almost convinced by homebirth article in the Guardian this weekend...

[elportodelgato]

I don't know if anyone else saw this article by Sali Hughes about homebirth on Saturday in the Guardian Family section? probably there is a whole thread about it somewhere but I can't find it...

I've never considered homebirth before but this article has really made me think again. I had a straightforward pregnancy with my DD but she was induced at 41+3 so I was in hospital so they could monitor the induction. Besides, it was my first baby and I would not have wanted to be anywhere except hospital. The whole labour was 7 hours in total and I did without any pain relief (not out of choice btw, would have loved something to take the edge off) until G&A for the pushing stage - I tore and had stitches but otherwise all was normal. It's entirely possible that I will be induced this time around too but if I'm not then I am really considering homebirth - can someone come and tell me if I am being silly and it's my hormones?

I almost cried when I read the bit about her being tucked up in her own bed in nice clean pyjamas with her new baby. It has made me really realise that my hospital experience last time was 'OK' but not amazing - busy London hospital, laboured for the most part behind a curtain in a ward which was not at all private or pleasant and I remember being hugely embarrassed when my waters broke on the floor. In the night following the birth the call button in my cubicle didn't work and no one came to help me. Because of my stitches I needed help to get to the loo etc but no one did this. I'd like to avoid all these downsides if possible and suddenly homebirth looks attractive. Can anyone offer a view?

Exactly nigglewiggle.

I would probably have been given forceps with my first birth if I'd been in hospital. The midwife told me so afterwards. She'd worked in a large, regional hospital before getting the job in the MLU (which was considered the creme de la creme of midwifery jobs btw). She said that after two hours pushing, the hospital would have been keen to intervene. She had the experience, confidence, patience and time to know that this was a normal, tough, long first labour.

If I'd been in hospital, and ended up with an epidural, forceps, or even a failed forceps and Csection, I would no doubt have convinced myself "Goodness, how lucky I was there, if I'd been anywhere else my baby might have been put at risk!!"

The simple fact is, one intervention can lead to another, and interventions are far more frequent in hospital. Fact. Just read the section on Epidurals on Mumsnet if you're in doubt. The list of side effects, and increased risks and knock-ons makes it very clear. Yet if you decide to have an epidural for pain relief, no one berates you for choosing that, even though statistically it poses more risk. Why then, is it 'acceptable' to criticise HBs when the evidence shows that they don't present a greater risk anyway?! It's just not logical.

At the end of the day, the safest method of birth for a normal straightforward situation is one that is non-medicalised. Many women don't want that, or want it but accept interventions, but it doesn't alter the fact that most births could happen completely naturally, and are very very safe at home.

Hoping for a home birth this time. Had hospial birtn with DS, and then planned a home birth and had to transfer to hospital with DD (she was a footling breech). My Mum is really worried about the home birth but I am certain that, if baby and I are both healthy, it is the safest place for me to be.

I agree that there is also this perception that if you're in hospital, in the event of an emergency, you'll be on the operating table out cold within 5 seconds, with the top surgeon operating on you and all the necessary staff in attendance.

Wrong.

Time is needed to scrub up, prep the patient etc.

If an emergency occurs at home or elsewhere, the medical staff in attendance are already working on the patient. If you have a 15 minute ambulance ride, the medics are working on you. It's not like they chuck you in the back of the ambulance and leave you waiting!

I bow to your greater historical knowledge, GrendelsMum, but I imagine that the maternity wards and midwives in the 19C you mention were for the super rich, not the average woman. The NHS and free healthcare didn't come into force until the 1940's. Until this a lot of medical treatment that we take for granted on the NHS (ie penicillin) was directly paid for by the patient which was a luxury some if not most couldn't afford 100 years ago.

Foreverastudent, you say "most of the time people require a crash c-section under GA it is because of hospital interventions".

How do you know this? As people like to say on here where is your evidence which backs this up? The idea that hospital interventions causes c-sections - well maybe they do to a certain extent, but then in these cases there were probably problems which necessitated interventions. In my case, when I was having DS he was two weeks post date and he was probably starting to weaken because there was less amniotic fluid around him. I don't know for a fact but if I had waited longer it could have ended up in a stillbirth.

