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.

I'm an untraumatised person. I didn't have any chemical pain relief (no pain relief for the 2nd stage) and I actually enjoyed giving birth - I'm quite looking forward to doing it again! But a sample of one doesn't really say much for statistics...

re. IMs and risk - some risk can be mitigated by experience. One of the reasons the NMC give for not recommending vaginal breech birth is that aren't enough MWs with breech experience. Becuase IMs tend to take on women deemed "high risk" by the NHS they have the opportunity to develop and maintain the skills that can reduce those risks to a more acceptable level. That said, from my experience, whilst IMs may be more open to taking on cases that the NHS are reluctant to support, they still want to be in a working relationship where the mother will take advice. They have no desire to be in a malpractice suit becuase they didn't discuss the risks of an individual, or because they didn't advise transfer to hospital when circumstances dictate.

"Sorry Sabire but you are just a perfect example of that dangerous type of mother who has a little bit of knowledge and THINKS she understands the processes of childbirth and labour"

[Just in case you can't resist coming back for a look to see if there's been any response to your post......]

Perhaps you could get your husband on here to give us all a tutorial. Am I not correct that 30% of births involve a nuchal cord? That was referenced from a current edition of Mayes Midwifery. Is it also not true that babies will often present with fetal distress during second stage if they have a nuchal cord that may cause problems during a vaginal birth?

And by the way, when I was making a decision about having my baby at home, I asked for expert opinion from my obstetrician, from my independent midwife and from an NHS consultant midwife. I assume other women make their decisions on equally expert advice.

"I also am annoyed at your judgement about other women's ability to cope with pain. You have NO RIGHT to make a judgement on this. Just because YOU could cope with the pain, you have no absolutely no right to say that "Most women can cope with the pain of labour" - sorry, who do you think you are? How many births have you attended please?"

I've only attended a couple of dozen births, but my comments have nothing to do with what I observed, or my own experience as a mum of three - all three births very difficult (I have had very long labours and big, posterior babies). My observation is based on the fact that most women choose to give birth without an epidural, even though in this country most have the choice to opt for one. If the majority of women found the pain of giving birth unbearable I suspect you'd have much, much higher rates of epidural use in subsequent births. In fact rates of epidural in subsequent births are lower than for first births.

Finally,
"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."

Well, of course she didn't, you were paying her to think it wasn't an issue!!!

Yes - and she's such an evil, horrible person she was happy to put my baby and me at risk in order to make a few bob out of us. Actually she's a friend and a colleague, and I'd trust her with my life and the life of my baby. Your comment is very arrogant and very unkind.

"However, I am willing to admit that what I do know is in no way comparable to someone with a medical qualification. Perhaps some of you need to admit the same - as I say, it is people like you who think you are experts who are actually quite dangerous, particularly when you start evangelizing to other people who assume you have more knowledge than you have."

What is dangerous about my beliefs? I'm not delivering babies! Or discouraging people to disgard the advice of medical professionals. But I've had five years of formal education on normal birth, and work with parents in an advisory capacity. I also know enough about my body and about normal childbirth to be able to make choices for myself and for my baby, as do the thousands of other women who opt for homebirth in this country. What is your husband's expertise when it comes to normal birth? You said he's a doctor? In what capacity has he been involved in normal childbirth? Is he an obstetrician? If he is I doubt he's seen many normal labours from start to finish.

So - why do you think the RCOG has come out in support of women's right to choose a homebirth - supported it as both 'safe' and beneficial for women and their babies? (RCOG statement on homebirth).
"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.1-3"

TBH I find your comments on this thread paternalistic and patronising. I imagine mumsnet is a bit of a challenge to you; I suspect you felt much more comfortable working with impoverished women in developing countries where nobody questioned your 'superior' knowledge about birth (despite the fact you are neither a midwife or an obstetrician), and where your husband was treated like a god. Seriously - it's attitudes like yours and your husbands which are scary. It's like a horrid flashback to 'Carry On Matron'.

(or this hilarious clip: The Miracle of Birth)

goodgrief

Alygrylls - I'm quite willing to have my beliefs challenged, but you haven't offered up any evidence which would persuade me to reconsider my belief that homebirth is safe for low risk women in this country.

If this is a debate and not just a squabble, we ought to be discussing this issue in light of the research into place of birth. There really isn't any point trying to make headway with this argument without referring to it!

I have found most people take the initial position of assuming that homebirth must always be riskier. Which is a forgiveable mistake, as intuitively I think most people naturally suppose an ideal standard of care and practice in a hospital, (which sadly does not always exist) and conversely assume a substandard availability of resource and equipment at home (not realising exactly how much assistance / intervention can be provided at a HB if needed).

