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.

What did the study involve?

The 10-year study covered all births in England and Wales from 1994 to 2003, totalling 6.3m, of which 130,000 took place at home. Of these slightly more than half (75,000) were booked to take place at home ? the remainder being the "accidental" home births referred to above. The findings, by the National Collaborating Centre for Women and Children's Health, London, are published in the British Journal of Obstetrics and Gynaecology (BJOG).

And what did it find?

It showed that the death rate during labour or after delivery (called the intra-partum perinatal mortality, which includes stillbirths) is one in 2,000 (0.48 per 1,000) for those who planned a home birth that was successfully completed at home. This is nearly half the average death rate for all births of 0.79 per 1,000.

Does that make home births safer than hospital births?

Yes ? but not if things go wrong. The researchers also found that for parents who planned a home birth and then got into difficulties and ended up in hospital, the risks were much higher, with a death rate in this group of 6.05 per 1,000. That is 12 times more risky than for birth completed at home and over six times more risky than the average for all births.

same study in independent as in telegraph here

But woozlet - all that tells you is that having things go wrong is a risk factor.

It doesn't say what the statistics were if the same problem was encountered in hospital, it compares problematic home births with ALL hospital and homebirths overall.

To do a meaningful comparison you'd need to look at (for eg) what the outcome was for a specific kind of foetal distress at home vs hospital.

Thank-you for elaborating, woozlet. The figures would seem to suggest that we are both right to some extent (as is only right, because we are mothers and mothers are always right).

no woozlet that's another misreading of the stats

the paragraph shows here -

Yes ? but not if things go wrong. The researchers also found that for parents who planned a home birth and then got into difficulties and ended up in hospital, the risks were much higher, with a death rate in this group of 6.05 per 1,000. That is 12 times more risky than for birth completed at home and over six times more risky than the average for all births.

that the comparison made is not fair - they are comparing planned home births where things have gone wrong with the normal hospital mortality rate. it would be fairer to compare it to the mortality rate for babies transferred to a SCBU. And not every hospital has one so there is many cases a long transfer time.

yep I agree, its not the best research. It is like they are perceiving that if the problem had occured in the hospital then the outcome would have been ok. It might have, it might not. I think it is safe to say it wouldn't be as risky though in those circumstances but maybe not '6 times as risky'.

Sorry no time to read whole post, but I gave birth (twice) in a midwife unit, 10 miles away from the nearest hospital. I chose the unit because I felt it was best for me and baby and I felt most comfortable there. I also had a lot of faith in the MWs there. After birth of both DCs (2 yrs apart in age) there was a problem with removal of the placenta (nothing specific - it just wouldn't come out). Both times, I was very nearly rushed to the 10-mile-away hospital, which made me VERY upset cos I didn't want to go. Luckily in the end everything was okay. But I don't think I was being selfish (although both babies would have had to be transported by ambulance with me etc etc). I was doing what I thought was best and was understandably distressed when it looked like it wasn't going to go to plan.
Also when I was in the birthing pool with DC1 they asked me to get out cos the labour wasn't progressing. I went mad and said I was staying there. I went for it and had DC1 10 mins later. I don't think I was putting DC1 at RISK (I certainly wouldn't have done so intentionally) but giving birth does funny things to your mind (and body !). Within reason, we should all be allowed to make our own decisions.

pigletmania

I know it can sound scary to hear that a baby's cord is wrapped around them but it is a fairly common event and can usually be dealt with promptly and without fuss by any midwife.

I had a homebirth with DS and he emerged with the cord around his neck and body (it was quite a long cord!) The midwife deflty unwrapped it; there was no panic, no fuss. All fine.

i think it does come down to trust. my first midwife, had she told me to transfer to hopital, i'd have resisted, because she was v. anti-HB so in my mind her assessment was not fair nor her opinion trustworthy. the midwife that actually attended I would have trusted OTOH...

you have to make your own decisions in the end, and get as good a picture as you can at the time.

Also meant to add that midwives do check heart rate during a HB, using a doppler, so would know if a baby's heart rate suggested they were in distress.

Have only read the OP, but I think that YABU. Sometimes people need to be by themselves to focus on opening their flower.

Strep b infection is carried by a certain percentage of the population and there is a small chance of it being passed to the baby at birth. This risk can be reduced to virtually zero by giving antibiotics, hence the test at 36 weeks (in most western countries - can't remember if I was tested during first pregnancy here).

www.americanpregnancy.org/pregnancycomplications/groupbstrepinfection.html

Have never heard of it being picked up in labour.

