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.

Hmmm...another pointless thread where the pro-HB's try and defend the choices to others who will never change their view on the 'risks' associated with homebirth. It's exhausting!

When will people stop making judgements on other peoples birth choices? Everyone has a different perception of risk and it's something that can only ever be changed through experience. Respect every woman's choice to plan a birth to suit her own beliefs and needs and stop making judgements on the 'dangers' each choice poses to the child. Life is not risk free and we can only ever make choices for our children based on our own beliefs and experiences.

ay bellebelle!

Yes, I used to work in a hospital, and I would agree that it's poor communication that fucks things up time and again. I could tell you stories of files being lost and...anyway. Tbh the doctors are the best bit of hospitals!

Your experience is horrible, but it still doesn't mean that you know your body better than any doctor. The pethidine seems to have been a big problem. But no one could have predicted that - lots of women get on fine with it. I don't understand why they gave you an epidural without you requesting it - most women have to complain for ages to get one.

What bothers me about the home birth thing is not people having home births but the reason why they feel they have to have them. If one to one care can be given during home births then I don't why it shouldn't be given at hospital.

Edgar - I sadly suspect that if more people did have HBs the service would not be able to cope. There's probably not enough midwives for everyone to have one.

OK I'm a mum and a doctor and have had one horrible protracted intervention laden hospital birth and one perfectly quick and natural home birth so my thoughts on this are coming from some knowledge. Most (not all) problems to do with birth are picked up either antenatally or during early labour, with plenty of time to get help if needed if you are at home. The beauty of home births is that they are not medicalised, intervention which slows things down leading to more intervention is not an option at home, so safer, quicker and more natural births tend to happen at home. Contrary to this post most doctors in the UK are pretty open minded when it comes to home births and will support this choice if its deemed medically safe. If your doctor isn't listening to you then change doctors, its not hard to do. Its your birth, your baby, your body, take control and don't give that control to anyone else.

they have enough staff to do all those c-sections...

a quiet HB with one mw for a few hours and then 2 right at the end probably comes up much much shorter on total staffed hours.

maybe those surgery staff ought to retrain (yes i know the skill set is different...)

One to one would be amazing, if I needed hospital birth but if I didnt Id rather my baby be born at home, especially knowing what I know and how lovely it has been.
Its a bitter pill to be told I am selfish... and I think its bollocks tbh.

Im sure that if Id had problems Id be more cautious but I havent so Im not selfish, Ive done the best thing

Yeah, and then people can die because there's not enough surgeons. Fab. Because, contrary to head-in-the-sky belief, surgery can be necessary even in such a supposedly 'natural' event as childbirth. The WHO (world health authority, not band, obv!) target is 10-15% C section rate, which is not insignificant.

that was at Edgar btw.

No, clankypank - selfish you are not.

clanky you said: "Agree that it has become evangelical quasi-religious movement because quite honestly I dont know what it means, seems like a sweeping statement youve picked up off another mn thread that makes you think you sound big and clever, but neverthless think it is again probably insulting.

I apologise for being literate and for pissing you off so much with my opinions that you are reduced to attacking me personally

wow this thread is still going!! just got up to speed with it.

'I think you have a very biased view. Like I said, I am sure homebirths can be great but the negative view on hosptials on this thread is totally OTT in my view and totally ignores all the posts which mention hospitals saving lives'

I totally agree with the above. I'm actually astounded by the view on hospitals! Especially someone saying they are dangerous In my experience, midwives are all for the non medicalised approach in hospital as well - if you don't need it.

Also, I am just not convinced on the 'home is safer' thing. Only 2% of births are at home, if you had 50/50 then you could make more of a comparison. Look at how many women died in childbirth back in the day, things DO go wrong - fact. And to those of you saying that things went wrong BECAUSE you were in hospital - you just don't know what would have happened had you been at home in that labour. Main thing is healthy baby, healthy mum.

Getting seriously confused now.

According to this article www.nrc.nl/international/article2213612.ece/, the Netherlands, so far from being the safest country to give birth is no 24 from the top out of 26 countries investigaged (though probably not due to homebirths); cf. this link news.bbc.co.uk/2/hi/health/7998417.stm

According to this link
www.guardian.co.uk/lifeandstyle/2006/oct/03/healthandwellbeing.health, the safest country in the world is Sweden where 99% of births take place in hospital.

