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 was viewed as a straight forward case because of my health, age and other factors yet the birth wasn't easy, I had a huge tear that could not have been done under a LA. I could have been viewed as a good candidate for a HB. Turns out it was for the best it was a hospital birth.

The reason MWs have to tell you all the bad things that can happen at a homebirth is because it's their job to inform you of the reality: it's not all plain sailing for people who choose this option. Wrapping it up in cotton wool for you isn't going to guarantee a good outcome, sorry. This also applies for hospital births too.

I wish someone had told me that there's a chance you may be incontinent when you have a third degree or fourth degree tear, but no, I wasn't told about that. And no, it can't be found in any books. Rather than childbirth being made out to be all lovely and airy fairy I'd rather have the brutal hard facts of what can go wrong. Depressing yes, but that's life, things don't always go great for all women.

I find it weird that some people seem to think doctors do interventions just for shits and giggles. They only do it when they think it's necessary

I agree the MW had a duty of care to make sure I knew what could go wrong at home. But as you say, she should then have been as vigilant about the risks of hospital births and she wasn't. I also found it frustrating that there was no discussion of the statistics, just a list of possible horrendous problems that could occur. It would have been far more informative to give me an idea of how likely these scenarios were - and the emphasis on risks with no quanitification or balancing talk of benefits is why, I think, the NHS are often accused of shroud waving when it comes to HB.

We also all have to make the decision that feels right for us at the time - I just wonder how many women are put off even considering a HB because their MW's initial reaction is so negative.

I'm sorry some of you had such a hard time of it as well . One of the things I find hardest to deal with is that we never know the outcomes of the choices we didn't make - as with Framey's story earlier, which sounds terifying, we don't know whether the outcome would have been different if the mother hadn't chosen a water birth. When things go wrong in hospital its great that you're there, but you'll never know whether the outcome would have been the same if the management of the birth had been different.

As for why the concept of HB should be normalised, from a personal point of view I'm getting so weary of having to defend choices that are unconventional. I had a HB for my first baby, I had a HB for my breech baby, I used IMs rather than the NHS, I was still BF DD at >2, I did baby led weaning, DD is still in a RF car seat at 2.7... So many of our choices are different to the norm and different to those of the parents around me, and its getting increasingly hard to defend what I'm doing without making it sound as though I think their parenting choices inferior. I genuinely don't want to upset them over issues that I think should be individual choice, but nearly all of them feel they have the right to interogate me as to why I'd do these things. If there was a little more understanding all round wouldn't life be easier for all of us?

InMyLittleHead - I don't think anyone thinks that Drs use interventions for entertainment but I do think Drs are as bound by hospital policy as anyone else. If policy dictates that a mother is "supposed" to dilate by 1cm an hour on average and she's only "managed" 5 cm in 8 hours, how many Drs would go against that policy and not strongly recommend augmentation of labour, irrespective of the condition of the mother and the baby? As long as care is dictated by policy rather than individual assessment, and as long as Drs are acting to cover their backs in case of litigation (I'd still say that the current legal environment makes it far easier to build a defense case based on action rather than inaction, even if your initial action may have been unnecessary other than to follow policy), I don't think you can assume that intervention is recommended becuase it is 100% the best option for you and your baby at this time

With regards to litigation - if all the relative risks of home vs hospital have been explained and that conversation has been documented, how are the NHS at risk from litigation from a problem that they warned against? Part of making a choice is accepting some level of responsibility for that choice and the outcomes it led to.

inmylittlehead, i can only share my experience of intervention. I was induced so intervention number 1. I then had the urge to push at 7cm dilated because DD was back to back. The MW told me I had to resist pushing and the only way was to have an epidural so I couldn't feel anything. I didn't want and epidural but was damn near bullied into it. I didn't want an epidural because I truly believed that if I did, having been induced and having an OP labour an epidural would have just been one step away from forceps or emc. When I resisted the MW (who had me on my back by the way, the worst position for an OP labour) spoke to a consultant who told her to change my position, give me a back massage. My wonderful DH took over and breathed through every single contraction with me for 2 hours until I was ready to push.