The FACTS show that this assumption is wrong. However counter-intuitive this truth seems. And then those people either demonstrate themselves to be open-minded and intelligent enough to begin to understand why their assumptions are flawed and accept that for low risk pregnancies, planned homebirth is as safe for mother AND baby (or in fact safer) compared to like for like planned hospital deliveries.

Or they ignore the inconvenient truth and obtusely bleat on about their own opinion, as if their vehemence somehow negates the actual facts; the well constructed, peer-reviewed, unbiased studies of thousands of births.

I don't pass judgement on women choosing birth in either setting. I wish both scenarios alllowed optimal outcomes at all times.

I do pass judgement on people who never let the facts get in the way of a good argument. (to paraphrase another mnetter)

littlecarrot Bravo!

why do people do that? I asked a perfectly acceptable and genunine question about why the medical profession support home births if they are so dangerous and the person I asked it of buggered off. Perhaps because there is no easy answer to that one

Alygrylls - I think there has been much debate here actually. I would like a homebirth, my DH is concerned and after reading this thread he has seen that there is much research to support it. I don't think people have been evangelical - passionate perhaps but that is always the way when one shares their own experiences. I for one have been given much food for thought.
at sabire's link

abcd, you say "I showed your post to my husband who is a doctor"

Really that doesn't impress me. When I went to inform my GP I was pregnant she said "I don't deal with pregnancy and I don't really know anything about it"

'If we could predict a safe and normal labour this wouldnt be an issue, but its all about the unknown. Nobody on here can say with 100% certainity that their birth will be straight forward, nor can you say a hospital birth will be without fault but surely its safer to be near the medical equipment and teams should the worst happen?'

I made this comment a few days ago and noone really responded to it. I'm interested to know why so many of you are happy to have a hb because your pregnancies and perhaps previous deliveries have been 'normal'. What has that got to do with this next birth? Everybody has the potential to become a high risk case and for some it occurs very quickly. As I have said before, I'm not against hbs or natural childbirth I just don't understand why you would be happy to wait for emergency treatment should it be needed.

Because it is more likely that you won't get into the situation that you need emergency treatment if you are at home because, as it has been pointed out many times on this thread, the level of intervention standard in hospital leads to more intervention which leads to an obstetric emergency.

For all that have had obstetric emergencies, do you consider the thought that they might actually have been caused by all the interventions you're so glad you had ?

Fibilou - I have also pointed out my 'interventions' on numerous occasions to no response from anyone. I laboured for 13 hours on g&a, I was checked once in that time by a mw upon arrival at the hospital. They placed a doppler on my belly once every half hour and checked my blood pressure. I laboured standing up all day, not strapped to a bed or too drugged etc...

Unfortunately after 13 hours my babys heart rate started to fall drastically after a very heavy show. They then put me on a heart monitor, checked my progression to find I was nearly 10cm, so they broke my waters and I tried to push. This made babys heart rate go down more and so a consultant pulled her out very quickly with a ventouse.

She had the cord wrapped around her neck twice which would have either a)snapped or b) strangled her had I been left to push her out by myself.

Now, what interventions caused the cord to wrap around her neck? Would a relaxed hb have allowed it to unwind by itself? What would the earliest indications that this was going to happen be so I could have been transferred to hospital in enough time to not cause damage to my baby?

I know that I am in the minority, but what I'm trying to say is anyone could be for a variety of reasons and I just don't understand why you would opt to be further away from the medical care.

hear hear littlecarrot.

But I think it's only 'counter intuitive' to assume homebirth is unsafe if you start from a position where you ignore the fact that with humans as with all mammals, the progress of labour is governed by a hormonal cascade which is highly vulnerable to disruption caused by social and emotional stress - all of which can be more common in unfamiliar institutions where we are forced to mingle with strangers at a time when we are feeling acutely vulnerable.

TBH I wonder if the high tranfer rate for primips birthing at home might be because even those of us who have read the evidence are subject to a great deal of unacknowledged anxiety about birthing out of hospital, anxiety caused by social conditioning.

Or could it be anxiety caused by knowing that should the need arise the medical expertise is in the wrong place?

This argument can be viewed from both ends. I understand the need for home comforts and familiar surroundings but can't understand why its ok to be so far from help.

Any response to my previous post? What would have happened if I had opted for a hb?