All that the study seems to show is that the unusually high mortality rate in the Netherlands cannot be linked to the home births; but this cuts both ways: Dutch home births otoh don't seem to have a lower mortality rate either. So not exactly proving that home births are safer.

Please note that I am not aligning myself with the posters who claim that home birth is the selfish option. I am just genuinely surprised. I have seen this thing about the Netherlands being the safest place to give birth repeated in so many posts, it never occurred to me not to believe it, I just wanted to see where the medicalised countries came in comparison.

The National Birthday Trust Study tried to look at all women planning a homebirth in the UK in 1994. 5971 women planning a HB at 37 weeks were included and their MWs tried to match them as closely as possible with women planning a hospital birth (the hospital control group eventually numbered some 4724 women). They found that the group which planned a homebirth were < 1/2 as likely to need assistance and < 1/2 as likely to need a CS. Babies born at home were likely to have better AGPAR scores at birth and need less suctioning and ressucitation. There were 5 stillbirths or neonatal deaths in each group - which was considered too small a number to allow a meaningful statistical analysis.

I know this study is old and the only summary I can find is on the homebirth site (which some of you will consider biased), but it does provide some real data to enable a comparison of the safety of home vs. hospital birth for women of similar (low) risk profile from a large enough population to be statistically meaningful.

More recently

2007 joint position statement from RCOG & RCM
("Summary: The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman's likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.")

Similar study to National Birthday Trust, but 2003-2006 and in Canada
(can only get to the abstract anyway)

There was another study that came out in the BJOG in April 2008 looking at historical outcomes for homebirths (between 1994 and 2003), but there has been significant concern expressed over the source and analysis of many of the statistics concerning outcomes for women and babies that transferred from a planned homebirth here for a start.

From what I've read since I've been a member of this board and others (which is a few years now), one of the key issues is how you define when you "need" assistance or intervention. I don't want it determined that I "need" my labour to be augmented because I haven't dilated by at least 1cm an hour. I don't want it determined that I "need" an assisted delivery because I got to 10cm dilated an hour ago and the baby isn't out yet. Basically I don't want it determined that I "need" any intervention because I'm not fitting into a tick box sheet of hospital policy taken in isolation of any indicator that my labour and/or my baby are running into trouble. And when we asked questions of the MW who did the hospital tour that's pretty well what we were told would happen.

I assume that those policies are based on research that shows risks increase if those targets aren't met - but then I now know of other guidelines that have no research to back them up, or are based on research that is very badly flawed so I'm now less prepared to make that assumption than I was pre DD. None of this gives me confidence to put blind trust in the system, and based on my previous labour I need to be able to trust my HCP's becuase for the last few hours of DD's birth I wasn't in a place where I could have a rational discussion. I was (and still am) very concerned that too many maternity units are understaffed and so MWs are forced to fall back on policy and guidelines rather than being able to offer individualised, one-to-one care through sheer lack of time. It doesn't make me think that all hospitals are dangerous - but it also doesn't make me think that all hospitals are safe havens where the health and safety of me and my baby are going to be a MW's first priority for the duration of my labour.

woozlet - I completely agree that you never know that outcome of a course of action you didn't take. But that applies equally well to many of the "I/my baby would have died if I'd had a homebirth". Everyone I know personally who started out saying this to me decided, after talking about what actually happened, that this wasn't true for them as there had been indicators earlier in their labour that all was not well (even if the MWs didn't act on those indicators until it was an emergency situation, which makes me for them).

cory - I think you've found one of the biggest problems in trying to make an informed decision, and that's trying to get hold of the information... To me, the first two links are saying the same thing - the Netherlands has a suprisingly high neonatal mortality rate, but the high homebirth rate isn't to blame. The last one was too much of a human interest piece without enough hard data to draw any conclusions, really - they don't even seem to say what "recent study" has Sweden as the safest country to give birth in, and nor do they say how "safe" is defined.

ps clankypanky - to make things bold you need to put * * around each and every word individually. Spaces negate the whole thing

Okay...I think we have to agree to disagree on this subject. The fact is, pregnancy and birth are risky by themselves. Obviously, there are success stories of babies being born at home AND in hospital. There are also tragedies that occur in both. We have ALL found ways to bring healthy babies into the world, and the fact that we are all HERE talking about it, means we're okay, too.

