to think home births are selfish?

[woozlet]

I just watched a 'desperate midwives' that I had recorded and there was a home birth on it which went wrong. It worked out ok in the end and the baby was ok. But I was really scared watching it, it just seemed like an unnecessary risk to take.

indieangel I would have been more than happy to give birth in a MLU but there are none in my area, only two extremely large CUs. I think it's a shame there isn't more choice..

"if you'd been in hospital, it would have been easier to manage."

HOw? By rationing midwifery care? IME of hospital care, if the team is busy they ration one MW between several women before they hire in bank MWs. Or women are left alone because, 'surely they can't be in labour yet'. One or 2 of these were the reason my Hospital birth was a nightmare.

Here is a bit of advice for every woman planning a hospital birth: Make sure you don't go into labour on weekends, at night or on a bank holiday.

It is that scary tip that would not have wild horses dragging me back to give birth in a hospital.

If people want better care in hospitals then they need to lobby the PCT for it. I want HB to be a choice for women so I should loud and hard for it. Not treat HBs as something that has to be compromised. IME of any thing with women or child services when they cut, we manage on less. so we manage on less so they cut some more. then we grump but cope. and since you say nothing to their faces, they cut some more. When will we stop allowing ourselves to be mutilated because it is 'too expensive' to have one mw to one woman?

I bet they would would never consider rationing triple bypass surgery. Why, because white men are by are frequent recipients of those.

I have only read the OP, but I think YABVVU as someone who would always choose a homebirth over hospital if I could.

I am sure others have already pointed out that evidence suggests the outcome for babies is slightly in favour of home births. Personally I think there are also risks with having a baby in hospital.

It is for the individual to consider all the risks on both sides and make a decision based upon what is best for them personally.

It's rather inflammatory to start a thread with selfish in the title, and certainly a simplistic way to view it.

Indieangel, you haven't answered my question.

Are you or are you not a midwife ?

My SIL is a midwife and often has to be managing several births at the same time. Would I rather be selfish and ensure I have 1 to 1 care all the way through established labour and delivery - yes I would. I am booked in a MLU where this is guaranteed - does this make this selfish because if the MLU was closed they could have the MWs that work there in the nearby consultant led unit so they could "manage" 4 births at a time at a low level of care rather than 1 birth delivering quality care ?
There is a very long waiting list for all types of NHS treatments now - yet nobody suggests that people having open heart surgery are selfish for expecting the best possible team at surgery. If surgeons weren't expected to do such a thorough job then they could fit more operations in. It's the same argument, IndieAngel, that you use - pushed to it's extreme conclusion.
And if it is selfish to want the best possible care during labour, so what ? For the majority of women it may be the only time they ever require the NHS services apart from their GP and why should we not expect to receive good quality service ? One of the reasons that HBs are becoming so popular is because of poor outcomes in hospitals, so if there was better provision within CLUs then maybe women wouldn't feel the need to stay at home because they would be confident that they would receive quality care in a hospital, be believed when they say they are in labour rather than ignored and told to go home, receive 1 to 1 care rather than abandoned in a side room with only their birth partner for company then ignored when they say something is wrong.

It is a very sad reflection on the NHS that you feel it is selfish for women to want to secure for themselves and their babies the best possible care at what is a frightening time.

I'm pushing a baby out of my vagina, your staffing levels are NOT my problem.

Indieangel - in our area most hospitals only send 2 midwives for the pushing stage. Usually only one is sent for the active labour stage.

And as for needing 2 to cover the midwife in case it was "her word against the woman's" - surely that's why MWs do checks and keep records of their actions, so they can show that they were acting properly?

Finally regarding resources, I agree there aren't currently enough trained midwives, but:

1. As homebirths cost less than hospital births and reduce the need for expensive interventions like epidurals and c sections, surely long-term it is conserving resources that could be used to train more midwives and pay existing ones better?