DD was pushed out in 17 minutes. If I had taken the epidural that was being forced upon me I don't think I woul dhave had that outcome. I would love to know if anyone else who knows about these things thinks the same.

So no, I don't think they would have intervened for the sake of it. Its just that it was the first (and unnecessary) response of this very medical midwife.

But the consultant made the right decision... He wouldn't have been there if it had been at home (of course neither would the epidural stuff, but you get my point)

thats a good point - had you been at home with that midwife you would have remained on your back!! Or maybe even transferred!

Sorry, I wasn't very clear. The consultant said that if I was refusing the epidural the ONLY thing to do was what he suggested. The MW only went to speak to her after I steadfastly and absolutely refused it but an epiural was their FIRST option. It shouldn't have been.

Honestly, I was made to feel as if I was being so difficult. The MW even said to me "why are you being so resistent. i think you have been to too many NCT classes".

woozlet, if I had been at home I wouldn't have been on my back in the first place. I was only put on my back when I had a midwife change and she turned on all the lights and got me on my back. if I had been at home, that wouldn't have happened. In fact my community MW was flabberghasted when I told her what had happened And why would have have needed to be transfered. DD came out naturally with no distress when I refused intervention.

sorry, am i not explaining myself very well?

sorry woozlet, i see what you mean. But i dont' think a community midwife experienced in homebirth and supportive of active birth would have had me on my back, practically with my legs in stirrups.

Well when you said the midwife wanted you to have an epidural but the consultant eventually said don't, that was making more of a case for being in hospital, because at least then you can get someone who might overrule the crap midwife. Whereas if you're at home you're stuck with them. But I suppose a midwife who did HBs would probably be more into the no intervention thing...

bellebelle - I said a homebirth for a first labour is high-risk not all first labours are high risk. First labours carry unknown risks. It is easier to predict the risks of a second labour.

I never said going to hospital lowers the risk of the labour. Having a homebirth for a first baby however could increase the risk of the baby being damaged. If the baby struggles and is starved of oxygen on the way into hospital then the baby is likely to be damaged. Possibly unnecessarily.

There's no real benefit to the baby in having a homebirth for your first as you don't know how your labour will progress, your pelvis is untested and the risks are to the baby rather than the mother if things go wrong. In this country it is likely things would be fine but it is also much more likely that you will be transferred and end up delivering in hospital as the midwives have no previous labour to compare to and will be twitchy trying to pre-empt any problems.

My aunt has cerebral palsy because of the delay in getting her and my grandma to hospital during which she was starved of oxygen. Whilst it's unlikely things would go badly wrong, why take the risk? I'd say the same about women who had needed ventouse or forceps for the first delivery too. It creates a potential, rather than a tangible risk when having a homebirth but since the risk is to the baby why would you do it?

Exactly, I wouldn't be considering a homebirth if any of the MW were like her . Scary woman. And the consultant didn't say "Don't". She responded to my refusal. And i refused because I was well informed about what could have been the outcome of unnecessary intervention.

As someone who sits firmly on the fence as I have posted previously (all mine born in hospital but despite having medical training found that being in hospital made me very anxious) I can understand the desire for HB. I suppose all we can conclude is that no birth is completely predictable and risk free regardless of whether it is at home or in hospital, things can go well or badly in both. It is important that people are armed with the facts and can weigh up all the information. Hindsight is great and it is easy to say that things would have been different in different circumstances but decisions are not made with the benefit of hindsight. Neither setting is a guarantee of a positive outcome, so as adults we make the best decision armed with all the information and our personal circumstances and live with the good and bad consequences of our actions.

""

There's no real benefit to the baby in having a homebirth for your first as you don't know how your labour will progress, your pelvis is untested and the risks are to the baby rather than the mother if things go wrong.

Sorry - but on what evidence are you basing your assertion that first time mums have worse outcomes having their babies at home than in hospital? There is no evidence that this is the case, from this country, or from the Netherlands, where far larger numbers of first time mums give birth out of hospital.

By far the most common reason for transfer with a first labour is because the mother needs pain relief, or because of failure to progress. It's extremely rare for any mum to be blue lighted into hospital during labour with great urgency - including in the case of first time mums.

