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.

clunky

"evangelical" means 'fervent' or 'religious' and implies preaching of some kind. Another definition is 'marked by ardent or zealous enthusiasm for a cause'.

"quasi" means 'resembling,' 'having some, but not all of the features of'

and I hope you know what religion means.

So, in simpler terms, just for you, I was saying that some people who are pro-homebirths have become like religious preachers, trying to convert others by scaring them (sometimes) by saying that hospital births are so terrible.

I stand by that, even if you don't understand it!

Given the choice I would like to deliver my next baby with as little medical intervention as possible in a comfortable setting with my dh there.

However, I also want access to drs, the scbu team, an operating theatre and drugs if required. I got little warning that my labour was going wrong before dd had to be delivered and no matter how relaxed I was it wasn't going to remove the cord from around her neck. I'm glad I chose a hospital birth as I had everything at my disposal my dd and I needed.

My biggest fear about hbs is if something went wrong I couldn't live with the guilt I would feel and all the 'what if's.'

get a life givememoresleep, I do understand what those words mean so dont be so patronising, its totally untrue that people who are pro homebirth go around preaching people and trying to convert them , on that basis it is indeed rubbish. Is it your intention to take a part in discussion or is it that you like trying to piss people off?
I've finished with this discussion now anyway.

usamama- in my case, entirely non-medicalised wasn't an option as both my pregnancies were high risk (with pregnancy 1 I had IUGR, high blood pressure, bleeding through pregnancy and a concern about the lack of movement of the baby; in pregnancy 2 IUGR, high blood pressure, bleeding in pregnany and a seriously nasty reaction to blood pressure drugs. So there was no way I was not going to be monitored in pregnancy)

Even so, I was happy to find that "monitored "did not mean "helpless". During labour 1, I was encouraged to be mobile, I had a warm bath in the early stages (not their fault that the fire alarm went off so I had to come out), I walked around, I never saw any stirrups, and the midwives kept encouraging me to move around and be comfortable even when I was strapped to the machine. And I was allowed to come off the monitor at regular intervals to relax.

The second pregnancy would have been the same except ds's heartbeat went down, so I had an emergency section. Even then, it was discussed with me and the reasons explained; I didn't feel bulldozed into anything. But I imagine that could have been incredibly stressful if we had been at home. Given the distance from our home, it would have taken longer even if the ambulance had arrived on the spot and I had been wheeled straight into theatre.

After both births, I was able to hold the baby and supported to breastfeed.

So that is what I would like a hospital birth to be like- and for me I don't think there is any way that a home birth could have been equally safe. With the medical problems I had, I would have been totally stressed out labouring at home.

But I don't see why other women under other circumstances shouldn't have a homebirth if that is deemed the safest and most relaxing option for them.

Cory - it's complete nonsense that you have your house 'tidy and hygeinic' for a homebirth!

But maybe your local hospiital is miles nicer than mine, which had blood on th-floor of the bathroom, was over-run with dodgy individuals talking loudly on their mobiles during visiting hours, and served up the most disgusting food I've ever had the misfortune to have to eat. I also don't appreciate sleeping on starchy sheets which slip and slide around on a plastic coated mattress which smells of disinfectant, or only having one pillow, or having to listen to other people's babies crying all night.

Where did you give birth? The Portland? My house isn't luxurious by any stretch of the imagination, but I had a damn sight more privacy and comfort there than in hospital!

"The pethidine seems to have been a big problem. But no one could have predicted that - lots of women get on fine with it".

Actually research shows that pethidine is pretty ineffectual for the majority of women as an analgesic for labour.

"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."

It's not just about one to one care. Humans are the only mammals who are routinely moved and exposed to an unfamiliar environment full of strangers during birth. We all know that if you do this to animals then their labours often go pear-shaped. The evidence seems to suggest that moving women into hospital during labour often has the same effect - hence the much higher rate of dysfunctional labours for women birthing outside the home. For women with significant health needs the trade off may be worthwhile - but for the rest?

clunky, you said you didn't understand so was helpfully translating for you

But sabire what about haemorrhages? You can't predict them and they can kill you pretty quick. One of the main reasons I don't feel I can risk a homebirth. Another is the baby having the cord round its neck. Agree with whoever it was who said you can't tell a labour is low risk until it's over.

Sabire, I think you missed the point of my post which was that it should be possible to make hospital stays a pleasant experience, and that if this doesn't happen, then something is wrong.

