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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

to think home births are selfish?

563 replies

woozlet · 10/11/2009 09:47

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.

OP posts:
Fibilou · 11/11/2009 14:52

Oh and one of my Mum's friends' grandaughters died during birth - again in a consultant led unit (last year) because the obstetric team didn't react quickly enough to the baby's dropping oxygen levels. There was nothing wrong with the baby - again it was entirely down to mishandling of the birth.

Perinatal deaths in hospital don't seem to be so widely reported as those resulting from homebirths - perhaps because they aren't such a hugely emotive subject with a great deal of agenda pushing.

sadlynoNOTthatPeachy · 11/11/2009 14:56

woozlet most hiospitals do prefer HBsto be restricted to subsequent pg'sanyway; first ones delivered at home usually facedouble the battle.

My HB was ds 84*, ds1 needed a lot of helpprebiryh (eclampsia,IUGR).... I wuldnt return there with ds2 but ewnt to a MLU. It waslovely. But i wouldn't do that again as I tried with ds3, my iron floored (Inknow now that when it happens in every pg as it did with me, there is evidence to suggest it is not a concern)mso I ended up back at hospital1. I worked in a suppoer job and within 4 hours of ds3'sdelivery I had been left with a lady in a wheelchair on the ward to arrange her support apckage becuase 'it won't get done otherwise'. FFS.hardly my job, but what was I to do- the poorlasswasantenatal and consideredtoo at risk toleave the ward and had basically either slept of faced a wall in her chair for 4 weeks.

We'd moved by the time we had ds4 and the over riding factor was the care for the boys, delivwring in a car would be bad,c ould you imagine delivering in a car with 3 under 8, two with asd in the back? er no!. But MLU crieria is such that if ourreason forahb ishospitalrelated, you run the risk of ending up there through non emergency incidents (eg low iron, bed shortage, closure of unit because most mw'son maternity as I have known happen.......)

sadlynoNOTthatPeachy · 11/11/2009 14:59

What I would sy though- if you have a HB you should absolutely be aware of the risk of your baby needing caretheycan't get, definitely. There isa mn lady who hadahb which may or may not have resulted in her severe disability and people should go in knowing that.

Only when you have the info can you make theright decision for yourself.

theyoungvisiter · 11/11/2009 15:32

Peachy - your homebirth was DS84 ?!! I am impressed. That beats even Michelle Duggar

sadlynoNOTthatPeachy · 11/11/2009 15:34

Nan had 16, always wanted to double her and then some

shock horror no it was a typo, bet ya never guessed

sabire · 11/11/2009 16:25

"Only when you have the info can you make theright decision for yourself"

I agree with you. People need to know that should a situation like a cord prolapse or placental abruption happen at home, the delay in getting to hospital may make for a worse outcome for you and your baby.

They also need to know that they are much more likely to end up needing a c-section if they op for a hospital birth, and that if this happens they are more likely to experience maternal death, infertility, hysterectomy, stillbirth, haemmorhage, dvt's and infections in subsequent labours - all of them.

It also appears to be the case that opting for hospital birth ups your baby's chance of needing a trip to SCBU.

You do need to weigh all these things up before deciding where to give to birth.

bellissima · 11/11/2009 18:40

I think the sad truth is that maternal deaths sometimes (if rarely happen) and that they can happen in any situation. I can't comment on the Telegraph article - one problem, it seems to me is that, as there aren't that many planned home births, then you don't have a large sample to analyse.

As to infant mortality then I looked up the latest figures (of course these can change year to year and medical journal to medical journal so don't flame me as inaccurate) - anyway in England and Wales it's approx 5 deaths per 1000. BUT for the professional classes it's significantly lower at 3.4 and in some deprived areas it's as high as one in a hundred. Maternal mortality is also higher in these areas. Now, I would stick my neck out and say that it's the professional classes who have both more planned home births than average AND more elective c sections - and yep, more epidurals. I say that because, in justifying the right to a home birth (which I fully support) some posters here seem to start lashing out at sections and even pain relief as being not only more likely to be avoided by HB (true) but also more dangerous for mother and child - well maybe not, for that significant percentage of home births that end up at hospital. But my main point is that it should be emphasised that all of these 'choices' are far less dangerous than giving birth in some areas of England and Wales.

As to the Netherlands - that bastion of home births, the latest infant mortality figure is 4.7 per 1000. So yes, indeed, lower than the 5 given for England and Wales. But in France and Belgium - countries with a tradition of hospital births and, yep, lots of epidurals (G&A is regarded as a bit primitive) - the figure is even lower at around 4 in a 1000. For the US it's higher at 6 - but that, as you might expect with their health system, masks great differences between the uninsured and the insured - and again I would suggest that it is the latter who have more planned (and properly attended) HBs AND more planned sections and certainly more pain relief (in some hospitals if you are not insured your partner is told to come back with the cash before the epidural is inserted).