Actually there's a good argument that first time mums are suitable candidates for homebirths because 1) they have more to gain from the lower risk of c-section and 2) their labours are longer and slower so if they need to transfer it is usually less of a rush.

Really Curiosity - I do think that we need to look at the evidence on this issue - not just drop in things from the top of our heads!

Sabire - do you have an opinion about anything - that ISN'T evidence based???!!!

sabire - that's what I was talking about. That you are likely to be transferred in labour in order to pre-empt problems because the midwives are aware this is your first baby. It is not likely they would allow you to get to a stage where you would need to be transferred on a blue light.

Please read my posts before you comment. I haven't said first-time mums/babies have worse outcomes after homebirths. I said a homebirth for a first baby is higher risk as your pelvis is untested and that you are more likely to be transferred in labour. I also explained that actually I wasn't implying first labours are high risk just that a homebirth for a first labour is high risk and that that risk is potential rather than tangible.

I went into my first birth with blind ignorance that it would all go to plan. It ended in a crash section. If I had been at home DD would probably be dead. She would certainly have been starved of oxygen. All because the NHS believe in blind induction with out sparing the cost for a scan.

Good thing I was in a hospital.

No to mention the absense of drugs at home. That would never do!

What I don't understand is why the caesarean people are happy to say "to each her own" and time after time on these threads the homebirth people want to persuade everyone that there was is indisputably the best. IUt's not. I may be right for some and they should have one. But I don't ever want a babby exiting through my fanjo. Sunroof only for me.

at sunroof... nominated for quote of week

curiosity, could you clarify what you mean by "higher risk" - higher risk of what, if not of a worse outcome? I don't understand.

I was a planned HB who transferred for slow progress, and then ended up with a classic cascade of intervention I had sought to avoid. Epi -> synto -> IV IBs -> CFM -> catheter -> supine immobile position

When I got to second stage, I asked to be assisted into a favourable upright position to push, i.e. not flat on my back in stirrups. I was refused help. I was told the baby was in distress and forceps were insisted upon as the only option, after I had been pushing only for a few minutes. I refused forceps and consented unhappily to ventouse. Birth was assisted but I had almost pushed her out whilst they were preparing the equipment.

Her apgars were fine (8 then 9) but the consultant justified her threatening attitude by telling me the baby's heart trace was the worst she had seen.

I recently saw that trace printout. The consultant lied. It shows some variability (as you'd expect in second stage, but no significant accelerations or decelerations that could give cause for such panic and urgency).

The evidence suggests that if I had not been on my back, the baby would not have been 'distressed', and would have descended better as my pelvis would have been able to provide better passage. On my hands and knees or squatting, without continuous foetal monitoring, I believe the outcome would have been better.

It was horrid, scary, resulted in a 2nd degree tear, and I feel all this was caused by the interventionist approach. If I'd have stayed at home , or at the very least been able to continue with the birthing practices typical of a HB, the outcomes would, I feel have been better for me and for my baby.

But I suspect this is one of those scenarios that many people will see as "thank goodness you were in hospital so that the doctors could save you both".

I do believe doctors generally have patients' best interests at heart - but this competes with a fear of litigation from inaction as Sabire has pointed out. And I believe there is an arrogance in many doctors which leads them to take unneccessary action rather than accept that in many birth situations outcomes would be better without their 'help'.

Haven't read the whole thread, but what an utterly bizarre OP. Just getting pregnant is a 'risk', woozlet, any birth can have complications/ go wrong, no matter where you have the baby.

Having laboured brilliantly at home for nearly 2 days (planned hosp birth) I ended up with a 3rd degree tear once I got to hospital because I had a bleed and then the doctor insisted I got on the bed and stayed there - putting pressure on my backside meant the blood supply to the womb was reduced, which meant, oh how surprising, that DS ended up in distress. So I had to push him out quickly - hence tear. If I'd been able to continue birthing upright in the same way that I'd managed labour (and being at home I think you take more control) I think it's highly unlikely that I would have torn. The doctors meant well, obviously, but bloody hell they didn't have to live with the tear, did they?

