don’t want home births - and that’s not because of misinformation but attributable to a number of factors.

As mentioned above, some want to be where they can have effective pain relief - epidurals, others prefer to be where doctors are readily available and not just midwives and others weigh up the risks and opt fior what they think is safest for them.

Some people don’t have much truck with nature and prefer science and civilisation - they feel more comfortable in the medical setting. A pp says it’s odd that some women want to be in a place with sick people when they’re not ill. But, to many of us, extreme pain, bodily discharges, risk to life and limb are being ‘sick’ with no guarantee of a positive outcome and we prefer to have all options including surgery immediately to hand.

The OP feels differently and that’s fine.

For arguments sake let’s say the baby needed delivering urgently as they were flatlining or in severe, life threatening distress. Should they still not do the episiotomy?

I remember seeing one case in the news a few years ago where a baby was sadly stillborn. Another high risk home birth situation (if I remember rightly mum was 40ish, and her previous labour had ended in EMCS). She was adamant she would query every decision, as was her right, but ultimately it slowed things down as she wanted to wait to the last minute before any interventions were done and her baby was stillborn in hospital after a transfer. She was on TV as she ultimately blamed the NHS and while I don’t know the ins and outs of it, from the information given I’m afraid it did read like while she was ultimately happy to take control of her labour, the catastrophic result meant she now thought the medics should’ve overruled her. What happens here?

I dont know what oyu argue about. If all women gave birth at home, then there would be many more deaths on averge. Many babies and women survive only thanks to medical intervetnion that is only possible in hospitals. It is risky to give birth at home if you may require medical intervention- and you may not know this will be needed until you do. My first pregnancy and birth were a model one, and yet my child ended up in ICU 10 minutes after birth. Unless I had a crystall ball, Id not have been able to foresee that.

Ultimately consent is consent. Of course if the person is unconscious or lacks mental capacity (eg severely disabled) then decisions are made on their behalf.

An example is some Jehovah’s witnesses won’t consent to blood transfusions. Doctors have had to just stand there and let them die when they know that a blood transfusion would save them. But they can’t override the fact that the patient has refused.

You have to consent to c sections, dont you? Regardless of risk to baby if you refuse.

You have to consent to anything.

Unless you’re in a coma of course

It is fine if you don't agree with home births and feel free to consider it uncivilised but it is entirely unfair to suggest that those who do are somehow ignoring science. There are many examples of scientific evidence comparing hospital and home births. It is disingenuous to suggest otherwise.

Dr Sara Wickham says it so well.

Ok, but I have to be honest and say there is an element of people jumping to blame medics sometimes (not in the case we’re discussing) when really they’ve taken matters into their own hands but the outcome wasn’t the one they wanted. If you decide to take big risks, you can’t really then go back on that afterwards and say they should’ve overridden you.