Please note that I said I would be very happy for women who want homebirths to have them; my whole point is that women should be allowed to make their minds up (within the limits of safety) as individuals. I'm not saying other people shouldn't feel comfortable inviting midwives into their room when they are about to give birth. Just that I wouldn't. Not having the house tidy in that situation would have stressed me out, having to tidy it would have stressed me out even more.

fwiw I gave birth in the Princess Anne in Southampton. No blood on the floor, pleasant company on the ward, food perfectly pleasant (I had hotpot and Bakewell tart while I was being induced- slight oversight that, but I did enjoy it ). I have eaten far more disgusting food since- mainly in the General Hospital across the road.

inmylittlehead postpartum haemorrage was one of my concerns when considering a HB as I had friends who had experienced this during hospital births. On speaking to my team of midwives and researching myself I found that the term postpartum haemorrage covers a range of incidences and is used to describe blood loss from as little as 500ml and if it does happen it can often be managed at home or in some cases may require a transfer to hospital but it is unlikely to be a 'blue light' scenario. Modern drugs which midwives have at a homebirth shrink the uterus and slow blood loss. All the studies which I consulted could not find a record of any woman dying due to a post partum haemorrage at a homebirth.

Regards cord round neck again midwives at a homebirth have the same tools available to them as they do in hospital. In the majority of cases the midwife will deftly unwind the cord as they would in hospital as the baby is coming out and all is fine. In the instance that the baby is not breathing the midwives have oxygen and resusitation equipment with them and an ambulance would be called straight away in case immeadiate transfer is required.

Basically all of the equipment and expertise which would be used in hospital to initially deal with any emergency situation is also available at a homebirth. If you live reasonably close to a hospital there is no reason why any particular treatment could not be available to you or your baby in the same time scale as they would in hospital iyswim.

Does it ever happen that you call a midwife and there are none available? How does it work that you always get the one who has seen you throughout your pregnancy?

Depends where you live but it can happen that you call and are told that there are no mw's available so have to go into hospital but I've never known anyone whom this has actually happened to. You aren't guaranteed your own midwife normally either, tends to be from a bank of community midwifes so you get whomever is on call but my midwife was very good at ensuring that I met a number of the other midwives during my pregnancy so in the end I did actually know one of the midwives who attended my homebirth.

cory Yours sounds like what an ideal hospital birth should be...I think if they were all guaranteed to be like that, there wouldn't be as much of an issue. It's really good to know that there are actually situation where a high risk labour STILL allows you to have some level of 'control' (I do use that somewhat loosely here, since in childbirth there isn't a whole lot of control, realistically), and some say in how you wanted to be cared for.

Thanks to you all who answered my questions...I like hearing both sides, and I think I was pretty caught up in how great home birth can be...I don't think I ever really thought long and hard about the fact that it wouldn't be a safe and viable option for all women. Again, we have healthy little ones and are all here to tell the tale...and it doesn't matter how that happened!!

"But sabire what about haemorrhages? You can't predict them and they can kill you pretty quick."

Yes - haemorrhages are a problem for some women. But they are so unlikely to happen after a homebirth that two studies involving 24,000 and 6,000 homebirths found not one maternal death. You know what the greatest cause of maternal death is in the UK? Thromboembolism - by a long chalk. And one of the primary risk factors for thromboembolism? Caesearean section. (which of course you're more likely to have if you choose, as a low risk mother, to give birth in hospital).

"Another is the baby having the cord round its neck"

One third of all babies are born with a nuchal cord. For the vast majority it causes no problems at all. Those babies whose cord is very tightly wrapped around their necks, or is too short to allow normal descent will generally present with fetal distress during second stage - and the midwife will arrange transfer to hospital. And when you take into account that the worst thing for a baby with a tight nuchal cord is a protracted second stage - something which is much more likely to happen in hospital........

Cory - I get your point about hospitals trying harder to create a comfortable birthing environment. Very true. The majority of mums feel safer and happier in hospital and much more effort should be made to make hospitals safer and more comfortable for them.

'Regards cord round neck again midwives at a homebirth have the same tools available to them as they do in hospital. In the majority of cases the midwife will deftly unwind the cord as they would in hospital as the baby is coming out and all is fine. In the instance that the baby is not breathing the midwives have oxygen and resusitation equipment with them and an ambulance would be called straight away in case immeadiate transfer is required.'

I couldn't have pushed my baby out as the cord was round her neck twice without risking the cord snapping or her dying in the time it took me to get her out. Trust me, if I had been at home she would not have come out as quickly or in such a good condition as she did in hospital. She also wouldn't have had access to a team from the scbu ready to resusitate her if necessary. A mw cannot be deemed to be as skilled as a team of hcp's in a hospital.

"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"

Whatever midwives are 'for' theoretically, the evidence shows that if you are a low risk mum and you give birth in hospital you are significantly more likely to end up having major interventions in your birth (with all the attendant risks of these for you and your baby), and yet it seems your baby is no less likely to die or be ill after birth.

"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".

That's just silly really - you don't need equal numbers of women having homebirths and hospital births in a population to compare outcomes, you just need equally matched numbers in the research group, and enough women taking part in the studies to make for a reasonable assessment of the evidence. The research into outcomes connected with place of birth involve thousands and thousands of women, in the UK and from the Netherlands, where one in three births take place at home.