I suggest you check your facts - though I'm sure a good many women on this thread have already put you right.

twofalls...I kind of understood you in that first post, and it sounds like we had very similar experiences. Both of my dc's were back to back; In the hospital, I was pushed into an epidural, then a pitocin drip, on my back, feet in stirrups, it took me an hour and a half to push ds out...fortunately...no forceps or anything, DS's head just looked a bit like a rugby ball for a few days!
Second birth, at home...I found walking around tremendously uncomfortable, so was tucked in bed, on my side with pillows between my knees...had a cup of tea and chatted with midwife. Hurt like hell, but I felt so comfy and safe!! Got in the pool at 9cm...on my knees, arms around DH, and DD was out in three pushes (about 5 minutes, tops). Absolutely no interventions that time, which I'm not sure would be the case if I had gone to the hospital.

Also, I didn't choose a home birth because I was under any delusion that hbing gives you a 'beautiful birth experience'. Labour HURTS...it's messy, it's ugly, it can make the sweetest woman mean. The end result is the beautiful part. I chose a hb because I wanted to be ugly, messy and mean in a place that I didn't feel like I had to be somewhat decorous for the sake of loads of people I didn't know, if that makes sense!! Also, I really do believe, from my own experience, and from listening to others that intervention can be counterproductive, and make what could be a straightforward birth (even if it takes a long time) a whole lot more complicated.

Read the whole thread MrsMerryHenry it is pretty interesting (and helpful if you are thinking about where to give birth in the UK).

"OK, so lets imagine that the default was for all women to give birth at home."

I would rather we not imagine that. For one, you are setting up an indefensible position here. Whenever you set up phrases will 'all' or 'no one' or 'everyone' etc in them, you are setting up a straw man. For some women, as it was with my first, hospital should have been was the safest place for me. I had pre-eclampsia. Should I therefore hold the position that all women with low risk pregnancies are selfish to want hospital birth because they take away valuable resources from women with complications who must give birth in hospital? No, that would be utterly unfair too.

There is a feeling in this thread that in hospital they are just intervening needlessly which I don't think can be true.

I can't see that feeling, tbh. Doctors intervene for a lot of reasons some of them are more ethically or medically valid than others. No general statement can simplify why doctors intervene. It is a complex decision based on their knowledge and training, (or lack of it) previous experiences, hospital policy, the patient's ability (or lack of) to advocate for herself, the doctor's personality, stress levels at the time, etc etc. The time of day or the day of the week and the month of the year even shows that there are statistical variations on what will be a likely outcome of your labour. For example, I would not be surprised that in August and Feb the C/S rates go up. Why? because many newly qualified doctors are on the wards. Talk about a lottery.

"Can I just go back to this programme I watched again?! At the end of the programme, the midwife said 'I would be a happier midwife if that happened in hospital'. Also - they phoned an ambulance and 15 minutes later it wasn't there yet."

Do you think that this midwife ever says after a quick and straight forward hospital birth (yes, I think those exist too). "whew, I would be a happier midwife is that happened at home." No? Didn't think so.

"Another thought I have had - midwives ime can be very blase about whether you are fully in labour or not. If you have a home birth do they rush out to you? "

No I don't think they rush out to you. I think they (ought to) listen to you and make an assessment as to how your labour is progressing and how you are doing on your own (with hopefully your birth partner/s). Then they decide from there whether to wait or to get moving. I dreaded the idea of the midwives getting to my house and then sit around tapping their fingers, waiting for me to dilate. But that was just me.

mrsmerryhenry you are wrong there. I laboured standing up and I tore badly! I gave birth standing up too. I had a third degree tear like yourself. You are more likely to tear where gravity is taking the strain.

lovechoc - I think the point mrsmerryhenry was making was that she was encouraged to push very hard and fast in second stage, because her baby was in distress, possibly because of her inability to mobilise properly in labour.

Third degree tears can and do happen when a woman is pushing in any position, but are less likely to happen when a woman is having a birth which can be described as 'undisturbed' (ie when she's not interfered with,not watched, is able to assume a comfortable position and isn't being badgered to get the baby out fast).