Grendelsmum, I think you are being pedantic and missing the general point on hospital births. Yes there have been improvements in hygiene etc which does, in part account for better outcomes (ie, mother and baby surviving) but you are forgetting other problems, for example decelerations caused by the baby weakening, uterine rupture, babies who are in breach and also babies born with the umbilical cord wrapped around their neck and need resuscitation. None of these are to do with hygiene - that is why I choose a hospital.

Your argument is spurious LeQueen. Mothers were not as healthy, nutrition was poor, infections were more common... There are various resons why infant and maternal mortality rates were higher, but that does not negate the current research that demonstrates that homebirth is as safe as hospital birth. And, no-one is suggesting being left to their own devices in a darkened room!

Just out of interest... how many of you on this thread who had a hospital birth also had a doula or independent mw?

Anyone?

I don't think LeQueen's arguments are spurious at all - I think they are well observed and spot on. I'm not anti home-birth (I've had one) but I think she makes some points that a pretty hard to argue against.

Well her argument does not compare like with like. She suggests that the improvement in medical science (amongst other things) that has led to the reduction in maternal and infant death is only relevant to current hospital births. She ignores how those advances have improved antenatal care and midwife training, all of which have similarly improved the safety of a midwife-led homebirth (ie not a freebirth in a darkened room).

Pointing out that "medicine has advanced" does not assist the debate.

" I think she makes some points that a pretty hard to argue against"

Err, what points are those then? The one where she equates a planned home birth today with that of a woman 100 years ago who'd had no antenatal care and was being attended to by a midwife with no formal training, no equipment and no medical back up?

"but you are forgetting other problems, for example decelerations caused by the baby weakening, uterine rupture, babies who are in breach and also babies born with the umbilical cord wrapped around their neck and need resuscitation."

Yup - but what causes babies to 'weaken' (your word) in labour? 60% of emergency c/s's are for 'failure to progress' combined with fetal distress. And this is much, much more likely to happen to you if you give birth in hospital!

Breech is a variation of the norm and the majority of breech babies can be safely born without intervention, if the mother is cared for by someone experienced in these types of deliveries. 30% of babies are born with a nuchal cord. The small number who need resucitation are usually resucitated successfully by midwives. Problems with nuchal cords are often picked up during labour, and in the case of a homebirth the mother would be transferred as soon as fetal distress was identified.

In any case, this is all a bit pointless. For all you say about the problems women have in labour which make a hospital birth a safer option - none of this seems to ensure better outcomes over all does it? Compared to mothers giving birth at home?

Marchpane, I had my second baby at home with an independent midwife, and my third in hospital with the same midwife present.

Maybe I'm just lucky to have had a positive experience in a great hospital with great staff. HB are becoming more popular round here though (I'm in the South East). 3 out the 8 in my NCT class had HB.

My DSIS had a planned HB with DN and can't speak highly enough about the experience. I can totally see it has its merits. I'm just a wuss and worry about outcomes a lot

Aren't we lucky to have the choice!

DD1 was a planned home birth, but after a VERY long second stage I was transferred to hospital and had a forceps delivery. Even though I had what many people would consider a difficult labour my recollections are quite positive, mainly because most of my labour was spent at home and I think I coped better with the pain there than I would have done in hospital. I also think the one to one midwife care you get with a home birth is a massive help whilst you're labouring.

DD2 was a planned hospital birth but only really because we'd moved house and were living much further from a hospital and also the hospital was much nicer with much better facilities, (more like a mlu). Also I couldn't be bothered to deal with laying down loads of plastic sheets again. In hindsight this was very definately a good choice because I made a mess and the midwife required an entire change of clothes. Just think it could have been my carpet and curtains.

During world war 2 when the doctors went off to war the mortality rates of women and babies fell. Go figure.

During the Enlightenment and Industrial Revolution rich women stayed at home to give birth and the doctors (or midwives) came out to them. If you didn't have the money for this, it was safer to stay at home in a city. Or live in the countryside where the infant and maternal mortality rates were much lower and deliveries down by midwives.

Many many women in cities went to hospital to give birth. These hospitals had routinely 25 - 30% deaths of mothers from puerperal fever with occasions of epidemic with death rates of 100% as well. Hospital births in charity hospitals (overcrowded and underfunded pet projects of philanthropists, I am assuming here) were encouraged to prevent poor women and the destitute from their babies at home. For similar reasons co-sleeping became frowned upon and the poor were educated into sleeping away from their babies. 'They' (the church and state mostly) were thinking that poor and destitute women would deliberately overlay their babies and try to pass it off as a natural death.