Balloonslayer, to answer your question, DS1's birth was never going to be an easy one wherever I had him, because of the position he was in. But the hospital spectacularly mismanaged everything, to the point where I was unconscious due to having been giving an overdose of the drugs they used in the spinal (and various other things they didn't do that they should have, plus failing to site the spinal correctly the first two times). My blood pressure dropped and of course this had an effect on DS1 so he became distressed. Luckily the effect on him was only temporary and he was born in the best of health If only the same could have been said for his poor mother.

As an aside, the thing I find most shocking from Woozlet's stats, is that there were almost as many accidental HBs as deliberate ones!

Not read the whole thread. However, it has struck a cord with me. I had a normal pregnancy and I was hoping for a water birth at hospital. I live maybe ten to 15 miles from hospital and this journey can take up to an hour if traffic bad. My waters broke with meconium and within an hour I was having a crash section with GA. it took maybe 5 minutes to get me from birthing room to theatre. I accept that if I had a home birth I would have been transferred to hosp at that time. However, it would still could have been touch and go.

I would never go as far as to say that women are selfish to want a home birth. However, I am so glad I didn't take that chance.

I couldnt bear the heart monitor around my tummy - it was only in hospital that they insisted i used it. I did manage to get rid of it as i was too distressed and wriggled about too much .

So even in hospital i am not sure they would have picked up the distress of the baby earlier.

OP, VVU, VVVU. I'm sick of we women beating each other up on everything and anything.

FFS if our kids are not allowed to play with Conkers duie to 'elf & safety' then I'm sure the Great No10 Nanny would immediately ban all independent thought and homebirths.

Oh yes and they'd probably shoot all those mums that don't breastfeed while they are at it.

You may not agree with homebirth, you may think it's riskier. In some cases it isn't. It remains our choice, thankfully. It is not SELFISH.

For baby no 1 (hospital birth) I was left alone for hours and fainted alone in the shower after the mw (who hadn't noticed I'd lost loads of blood) made me have a shower and left the room.

For baby no 2 I had 3 midwives with me throughout established labour who were focusing solely on me, and could have whisked me into hospital at the first sign of danger.

Which birth was more risky?

bellissima - I had my second baby 13 weeks ago and have never been tested for Strep B during either pregnancy, its not routine in my area.

Having a baby in hospital was bloody awful

having a baby at home was bloody awful but inestimably BETTER both for me and him

You get almost zero help in some hospitals leading to panic intervention when surprise surprise nobody noticed your baby was in distress because nobody could be arsed to come and check for 3 hours

Can I just chip in with a thought here?

I've often wondered whether we ought to give consideration to community midwives (who see very little normal physiological birth during training and during their time in hospital), bringing practices into homebirth that are acceptable in a high tech environment, but may cause problems in a home setting that are then more difficult to resolve.

I had two homebirths (well, one homebirth and one home to hospital transfer) with an independent midwife who had spent almost the whole of the previous 2 decades doing very little but delivering babies at home. She was very, very unwilling to intervene in my labours in any way at all - particularly when it came to doing things like vaginal examinations (which are interventions, given the way they can disrupt the normal hormonal cascade of labour) and amniotomy. In fact she suggested we transfer in during my third labour, which wasn't progressing, and wouldn't break my waters at home. She felt very strongly that once a labour needs any sort of 'meddling' from the midwife, then the mum is safer at hospital. She was also not enthusiastic about the use of pethidine at homebirths, although was willing to administer it, if it was what the mother wanted.

I remember reading an editoral in the BJM about the career pathways of midwives. It pointed out that in the past midwives either worked in the community doing homebirths or in the hospital, and that they learned a different set of skills to suit the environments in which they were working. The suggestion was that midwives who train in CLU's and even in most MLU are sometimes not equipped with enough understanding of physiological birth (because they so rarely see any) to practice safely at a homebirth.

I'd be very suprised if there's not something in that. I wish all areas had decent homebirth rates and dedicated homebirth teams. In our area the planned homebirth rate is the same as the unplanned homebirth rate (ie really bloody low) , so midwives don't get enough experience at home deliveries. It also doesn't help that they circulate them through the MLU and the CLU too so they see even less homebirth than they might otherwise.

www.belfasttelegraph.co.uk/news/local-national/home-birth-warning-after-baby-death-14554966.h tml

Belissima, have you seen this article on Strep B?

here

It doesn't support the view that prophylactic antibiotic treatment reduces the incidence of infection to nothing in babies.

There was a recent Cochrane review on this issue - can't remember what it said accurately, but I think it raised doubts about the efficacy of this treatment in preventing infection. Can't access Cochrane right now so can't check it.

Sorry - would want to add that it's very sad that articles like the telegraph ones will suggest that the place of birth was implicated in the cause of death when this hasn't been confirmed by autopsy. How devastating for the family.

BTW - Ireland has an unusually low rate of homebirth. I supposed you'd expect the obstetric community to be more concerned about it than over here - given their lack of experience of birth out of hospital.