"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".

If you compare equally matched groups of women, and see many more of those women going into hospital will end up having c-sections than the women birthing at home - (even when both groups are low risk and matched for a range of other factors) then I do think you have to ask yourself the question - 'why is this happening'? If many more babies were dying at home than in hospital I don't think you would be arguing that it was just random chance that this happened.

"Main thing is healthy baby, healthy mum."
And women birthing at home seem just as likely to have a healthy baby, but are more likely to be fit and healthy themselves after birth, are happier with their births and have lower rates of PND than low risk women birthing in hospital. That's not just my opinion - that's what the research shows!

I do find it odd that some people on this thread seem to think that midwives attend homebirths with nothing more than some crossed fingers and a bottle of smelling salts.
The equipment available at home is exactly the same as in a stand-alone midwife unit so your risks at home are pretty much the same, yet there is no kerfuffle about women that choose to deliver there.
I am booked in a MLU which is 20 minutes transfer to the nearest labour ward, indeed I am now thinking I would actually be better off staying at home where we are 5 minutes from the hospital - because the midwives bring everything with them. Home midwives can stitch, do managed 3rd delivery, give Vit K etc, administer entonox & morphine. The only additional thing that I can get in the MLU is pethidine and the kiwi ventouse.

"think that midwives attend homebirths with nothing more than some crossed fingers and a bottle of smelling salts."

Lol

fibilou, that is exactly why I have decided to stay at home. Our local MLU is further away from the main hospital than I am. You are right in that there really is no additional equipment there so if you are closer to the hospital, they there is no benefit to the MLU really.

Also lol at a bottle of smelling salts and crossed fingers.

abeeceedee - I am not the one making that judgement. It is well documented that hospital birth in this country increases your chance of having unecessary interventions during labour. From what you say I don't think you know much about the process of birth or the various things which are offered in hospital during labour which can increase your chance of having interventions. If you have an epidural for example and can't mobilise your labour may be slow and longer than it would have been, you may struggle with the pushing stage and need episiotomy and forceps/ventouse or an emergency section. If you had not had the epidural you may have had a shorter, easier delivery with no help. If you ask any obstetrician they should tell you that any intervention during childbirth has the potential to necessitate another intervention.

Homebirth is not the problem, it is the level of care and the risk assessment pre-birth. You can recieve excellent care both in hospital and at home. You can recieve terrible care both in hospital and at home. There are risks to homebirth and hospital birth. Birth is fundamentally risky. It is a good idea to look up the issues yourself when planning your care and talk to the care providers about producing an individualised care plan for your birth whether it is in hospital, MLU or at home. Hospitals will administrate care to women in labour using their policy structure - if you think about it how likely is it that this way will provide you with the best care you can get?

If you have had a baby before with no trouble at any stage of labour (particularly trouble-free pushing stage), you baby is engaged pre-labour and you can manage without pain-relief that needs to be administered in hospital then homebirth is likely to be safer than hospital birth. There are risks to being in hospital. Stress of the mother should not be underestimated, a mother who is very stressed in labour will be more likely to struggle and need interventions. The most successful births are ones where the mother is relaxed during labour.

home births need 2 midwives, hospital births, you are lucky if you get one. I'm guessing home births are more expensive.

Framey - homebirths are less likely to involve obstetricians, anaesthetists, antibiotics, scrub nurses, additional midwives, paediatricians, theatre time, follow up visits, re-admissions to hospital, malpractice suits, trips to scbu, additional breastfeeding support.

The second midwife generally only attends for the last hour or so of the birth.

"If you have had a baby before with no trouble at any stage of labour (particularly trouble-free pushing stage)"

Our local hospital no longer suggests that women who've needed ventouse or forceps for a first labour are not suitable candidates for a homebirth, as so many primips end up in this situation after having an epidural.

I had a forceps birth with my first and my IM didn't think it was an issue when it came to booking a homebirth second time around.

During my HB, the 2nd mw (who was my regular community mw) only just turned up in time to catch the baby. She had to let herself in the front door to the sound of me bellowing like a wildebeest

If you factor in the capital cost of the hospital bed you occupy, a home birth probably costs less than half of a hospital birth, even accounting for occasional transfers for emergency interventions (which are less frequent partly because it tends to be a self-selecting group, and partly because women are more likely to avoid a cascade of interventions resulting in problems and eventually a cs). So all in all, home birth is probably the green and economicaly way to do things. I don't think it's any more 'selfish' than going into hospital because you're a bit wimpy and afraid and fancy having expensive pain relief drugs when nature could probably do the job for you, or because you are worried your carpet might get damaged, or whatever. In short, women have to decide for themselves and get on with it, and not judge each other.

PS I bet if we reduced the number of internals women had at home or in hospital, we'd reduce all sorts of other problems, such as the panic associated with failure to progress, infections being introduced, psychological barriers to birthing ets etc. What do other people think?