Death from puerperal fever only began to decline after the work of Louis Pasteur in 1862 and Lister's research in antiseptics shortly after that doctors began to understand that they were the main cause of death of women and babies.

The work of Semmelweiss and Oliver Wendell Holmes (1844 and 1843) had already shown that filthy hands, clothes and kit was the cause of puerperal fever but their work went unheeded. Doctors thought it was poncy to be clean back then: not washing their hands between patients and prided themselves on wearing gowns made stiff by blood. It was Semmelweiss I think who noted that mortality rates in his hospital was much higher than in the midwife led one.

So Le Queen's ideas don't hold water here either.

"to prevent poor women and the destitute from killing their babies at home."

"Presumably you're in the ambulance because the midwife can longer provide the level of care/expertise you need?"

You can't presume this though. the majority of reasons women transfer is because they would like and epidural which can be a decision based on many factors.

Another reason can be that the midwife feels like she has identified a problem which she does not feel confident or have the experience in attempting to resolve at home eg breech, shoulder dystocia. When home births were more frequent the skills for resolving these issues were more prevalent among midwives. Sometimes women decide on a transfer and then proceed with vaginal births in the hospital anyway because she or the midwife is happier to proceed there.

Transfer for PPH has been addressed further down the thread. Cord wrapped around the neck has also been discussed too. If decels are because of the cord around the neck (and other reasons) then the one to one care at home births ought to allow it to be picked up earlier than in hospitals where one to one care can be thin on the ground.

Decels are more common because a woman is in the lithomy position (hospital), has had an epidural or is having constant fetal monitoring.

Uterine ruptures don't happen like a balloon bursting on the grass. Again, warning signs are there are one to one care (where ever birth is taking place) is more likely to pick waring signs. Besides they are more associated with inductions which is a hospital event.

There are catastrophic incidences which can still happen that have not been addressed. Some of them would have been catastrophic irregardless of location. It is about taking ownership of one's choice of location and most of the people who seem to have chosen home births have educated themselves of the risks in both places and have plopped for home births as the set of risks they prefer to take. And many of those have also thought considered ownership of the possibility of a catastrophic event leading to the baby's or mother's death or disability.

you can keep your kooky midwife and your crazy home birth.

Exactly. The guardian article made it clear that most transfers to hospital from home are because the woman wants an epidural for pain relief- ie: not because the midwife can't cope or the baby is in distress. The problem is that all transfers then get lumped together in the same statistics, so anyone looking at them gets the false impression that HBs Lead to more transfers due to problems than is actually the case.

Anyway, all this is slightly off topic because as the evidence proves, for the majority of births, a HB is just as safe as hospital. There is also evidence that being in hospital and having the interventions which go with it can affect outcomes for mother and baby. Eg: read the mumsnet section on epidurals . It lists the side effects and possible knock on effects. That's something that only happens in hospital.

Couple of facts:

Midwives know what to do in emergencies!
When they attend you they will have equipment with them for recusitating baby or you. They will also have the same drugs as the hospital for serious bleeding, so in emergency the actions in the first instance would be similar.

I have done both longbhospital induction /emergency section, and twin home birht. Home birth anyway. If you are pregnant for the first time do consider having baby at home, as fist time pregnancy is NOT a reason to need to be in hospital.

We had a home birth amazing and so so relaxing in your home we had a doula with us Deearna which really did make all the difference, when it came to being calm and relaxed Deearna had us all calm and relaxed.

We knew exactly what was going to happen and when.I was totally prepared having completed a birth plan with my team

We didnt need to ask for lighting to be dimmed, Deearna knew from my birth plan my wishes and she really did make sure this happened where possible.

Dimmed lights , warm water , candles burning and a massage really did make the difference.

I remember just lazing in the water having my shoulders massaged by my doula,some jazz music playing and Deearna bought a candle to burn in the background.

Our midwife Jasmine was fantastic and her and Deearna together were just the best birth tteam i could of wished for.

Jasmine & Deearna not sure if you are on here but you both really did make a difference I think you should always work along side each other.

I had a hospital birth with an independent midwife present. What is the point regarding that? I am doing it the same way this time round because she kept DH and I calm.

tittybangbang, In answer to your points:

there are reason why babies weaken during labour. It is most common when the baby is post-date because there is insufficient amniotic fluid surrounding the baby. In days gone by this is one of the reasons why babies did die if they went overdue. Some decelerations aren't dangerous but that is why they monitor the baby, ie, to see whether the heart rate comes back. Decels may also be more common in hospital because usually if a woman is in hospital there is a reason why she is there - if my first birth had gone to plan I would be having number 2 at home.