I had a very fine, very successful birth in a lovely hospital with my first born, but found a hospital setting very stressful for me, and therefore, for my newborn, which I just hated. I had an even lovelier, successful home birth with my second child, and it was much better for my stress levels, and therefore, for my newborn. Both had levels of risk invovled, but I was extremely fortunate in both cases to have very good outcomes with no major problems. And, I am so GLAD I had the CHOICE...there are lots of places where that simply doesn't happen.

Healthy babies and healthy mamas are the important things...no matter where or how we give birth.

Yes, could go on for ever, agree to disagree that hb is selfish, agree that we are lucky to have the choice.
givememoresleep: if you dont want to be personally mentioned then try not to write nonsense sentences that are insulting...just because people choose to have home birth does not mean you have the right to say they have made a new religion of it. And I wasn't annoyed, I laughed out loud when I read that sentence because it was such tosh!
woozlet I dont think anyone said hospital was dangerous, just that its not always the right option for everyone. At the end of the day the majority of people have their baby in hospital and there is nothing wrong with that, I certainly would never go round trying to convince people out of it. Im not convinced people are saying its safer to have at home either, they are just defending their position that for them it felt like the best thing to do. Lets not forget that most people responding to this in a pro way have had their babies at home so therefore to say it is selfish is in fact an insult to them...of course they are going to defend their actions and who is to say they are wrong?

cory - when I looked at latest figs on infant mortality (see a few pgs back) it was an average of 5 in a thousand for the UK (with wide variations depending on socio-economic status), a worse 6 in the USA (again wide variations), 4.7 for the Netherlands - so indeed lower, and around 4 for both France and Belgium (lower still, and in those places it's mainly hospital births).

This is only one aspect of risk and it doesn't distinguish between home and hospital births in the Netherlands. As I've also said - Dutch women are amongst the tallest and longest limbed in the world (look it up).

agree bellebelle. No amount of arguing will persuade some women that home births aren't risky, and equally so for hospital births. We are all a hell of a lot luckier than women in many countries whose mortality rates (infant and mother) are far higher than the above.

Apologies for weak third link of last night- yes, I admit it doesn't prove much.
Trying to do better this morning:
here is the WHO report of 2006 on perinatal mortality whqlibdoc.who.int/publications/2006/9241563206_eng.pdf
From this it looks like Sweden holds the second place (shared with Italy) for perinatal mortality, very slightly outperformed by Singapore and Macao, but significantly outdistancing both the Netherlands and the UK. THis link seems to suggest that home births are not accountable for the good statistics of Singapore.
singapore.angloinfo.com/countries/singapore/birth.asp

Maternal deaths are here: [[http://www.who.int/whosis/mme_2005.pdf. Again Sweden is second after a shared first between Brunei and Ireland (neither of which performs particularly well in the perinatal stakes).

So what do these results prove? Tbh I am not sure they prove a lot. My first link in the last post mentioned that Dutch women are usually older than their European counterparts when they give birth to their first child- so that might account for a higher percentage of perinatal births, before we even start thinking about the birth plan. Otoh the UK has a far higher percentage of very young mums (also a potential risk factor) than e.g. Sweden; it also has far more serious problems with obesity, drug use and a generally unhealthy diet (which might lead to IUGR and pre-eclampsia). A nation that does not take a packet of crisps in its daily lunchbox might be expected to perform slightly better in the maternal health stakes from that cause alone. Smoking in pregnancy is possibly also more common (no statistics on this one): having spent a few months on ante-natal wards, I couldn't help noticing that a fair few of my fellow patients had to sneak down to the carpark at regular intervals for a quick fag. There are things that midwives and obstetricians can't do a lot about, but which might just be enough to influence the statistics.

Also, just because Sweden and Singapore births generally take place in hospitals doesn't have to mean they are therefore highly medicalised. A hospital is just a building: you can't tell from the outside what goes on inside. A number of articles I came across seemed to suggest that while the Swedish model expects virtually everybody to give birth in hospital (also the impression I have got from speaking to Swedish mums), it also relies on primarily midwife-led hospital care, rather than a highly medicalised variety. And it has lower caesarian rates.