My conclusion - as before, support women in their choices. Don't justify one by sniping at another. Argue for more resources to make these choices available - and certainly more resources for deprived areas. I can understand arguments that are based on risks and outcomes - and there are points to be made on both sides. But what I don't quite understand is why so many seem to argue for the NHS' need to keep costs down in an area in which it already devotes rather fewer resources than our European neighbours.

usamama · 11/11/2009 20:30

In most states in the US, homebirth is illegal, and midwives are basically specialised nurses...they would not attend a birth solo. Because of the insurance issue, and birth is big business anything that costs money is encouraged; C-sections, epidurals, hospital stays, etc. Most docs in the US would read you the 'bad' homebirth stats, but what they don't tell you is that if you misscarry at home, that counts in their homebirth statistics. Infant mortality unfortunately does not have all to do with who has insurance and who doesn't, it has to do with the fact that the majority of births are in hospitals, but they are rushed, poorly attended, and women are sent home within 24 hours with absolutely NO after care...no health visitor, no midwife...you are on your own until your 6 week check up. America has the highest maternal death rate of ANY developed nation, and the majority of births are in hospitals. Hmmmmm...doesn't really sound any safer to me!

CarmenSanDiego · 11/11/2009 21:23

Agreed, usamama. I arrived prepared to have a hospital birth and when I found out what it entailed, I opted for home birth and am very happy with my choice. Given the length of my labour, I would have been guaranteed a c-section. In my area, the C-section rate is 50 percent.

A neonatal nurse I know says she is seeing more and more babies in severe distress because of unnecessary inductions.

In this area, they consider 40+1 weeks to be overdue and if you are over 40 they /will/ induce on that day unless you sign umpteen waivers. The American situation is very sad. I'm training in childbirth education to try and do what I can to help women see what is going on here.

EdgarAllenPoo · 11/11/2009 21:24

i had my first at home. it went well, and you ahve to wonder what they are counting as 'unforseen complications' - the majority of transfers are for pain relief, or slow progress- is that included?

as already commented, the claim that in the event of complications it is greatly worse if you are at home is not based on a fair statistical analysis. Many of the likely problems are readily handled by the midwife in situ.

i know plenty of anecdotal cases where things have gone sadly wrong in hospitals, peopl giving birth unattended, etc. People assume they are 'safe' and don't factor in that some things no intervention will help, or that not every hospital has a SCBU (therfore requiring an ambulance and transfer time). or that essential staff may not be in place anyway.

CarmenSanDiego · 11/11/2009 22:19

I know that for millenia women have had to give birth with no surgical intervention if it became necessary. But countless women and babies died as a result.

Well, most of the deaths were more to do with education and lack of antenatal care. Complications which could be treated or fixed were poorly understood. It's not really got anything to do with prepared home birth with an equipped and trained professional midwife.

LeQueen, you're talking about perceived risk. Loads of studies show that home birth IS as safe as hospital birth for /most/ women.

Some studies show it to be considerably safer.

charleymouse · 13/11/2009 10:09

I know not evidence based and only a tale but I think the following is great. I am afraid I do not know where it was from originally so can not reference it but think it is a good read.

A Bowel Movement

Imagine if you will, that about a hundred years ago, people began having great difficulties having bowel movements (BM for short). It all came about because of some very unhealthy lifestyles. People weren't eating correctly because they were desperately trying to be thin and beautiful. They had malnutrition and took a lot of pills and other drugs to help them become and stay thin. People were so concerned with looking good that they put their health aside to get there.

As a result of this lifestyle, many people had a terrible time having BMs. Some people even died. Something had to be done to save these folks. So instead of changing their lifestyles, people flocked to the doctors to have their problem fixed. The problem became so prevalent that people became fearful of having BMs. Everyone dreaded going to the bathroom because of all the horror stories of pain and death. This normal, natural bodily function was labelled dangerous and hazardous and needed to be monitored and controlled to save lives.

Over time, it became the "norm" to go the hospital whenever someone had to have a BM so that doctors could monitor the process and intervene if they needed to. This continued through the years and is still practiced today. An onslaught of new life-saving technology and machinery was invented for us in aiding people to have a BM. It has become such a common practice to go to the hospital to have a BM that people have become uninformed. They don't trust their own bodies to have a BM on their own. People are scared to have a BM that having one anywhere besides a hospital is considered irresponsible, dangerous and risky. Even though the old, unhealthy lifestyles, which caused the problem in the first place are no longer practiced, having BMs is no longer considered a normal event. Even the healthiest of people go to the hospital to have BMs out of fear that something might happen. They go "just in case".

