abeeceedee - It is well documented that having hospital care during labour and birth is linked to unecessary interventions. Also that one intervention leads to another. Hospitals have stopped routinely offering constant CTG monitoring for normal singleton labour because it was shown to have no beneficial effect and simply increased a woman's chance of having an emergency section. Induction is linked to poorer postnatal outcomes for the baby, having epidural is linked to having difficulty in delivering. There is often a cascade which is begun by having a relatively small intervention and leads to a woman needing more interventions or a section.
There is no medical need for my local maternity unit to have a 33% section rate, we live in a rich area and have too posh to push type mums who were bog eyed at my assertion I wasn't going to have a section for my absolutely healthy twin pregnancy (didn't have a homebirth either but did have an MLU delivery). They are also very interventionist.
What is ideal for all mothers and all babies across the whole world is natural childbirth with good medical support and interventions when necessary. Medical professionals should provide each woman, in each pregnancy, individualised care.
Unfortunately this is not what I have experienced with my local hospital who were at best incompetent and at worst negligent. My first was too small because I had an underlying thyroid condition which hadn't been picked up (not their fault) but they didn't even notice he was tiny - although strong and fine with normal delivery.
My second was a planned homebirth, they knew about my thyroid condition then but completely failed to care for it during pregnancy until they realised they had forgotten 2 weeks before the birth and rushed me for blood tests and monitoring. They diagnosed the baby as small for gestational age at 36 weeks and tried to induce me. I refused until the consultant had reviewed and agreed the plan. When the consultant reviewed he said he could find no evidence that this was anything other than a healthy pregnancy and baby and I should be discharged and homebirth was agreed.
When I laboured the midwives did not believe I was far along because I was calm on the phone and so would not come to assess me despite my mum's assertions that they should. In the end only one made it in time and ran in 20 mins before DD was born and had to deliver her straight away. There were no problems, my birth partners were my mum and sister who are both doctors and could have easily (and did help) delivered the baby without complications but the whole thing was poorly managed by the medical professionals involved. It was still my best birth, most relaxed, easiest, quickest (I tend to have long labours). I recieved poor care for my hospital birth and poor care for my homebirth. It's the level of care which is important, not the place of delivery.
When I found myself pregnant with twins I knew I would have to have a hospital birth but did not trust my local hospital, with whom I had also developed a very poor relationship. We transferred care to Liverpool Women's Hospital and were fortunate enough to have a brilliant midwife-led delivery in the MLU there as it is just down the corridor from the CLU if anything had gone wrong. They were fantastic, really amazing.
I suffer quite badly from white-coat syndrome which actually has a large effect on my blood pressure - monitoring at home saw it stable at 120/80, when in the hospital in the cubicle on my own it was ok but when I was put on CTG monitors or was talking to anyone in a uniform it went up, sometimes to 150/100. It is better for me and my babies not to be exposed to rises in blood pressure and is therefore better and safer for us not to have excessive monitoring or hospital intervention. In the MLU we had intermittent monitoring in labour rather than CTG (which is policy), the hospital were fantastic - they really provided individualised care and my delivery was normal and safe at 40+3 even though it was wholly outside policy for twins - should have been in CLU on constant CTG monitor, not allowed in the pool and delivered by doctors in an operating theatre, had my waters broken, been induced at 38 weeks e.t.c. The care I recieved in the MLU I could have had at home.
It is perfectly possible to provide good medical support at a homebirth for a women with a normal pregnancy and good obstetric history. A homebirth should be well planned, orchestrated, managed and thought about sensibly. How near is the hospital should you need transfer? How many teams are there to deliver you at home? How many women booked for home deliveries around your due date? Have you got a good obstetric history? - How long was your active stage, did you need help with pushing (ventouse/forceps/episiotomy/tearing), what kind of pain relief did you need, have you got good pelvic space, did you have any postnatal complications such as a lot of bleeding? Have you got any underlying health conditions which need monitoring?
If you have a normal pregnancy and good obstetric history then a homebirth is likely to be as safe, if not safer than a hospital birth. Not to mention more comfortable and easier because being comfortable in your birthing environment has a large role to play in the difficulty or ease of your delivery.
Saying childbirth should be natural is not insulting to people in poor countries, those women are pregnant and labouring in extremely poor conditions without any medical support at all. They most likely are very young and therefore have small pelvis', have been malnourished or ill all their lives and throughout pregnancy and then have laboured without support in dirty and cramped conditions. Here we have the opposite problem. I fully believe that the over-medicalisation of birth in this country is contributing to the rise in PND.