2. I know several ex-NHS MWs, and they all left the profession because they felt unhappy operating in the NHS mode of midwifery care that you describe as ideal and "easier" to manage.

I appreciate that from a staffing and logistics POV then hospital births probably are easier to cope with, but from the POV of job-satisfaction many midwives seem to prefer home births - at least the ones I've spoken to.

Don't you think that more homebirths might enable more midwives to practice in the way that they want to, and thus increase job retention and staffing levels?

Sabire - no I'm not a MW (although I'm quite chuffed to be mistaken for one ). Just a woman that felt forced to learn too much about breech birth when I felt the NHS were more interested in getting me to follow policy than considering what was best for me as an individual.

One of the things I liked about having IMs was the chance to get to know them - and I think they both commented that some of their reasons for leaving the NHS was that they felt it was becoming impossible to provide care for women in the way they felt they should - in the way they felt was safe. They weren't prepared to compromise in that way any longer. The thing I find most shocking is that one left the NHS 20 years or more back - and the problems don't seem to have changed

It seems that some other helpful people have come up with evidence that proves the point that home births are cheaper, and that is, imo, the best explanation for why they are being pushed by NICE (possibly at the expense of some safety, but that's me being cynical).

I probably wouldn't have a home birth myself. BUT in the majority of cases, mother and baby will probably be safe enough during home birth providing there are no emergencies. I defend everyone's choice to give birth wherever they want as long as they take responsibility for their own choice (obv. excluding acts of negligence on the part of hcps).

The issue that has really come up here is that many women choose to give birth at home because they don't trust hospital services, usually from personal experience and don't believe they will get the right level of attention due to stretched resources, not enough midwives etc. This is the issue we should really be addressing and taking action on, rather than snitching at each other for our birth choices. Foxytocin's last point is totally true - funding is cut from maternity services again and again, imo probably because of this 'Oh it's a natural process, so you don't need to be continually attended by hcps, do you?' Sometimes I think this emphasis on 'natural', while helpful in many ways avoiding medicalised traumatic births, can be used as an excuse by the government and PCTs to not give the proper level of attention.

'for people to have to compromise slightly in a midwifery led unit''

the MWLU was a good hour away,so even more unlikely to arrice there than the main hospital. Only in that case baby would have ben norn somewhere out in the valleys (Wales)

Community Led MW team delivered baby (My MWwas well narked she wasn't on team that day)

keep trying....

indieangel Indeed, a MLU would be a lovely compromise for some women but not all of us live near enough to one. My nearest is over an hour's drive away and that wouldn't have been possible once I was in established labour with DS. I was supposed to be attended at home by my community midwife but she was running a clinic at the time so they managed to send me a midwife from the hospital. Evidently they can't have been very busy at the the time as they considered sending the hospital midwife less disruptive than pulling my usual mw out of her clinic. That was just luck, I guess.

But I don't feel selfish nor guilty for having a quick and complication-free birth at home which required no intervention or drugs and therefore was hopefully fairly light on NHS resources.

I'm afraid NHS staffing is a problem for the NHS and the government, not for individual women to worry about.

Though it made me think of my lovely Grandma who had 7 babies at home, with no complications and was then mightily peeved at having to go into hospital to have her 8th child as the community midwife was already occupied; at Grandma's neighbour's house, delivering twins!

Hi! This is my first post ever on MN...boy did I pick a hot one!!

I had a home birth with my second, and never thought for a minute that I was being selfish...and it was so much better than my first hospital birth. My blood pressure stayed lower, I was way calmer, I had midwives sat right on the end of my bed (in hospital, I only saw the doc at the beginning, and at the push stage). IMO, I felt like my HB was safer because of all those factors, plus I was way more in charge. Things can go wrong no matter where you give birth, and sorry, but the stats for HB are a bit better in terms of safety.

Am also astounded that we should be governing our childbirth choices by how "selfish" they are.

Does that mean we shouldn't be allowed epidurals except in the case of life-threatening sections? Because of course to want one "just" for pain relief is so selfish.