So, you have to have a BM and even though you are a healthy wo/man and having a BM is a normal, natural physiological function that your body was designed to do, we go to the hospital. We grab the hospital bag and head out the door in a hurry. During the car ride you get very tense because the cramps are coming on strong and you can't get comfortable. You try breathing through them but this only helps a little with all the stop and go traffic and bumps in the road. Not to mention that you just wish you could be at home and have privacy. Upon arrival at the hospital, you are wheeled up to a room and instructed to put on a gown with nothing else on (it has a large opening in the back which will show you rear end if you get up and walk anywhere). You are told to lie down so that a nurse can examine you. Then a strange female nurse comes in and explains that she is going to have to insert 2 fingers into your rectum to check the progress of your faeces. You obviously feel humiliated because someone you don't know has just touched a very private and personal part of you.

Then the nurse straps a monitor to your belly to measure the severity of your cramps and stick an iv in your arm. This is very distracting and makes the pain of the cramps even worse. Soon, your cramps become stronger and you are getting very uncomfortable. At this point, the nurses change shifts and new nurse comes in. She says she needs to check you again since it's been a while and you don't seem to be making any progress. She inserts 2 fingers again and shakes her head from side-to-side and gives you a very disapproving look. You have not made any progress. You want to try so badly to relax so you can make progress but with the iv, the strangers, the fingers in your rectum and the negative attitudes of the staff, there are just too many distractions and you can't. By now your cramps are very painful and it takes all you've got to just stay on top of them.

The hospital team decides to insert a wire up your anus to determine if, indeed, your cramps are as bad as you say they are. They again insert 2 fingers to check the dilation and faecal decent. They tell you that if you don't make any progress in the next 30 minutes, they may have to cut the faeces out. This causes you to be even more tense and you have a hard time trying to relax just knowing what may happen if you can't push it out yourself. After another hour of laying in bed, the female doctor comes in and does yet another exam with 2 fingers because she says she wants to be sure the nurses were doing it right. She feels it is time for you to begin to push. So you are in bed, flat on your back with your feet up in stirrups trying to have a BM and pushing with all your might while the strange nurse and a doctor intently watch your anus. The faeces are not coming down fast enough so the doctor decides that your anus must not be big enough for the faeces to pass through so they make a large cut in your anus to make it bigger. They also need to use a vacuum extractor to help pull the faeces out.

You finally manage (with the help of a large cut and vacuum) to push the faeces out. You are in a lot of pain, you're bleeding, exhausted, spent and humiliated. You feel like something in your body is broken and didn't work correctly. This must be true since you needed all this help for a normally natural bodily function right? The nurse then pushes on your abdomen to make sure all of the faeces has been expelled. This is VERY painful but thankfully you were in a hospital or else something bad might have happened. Someone stitches you up and you are given instructions on how to aid your healing.

So, you made it through. You're alive and that's what really matters right? Is it though? What about your pain? What about the humiliation? What about the violation of privacy? What about the anger you feel towards the whole damn thing because your experience could have been completely normal and uncomplicated at home?

Now, this scenario is absolutely and utterly ridiculous right? It seems absurd to go to the hospital for something that could have easily, and much less painlessly, been done at home. The same is true of birth. This scenario is exactly what happened to birth (the "unhealthy" habits were obviously a bit different) and many women are suffering, needlessly, as a result. I can attest to the fact that this scenario is VERY common in hospitals today? I have even experienced it with my own hospital birth.

People have been raised to fear birth and to think that it needs the medical community to make it happen. Birth interventions have become so common that people accept them, and every side effect that comes with them, as necessary for a good outcome. And most don't believe it when someone tells them that it can be so much better if those things weren't done routinely.

A healthy, informed woman who is knowledgeable in birth had just as slim a chance of dying in birth as someone does while having a BM. All you need to have a safe birth is to be informed and to listen to your instincts (something that is very difficult to do with people watching you? just like it is difficult to have a BM with people watching you!). Birth is safe and simple. Just like having a BM is safe and simple. I need as much assistance while birthing our children as you do while having a bowel movement!

Fibilou · 13/11/2009 11:23

What a great, though provoking piece.

clankypanky · 13/11/2009 14:09

idiot

InMyLittleHead · 13/11/2009 14:31

That is such a load of shite (pun intended).

There is no recorded incident in history of someone dying whilst taking a shit (except George II, but they think that he had a stroke and it was just coincidence). But loads of women did die and not just because of bad hygiene, diet etc. but because they were physically incapable of giving birth. There are lots of examples of women dying during childbirth and being buried with the child still inside them, after labours up to two weeks long (I have boring academic references if anyone's interested). Obviously by this point the babies were already dead and starting to rot inside the mother, giving her blood poisoning and leading to a very slow and horrible death.