Hollyoaks - my first child also had his cord wrapped twice round his neck. It's a very rare occurance and I know of no one else (other than you now!) that this has happened to.

He was born blue, barely breathing and with a very thready pulse. If you search on my name you'll also see that he was a planned homebirth. Despite these issues it was the best birth for both of us. The midwives totally knew their drills, had the resuss equipment that they all carry, and he perked up perfectly well. I had to stop pushing for a while to allow him to descend more slowly so that she could access his neck and cut him free. If at any point she'd have said that I needed an episiotomy of to emergency transfer then we'd have done it in a heartbeat. I knew and trusted my midwife - that wouldn't have been the case with a stranger in hospital.

I know I'm babbling but as you pointed out, these things do just happen sometimes, there isn't necessarily any identifiable cause, and it often doesn't matter where you are when it happens. To be very blunt, we discussed the possibility that our child might die during birth at home (and of soure conversely, in hospital), and how we though we might cope with that. Having to go into the same room etc. I think anyone planning a hb has to accept that element of risk, and they are foolish if they don't discuss it. But then risk, and how bad we are as a nation at understanding and assesing it is another of my pet issues...

My point it, some people are comfortable with it, some are not. In many ways I don't give a rats ass what other people think of my decision, I know we made it with all the available facts, and with a great deal of discussion. It was the best one for all of us. I would just like people to accept that in the same way that I accept anyones right to decide to birth in hospital.

HollyOaks - you really can't know what would have happened had you been at home. You can only speculate. If I'm speculating, I'd say your labour would have been managed in a different way for a start. You probably would have been transferred as soon as there was a sign that your baby was in distress and that the distress wasn't going to resolve. Your labour might have been shorter also and your baby might have rotated more quickly. Your midwife probably wouldn't have broken your waters at home in that situation - what difference might that have made for good or for ill? Secondly - your baby was born vaginally, so the cord was long enough for her to descend. Using a ventouse makes no difference to the length of the cord does it? It might have also been the case that you could have pushed your baby out quicker and more easily at home, so avoiding a prolonged second stage, which would have been hazardous to your baby because of her nuchal cord (see here for information on 'fetal ejection reflex' and how an unsympathetic birth environment can disrupt this: here

I had a complication during my second birth, which was a homebirth. My baby got stuck (shoulder dystocia) and there was a real struggle to get him out. Two ambulances were called and were outside the house withing minutes (they were sent away shortly, as soon as we were OK).

When ds was born the midwife needed to resucitate him. Had this all happened in hospital I have no doubt I would have been saying 'thank goodness that happened in hospital' and there would have been doctors involved in the birth. But actually in the event the midwives handled it fine, and all was well.

"I know that I am in the minority, but what I'm trying to say is anyone could be for a variety of reasons and I just don't understand why you would opt to be further away from the medical care"

Midwives have medical training and medical skills you know! You're not giving birth out in the bundu without access to a telephone or to a sophisticated network of high tech medical back up!

The evidence suggests that you are less likely to have problems during birth if you birth at home. This balances out the additional risks that come with being further away from that high tech help (because it's undeniable that occasionally a baby will be born at home who would have done better born in hospital) and results in homebirths having as good outcomes in terms of maternal and infant mortality, and considerably better outcomes when it comes to maternal morbidity.

Sparkle - thanks for the response, I'm not judging anyone on their decision of where to have their baby just trying to understand why you would do it at home. I'm pleased you had a healthy baby and know its a very unusual occurance but also one of many that can crop up during labour.

I guess I just can't cope with the risk associated with being at home. Especially as the majority of my labour had minimal intervention but when needed the medical team were there. I think I had the best of both worlds.

Was your ds your first baby, dd was my first and she wasn't decending quickly enough to wait.

I wish I was as articulate as you sabire! There are so many people on mumsnet who put me to shame

Sorry - hope you don't mind me speculating Hollyoaks, I'm not a midwife, but I have spent a lot of time reading about the different management of homebirth re: hospital birth. I transferred in to hospital with my third baby from home after the labour failed to progress. My midwife and I talked through all the scenarios where transfer might become an issue, and what to expect. I think it's easy to assume that homebirth is just managed in the same way as hospital birth - just without the doctors and the equipment, but really it's not. There are different protocols for dealing with fetal distress and different strategies for managing problems in labour.

Hollyoaks - do you mind me asking what your response is to the EVIDENCE that homebirth has such good outcomes? That babies born at home are less likely to have low apgar scores, need to be admitted to SCBU, more likely to breastfeed successfully, and that mothers are less likely to need a c-section, and are in better emotional and physical health after birth? By the way, the research includes in the 'born at home' group all those babies whose mothers transferred in labour, who have poorer outcomes overall than the rest of the group.