How about, should we go back to the days where we all had episiotomies to speed up delivery? Thus saving precious minutes of MW time that could be used to deliver another woman.

On the basis that women delivering at home do so without using up NHS beds, food, postnatal care, consultant time, anaesthetist services and pain relief drugs, and reduces the chance of you and your baby needing specialist care after the birth, then I think it could be argued in terms of pure resources it's actually a rather UNselfish thing to do.

Looking purely at MW staffing levels is a very narrow definition of resources, and one that can and should be fixed for the sake of ALL women, particularly high risk ones who at the moment get the crappy end of the stick IMO.

It's hospital policy to cover the hospital. OH, not to cover MEEE! very enlightening. Then that burden of cost is the hospital's, not mine so they don't have me to blame for half the cost of my HB already.

"So you had 2 midwives for 7 hours, out of how many midwives in the area? How many other women wanted home births at the same time and couldn't because they're weren't enough midwives to go to their house."

Possibly none. Because the HB rate in my area is 0.5% which I believe includes unplanned home births. Because I had to fight tooth and nail for a HB and most women would have given up after being lied to and obstructed like I was. The MW whose caseload I was initially assigned did not even tell me the MLU equidistant to the hospital was newly opened even though I raised the issue.

Because 'not having enough midwives' is not a good enough reason to decline a home birth. They have notice well in advance for all planned home births in order to plan their rota properly and to use bank midwives and then even independent midwives to cover births regardless of location if things truly get busy.

Saying 'if we are too busy you will have to come in' is normally the first method to deny a woman a HB. (I heard that one too.)

When an unplanned HB is in progress, a MW is expected to turn up. Why is the same luxury not afforded women who plan one? really scratching my head at that one.

"I'm not having a go at you," (you can have a go at me if you want though. )

"but you must see that it's a big resource." It is a big resource that is why people are paid big wages to plan the budgets for all eventualities.

"If you'd been at hospital, you would have had one and possibly one other if needed."

There is no way I would have made it to hospital. If I could have made it into the car, I would have given birth by the side of the motorway at 3am which you'll agree is a risk when women plan for hospital births.

And in my previous hospital birth, I was induced, dh sent home, left on my own, was passing out and when I rang for help, someone gave me paracetamol with codeine and said that it would 'help me sleep'. I began to go in and out of consciousness only waking up, already screaming at the height of contractions. I was given etonox on the labour ward and left alone. (the MW who I told this to when pg with dd2 said that the policy was they only gave etonox in a delivery suite - well that didn't happen to me.) When they realised things were going horribly wrong for me then it was all hands on deck and 10 people were all flapping around me. What I am saying is that something different should have been done a lot earlier to spare me the PND and PTSD I suffered post birth. Even now a C/S would have been preferable to the physical and more enduring, mental torture I endured in that labour ward. As I said further down the thread, my birthing experience was like one of rape. No woman should have that experience when in a hospital full of HCPs. An emC/S I only avoided because I began having eclamptic fits while waiting to go under the knife so the registrar tried (and succeeded a ventouse.) (The wait for a em/CS is longer than most on here would think)

So maybe you can see why I am most unwilling going to go to hospital and possibly have 1 midwife or to lose at the NHS lottery and have far less than one. Been there and I have the t-shirt.

As I fought for my HB. I kept telling the HCPs that if at any point pre or intra labour, I had a good medical reason to go to have my baby in hospital, I would go. But only for a C/S. There is no way on earth I would ever, ever, labour in a hospital again. The nightmare is still too vivid nearly five years on.

4 hours after giving birth to dd2 I was alone at home with my doula and dd2 and I began crying all over again at the horrific birth I and dd1 had endured. The majority of the distress for me and her was unnecessary. All for the sake of lack of human monitoring.

"but that one other could have covered several other births at the same time." I think I have answered this one already.