Obviously this is not strictly relevant to home births as if there was a serious problem they would bring you into hospital. But this view that childbirth is a process which every woman's body can successfully go through without assistance is just bollocks, and it puts negative pressure on women who were not able to deliver without intervention.

abeeceedee · 13/11/2009 17:16

a bowel movement?oh for god's sake, words fail me.

abeeceedee · 13/11/2009 17:19

Actually, they don't. This thread has now deteroriated to the point you are comparing babies to jobbies?

independiente · 13/11/2009 17:24

Please note usamama's post of 20:30:57 on 11/11.
I'm going to c&p it, because it's so true and relevant:

'In most states in the US, homebirth is illegal, and midwives are basically specialised nurses...they would not attend a birth solo. Because of the insurance issue, and birth is big business anything that costs money is encouraged; C-sections, epidurals, hospital stays, etc. Most docs in the US would read you the 'bad' homebirth stats, but what they don't tell you is that if you misscarry at home, that counts in their homebirth statistics. Infant mortality unfortunately does not have all to do with who has insurance and who doesn't, it has to do with the fact that the majority of births are in hospitals, but they are rushed, poorly attended, and women are sent home within 24 hours with absolutely NO after care...no health visitor, no midwife...you are on your own until your 6 week check up. America has the highest maternal death rate of ANY developed nation, and the majority of births are in hospitals. Hmmmmm...doesn't really sound any safer to me!'

YAB utterly U

bibbitybobbityhat · 13/11/2009 17:32

Charleymouse - I cannot believe you posted that utter rubbish about bowel movements with a straight face. I really cannot. What an insult to people's intelligence.

Tangle · 13/11/2009 20:06

OK, the bowel movement analogue is a bit tongue in cheek and it definitely isn't perfect, but then what analogue is? I haven't seen even the most strident pro-homebirth poster on this thread advocate unassisted birth or suggest that refusing to transfer to hospital against medical advice is anything apart from foolhardy.

Like it or not, its widely accepted (and I'm pretty sure there are studies out there to back it up but not in the mood to try and find them right now) that women labour better if they are in an environment where they feel safe and cared for and for some women that will never be a hospital. In many ways its exactly the same as a lot of personal acts, of which a BM is one. I know women that can't do a BM if their toddler is watching, and I don't think I know any (although its not something that's come up in conversation ) that would be able to relax and have good sex in a surgical environment to a time limit while being marked.

The more relaxed and uninhibited you can be during labour the more likely it is for your labour to progress well and lead to a straightforward birth. Yes, there will always be exceptions (both in hospital and at home, regardless of how text book everything has been during pregnancy) and I'm very glad that there is medical expertise and a good network of hospitals - but that doesn't change the basics of biology.

From what I've been able to learn the way in which the majority of women in the westen world are expected to labour and give birth is geared towards making life easier for birth attendents (or their managers) and pays very little attention to the mechanics and psychology of the process involved. The people who suffer most are the women that don't labour well in that situation and so wind up with a cascade of intervention that could, in a different environment, have been completely unnecessary. And that's the tragedy in this discussion for me

usamama · 13/11/2009 20:09

thanks, independiente...

charleymouse...I appreciate the sentiment, but the bm thing is a bit of a stretch...sorry!!

usamama · 13/11/2009 20:10

Well said, Tangle!

bibbitybobbityhat · 13/11/2009 20:14

Why do we need an analogy? (I think thats what you mean). We don't need one. Its utter tosh. Do not tell me that all you need for a healthy birth is to feel relaxed safe and happy because I'm afraid that is simply not the case.

Tangle · 13/11/2009 20:41

(sorry always get those mixed up - but you worked it out).

I don't think I did say that "all you need for a healthy birth is to feel relaxed safe and happy". I don't think anyone on this thread has said that. But I do think that for many women it can help towards achieving a healthy birth - and certainly it will help a lot more than putting women in an environment where they feel threatened and scared.

As to why do we need an analogy at all? Before I started looking into it for DD, my whole experience of birth was what I'd seen on TV - either Casualty and ER (panic! drama! women bleeding out on the floor!) or soap opera. In nearly all of it the mother was on her back and quite possibly in stirrups. In most of it the mother was told what to do and when to do it. To me, that epitomises the culture we live in where we have been conditioned to believe that in order to have a healthy birth it is necessary to submit ourselves to a medical process, to put what we are told by someone in a white coat over what our bodies might be telling us, to try and sublimate some pretty deep rooted instincts in order to fit into that expectation. If that's in anyway accurate then I think we do need an analogy that is bordering ridiculous to make us take a step back and re-evaluate what we have come to believe is normal and ask who's interest these procedures are really in place for.

daisy5678 · 13/11/2009 21:01

J would have died if I'd had a home-birth. He very nearly did in hospital anyway.

I know of home births where the child's 'outcome' was worse than it would have been if they were in hospital.

YANBU, OP, imo. I agree that birth should be about the safety of the baby rather than the choices of the mother. Controversial, perhaps, but I don't think it's right to gamble with life/ health.

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