Thanks sparkle!

'You probably would have been transferred as soon as there was a sign that your baby was in distress and that the distress wasn't going to resolve.'

From her heartrate dropping to her being born was less than 30 minutes (ish - bit hazy from g&a, but very quick).

'Your labour might have been shorter also and your baby might have rotated more quickly.'

If 13-14 hours long for a first labour, the first 6-7 hours at home?

'Secondly - your baby was born vaginally, so the cord was long enough for her to descend. Using a ventouse makes no difference to the length of the cord does it?'

No, luckily the cord was long enough but the ventouse minimised the time spent in the birth canal where she was in distress. This was my first baby which I couldn't push out quickly enough so I was told not to push.

'Midwives have medical training and medical skills you know! You're not giving birth out in the bundu without access to a telephone or to a sophisticated network of high tech medical back up!'

Agree, but the mw wouldnt have the skills to use a ventouse, she wouldn't have a scbu team plus incubator in her bag or a spare hand to hold my hand during the delivery. All of the mentioned people were in the delivery room when dd was born and I would rather have access to all of them than one or two mws and some basic equipment.

Ds was my first, yes. When we mentioned the homebirth to the in laws we could tell they were nervous, and FIL is a GP too. Ds was descending too quickly with my pushing and was getting strangled, which was why I was told to stop. It was the hardest thing in the world not to push! We also went on to have a second planned homebirth, which also had complications - like sabire's it was a shoulder dystocia, though it resolved easily with a standard McRoberts manoeuvre.

As to the why's, for us it was mostly about the safety and security of our own home - it's a very primal thing almost - my turf, my nest, mine. I wanted and needed to be here. That's the emotional side of things, but I can reassure you that I would never put that above any genuine specific medical risks. I really wouldn't, and we discussed it many times with the midwives whilst I was pregnant, as I also had chickenpox at 37 weeks pg with ds1 and parvovirus at 18wks with ds2, who was also bigger than ds1 by quite a bit. Close second was the fact that we are less than ten mins from the local big maternity hospital - we'd have had an ambulance here in the same time that it would have taken to prep a theatre. Hot on the heels of that is thirdly I wanted the consistency of care that a hb gives - 2 midwives that will not leave your side (the fact that both times I laboured so quickly is by-the-by: first time the second midwife got there with ten minutes to spare, second time ds2 had already been born!). Frankly the thought of giving birth in a hospital, whilst frequently unattended scares and depresses me. I think home-from-home midwife led units are probably the best thing for most first time mums, if only the funding were there. And that's a whole other debate...

Sabire - sorry cross post. I am not denying the evidence that many babies are born at home safely, nor that it's a safe and secure environment for mother and baby. What I'm saying is that no-one can know in advance the outcome of each delivery and if something does happen I don't understand why you would take the risk of increasing the time spent before a suitable medical response became available.

I know this is only applicable to a small number of births and many babies are and would be born safely at home, its the not knowing that would probably cause me more stress if I was at home.

P.S. dont mind you speculating on my labour and delivery just not sure I agree with some of your points.

sparkle - sorry cross posted with you too. I guess its just a matter of where you feel more comfortable. For you it was at home for me it would be hospital every time. I felt more relaxed in hospital than I did before I went in. Agree about mlu's being the best option for most people as a happy medium between home and hospital.

Just to point out, i don't agree with the op that your selfish to have a hb and dont think people do it blindly and with no research. Just trying to understand it from a different point of view.

I'm always happy to discuss my births and my reasons, especially with someone who is genuinely trying to understand, such as yourself. I just really, really resent being labelled by people like the OP, or the awful Melanie Reid column in The Times some months ago - that really got me riled, that one.

I would be as vocal for your right to birth in hospital as my own to birth at home - it's critical that women feel safe and supported in labour, and I don't care where they want to be tbh - I care more about the shocking shortage of midwives and lack of government funding that means so many don't get the impartial information and support they need to make their own decisions. You have to make a decision that suits you and your family - it's none of mine or anybody elses business; it's your right to make the decision that is best for you.

did anyone reading/posting on this thread just hear the piece on Woman's Hour about a Doula scheme in Hull? The Midwife from the RCOG who spoke in the second half of the piece made some interesting points about the current state of maternity care in the UK. Maybe it will be worth listening to online later on. It is not about home births per say but throws a lateral viewpoint on some of the issues which have been raised here by various posters.