My midwife is extremely supportive of home births. As is the chief obstrician at my local hospital (John Radcliffe in Oxford). His view is that if more low risk pregnancies could be supported within the community then it would free up valuable resources for pregnancies that require more medical support.

So how could my decision to go for a homebirth, if that is what I decide, be seen as remotely selfish?

I didn't realise that midwife led units were not in all maternity hospitals!! I loved it in mine, its a real shame that they are not everywhere. I'm so sorry to hear of the bad hospital experiences many of you had.

I also didn't realise that 1 in 4 first time labours will have unforeseen complications. So maybe home births should only be offered for 2nd or more births??? Not sure. I mean, there's a few posts which say 'my first birth in hospital all went wrong and my 2nd at home was lovely'. That could also be to do with the fact that 2nd/3rd/4th/etc births are normally faster and more straight forward?

my first birth was already a medical complication (severe) Pre eclampsia which in retrospect I think my CMW should have pre-empted but that is another tale. that the care was so bad that is seriously endangered dd and myself after I got to hospital is a disgrace.

woozlet, I think 1 in 4 births for first time mums have complications for lots of reasons, including going to birth in a strange place. A hospital is a strange place for a first time mum and many times her body will resist going into labour properly until she feels safe. It is therefore from this POV no mystery why many women who seem to be in active labour get to hospital to find their labour has slowed down or stopped, only to restart once they get home again. so her labour is therefore statistically going to be longer and the longer it is, the higher the rates of intervention because she will tire and stress and so may the baby hence the interventions. You can even argue that the first intervention many births have is to leave the safety of home and going to a strange place with strange noises, bright lights and lots of people to give birth. All other mammals chose dimly lit, familiar places away from the hustle and bustle of life. Why are human mammals not expected to need the same thing?

Excellent thread everyone. I think I am going to do a homebirth.

Can anyone recommend any links for info on what I will need etc? Obviously will google and research the hell out of this, but anything anyone found particularly useful?

www.homebirth.org.uk

and join their yahoo group also. lots of lots of educating will be done there. without reading that board I may not have developed the bollocks to fight to the end for my HB. Hopefully you will have a wonderful MW who adores HB like my friend only 12 miles away did. different PCT.

also read Ina May's Guide to Childbirth. that woman deserves sainthood.

Thanks foxy.

Chelsea & Westminster are really keen on the HB gig it seems to me, my GP (who I saw today and mentioned it to) is quite happy with it as well.

yeaahhh! informed choice is the best.

"I think you should give yourself, and your baby the safest possible environment in which to give birth" and for low risk pregnancies that may not be a hospital despite the extra ordinary scenario you have presented before.

My second pg, for example, went over due. I was offered and I refused a sweep. Some women may have accepted a sweep as they may have been fed up and suffering SPD like myself.

When checking the placenta the midwife declared that an extraordinary example of velamentous cord insertion. She said if the membranes were ruptured (as is possible in a sweep) it could be dangerous. So I saved it, photographed it and asked my HV who is an ex-MW what that was. We went online and researched it. Lo and behold that offered sweep carried the risk of my baby bleeding and death. Many people would say it would have been no body's fault were it to have happened in hospital birth (despite having a doppler scan of my placenta at 24 weeks where it wasn't picked up,) I am sure but had it happened at home, so many would be judgy and say 'it was because of having a hb.' Though the likely hood of the vein/artery rupturing without an intervention like a sweep or SROM is highly unlikely. Apparently only 10% of babies survive this sort of scenario and being in a hospital is no safety net sometimes. I am sorry for your SIL's cousin but life is one big risk.

PS for those who think I am clearly off my rocker, had the VCI been picked up by the doppler scan I would have been the first one to sign up for a elective C/S and had saved everyone the stress of the battle I had.

argh. SROM AROM - artificial rupture of membrane

LeQueen, plenty goes wrong in hospitals; it's not just the domain of homebirths. A baby died in my SIL's consultant led unit a few years ago because the midwife was negligent in the care she gave to the patient.

And you still think hospitals are safer ?