The thing that stands out for me is that the Swedish women I have spoken to generally seem less traumatised than their English counterparts. They take it for granted that their stay in hospital will be quite a pleasant one, and that they will not feel like helpless pawns in the hands of the specialists. So maybe it's not just the attitude to home births that needs revisiting but also attitudes about what makes for a reasonable hospital experience.

I am all for fit healthy women's right to give birth at home if they wish to do so. But I am unhappy about a situation where women choose to labour at home because they take it for granted that any stay in hospital will be unpleasant. ANd I know that even in the UK it doesn't have to be like that: I had a very good level of care when I gave birth at a well respected teaching hospital with a particular interest in supporting breastfeeding. It shouldn't have to be luck of the draw.

cross-posted with bellissima- we're clearly looking at different years and with such small numbers it is going to vary slightly from year to year

one thing that does seem clear is that home birth v. hospital birth is not the defining factor in perinatal mortality

(except of course in individual cases: children do die or end up permanently brain damaged because the ambulance didn't get there on time, but equally children do die or end up brain damaged because of mistakes made in hospital or infections contracted in hospital: either could happen in any one labour)

but there seems to be no clear result that can tell you that this or that is definitely the overall safest option

there does seem to be some suggestion that countries with a less medicalised approach actually do slightly better- but that seems to be regardless of the home/hospital debate

even in the UK, not everybody who goes into hospital as high risk has to labour on their backs and put their feet in stirrups: I had baths and moved around despite a highly monitored situation and to this day don't know what a pair of stirrups look like

and that seems to be the whole crux of the matter: the whole thing is so patchy; once again, it's postcode lottery

YANBU
but tbh i frankly couldn't care less as i'm one of those selfish women who has had 2 homebirths
and i simply can't stress enough how utterly wonderful climbing into your own bed,having your own bathroom,eating what you want when you want is..
..as well as having midwives with you who you have met during the course of your antenatal care
totally selfish but totally worth it

whereas from my pov to have to let strange women into my home, to have to have the house tidy and hygienic before I went into labour, to have to organise my own meals, to have my own sheets and potentially my own carpet messed up, to have the neighbours (one of whom had nervous trouble) listening to me screaming, to have to use my own cold and grotty bathroom when in labour, would have required a supreme level of self-sacrifice

which is why the only way forward must be not to assume what women want- but to ask them. Individually.

Tbh most people's experiences of home births sound lovely. But I could never have one living where we do now, down 3 miles of one-track road, minimum of 20 mins from the hospital (and that's with blue lights).

May go private, seems to be the next best thing

I think the point about birth not having to be medicalised in hospitals is a really good one, and I think that's what puts many women off the thought of giving birth in a hospital. It's what put me off...even though I had really good care, I was frustrated by how little control I actually felt I had, and how I felt I was sort of pushed into things that I was in too much pain to make a clear decision about (re: the epidural). At home, I had much more freedom in terms of movement and how I wanted to manage my pain, and I think that's really the key...there are hospitals, doctors, even midwives who really follow that on -your- back- feet- in- stirrups-, epidural- is- the only -pain- relief kind of model, and that may be where some of the problem lies. If more maternity units, even for high risk mums, would turn to a more birthing unit type model, maybe women would embrace it more??? I don't know...again, I don't understand what it's like to have a high risk pregnancy, so maybe that's not a viable solution...
Those of you who have had and advocate for birth in hospitals...what would your preference be? For a medicalised approach, or to have a more natural approach? Or does it just depend on the circumstances?

usamama - I gave birth in a maternity hospital in the midwife led unit. It was all very natural - dimmed lights, music, gave birth leaning over the head of the bed, just a bit of G&A. But the labour ward was just along the corridor had I needed it.

I think it's a real shame that all hospitals don't have MLUs in them. I think that is a great way to give birth. Of course - there are some wimen who WANT an epidural etc so its not right for everyone.

I think that if home birth had not been an option for me then mlu would have definately been the next option, unfortunately they are not available for everyone.

clanky just because you don't understand it, doesn't make it rubbish! Don't blame me because you don't understand it.