Regarding breech. Not sure if you know this but delivering a breech baby is not actually covered in the MW course anymore, which personally I think is shocking. If I were to ever have a HB I would like to know that the MW had been trained to deliver.

Regarding the nuchal cord - yes it is fine if the baby is still alive and breathing but what if, for instance, it isn't and the baby requires resuscitation?

You are right that for the majority of births a HB would be just as safe as hospital but for the reasons which I have already stated (and in my view and the view of statistics) I would prefer a hospital where there are doctors present.

My homebirth with DD2 was one of the best things I've ever done. I wish now I'd had the nerve to have DD1 at home too. It was lovely to have a shower in my own bathroom, eat and drink what I wanted, when I wanted, to feel totally comfortable and at ease in my surroundings, with DP, two MW's and my Mum there should I need anything. After a (unnecessarily) traumatic labour with excessive intervention in hospital with DD1 I wanted to feel secure and confident and in control. My labour didn't hurt especially, just a few ouchy moments (ie crowning) and the mw who stitched up my tear as I sat on my sofa did a 150% better job than the Dr who stitched up my episiotomy when I was in hospital.

DD2 was a whole pound bigger than DD1, but came out quicker and easier, and I think this is as much to do with the fact that I was relaxed and happy as anything else.

My advice? Book a homebirth, you can change your mind and go into hospital at any point, even when you are in labour. But if you don't book a homebirth and then decide you don't want to go to hospital, you are shafted.

And DD1 slept right through DD2's birth, and came through to our room in the morning to find her new baby sister asleep on my chest in our bed, we had breakfast together as a family, all quiet and chilled, no call bells, no "visiting". Lovely.

Do it!!!

MWs are trained to deliver breech babies.. also , as some babies are undiagnosed breech, all MWs have training in delivering undiagnosed breech too. you might find many midwives are not experienced in delivering breech babies as many are born by c.s, but they have to know how to delvier breech surely, for the undiagnosed breech deliveries that occur. i have a friend who is a stuent midwife, am going to ask her re this, i also sit on a maternity services committe, again, am going to raise this re MWs not being trained to deliver breech, if this is the case. if it is, it is ,you're absolutely right, shocking.

hilda- i can well imagine if you are a midwife, seeing normal happy deliveries day in day out, you would opt for a HB.

IME paediatricians opt to go to hospital, having seen the consequences of the complicated births

novicemama: fundamentally, it depends on your attitude to risk: how do you feel about things that happen very rarely, but not never?

also: i think most labour wards now have private rooms.
How about a birthing centre as the middle ground?

"there are reason why babies weaken during labour."

Well - yes. I think we've covered that.

"It is most common when the baby is post-date because there is insufficient amniotic fluid surrounding the baby. In days gone by this is one of the reasons why babies did die if they went overdue."

Oh come on - it's massively more complex than that. The vast majority of women who carried their babies past 42 weeks in the days before universal induction for post-dates would go on to deliver healthy babies. It's just we're very bad at identifying which babies need to be be born sooner rather than later, so it's blanket induction for all.

60% of emcs are for failure to progress and labour for these mothers very often involves oxytocics and ctg. How on earth can we separate out those babies whose fetal distress is caused or exacerbated by being exposed to the too frequent and too powerful contractions that so often accompany induced and accelerated labours?

"Some decelerations aren't dangerous but that is why they monitor the baby, ie, to see whether the heart rate comes back."

Don't see the relevance of this to the debate in hand.

"Decels may also be more common in hospital because usually if a woman is in hospital there is a reason why she is there"

Actually that's really not the case! As far as I can see the research supports the view that most women who give birth in hospital could safely give birth at home and have no need to be in hospital. And when I was talking about higher rates of fetal distress in hospital labours, I was referring to research which compares matched groups of low risk mothers.

"Regarding breech. Not sure if you know this but delivering a breech baby is not actually covered in the MW course anymore, which personally I think is shocking. If I were to ever have a HB I would like to know that the MW had been trained to deliver."

My understanding is that it IS, because midwives still have to do emergency breech deliveries occasionally. It's certainly got a fairly big section to itself in my midwifery textbook!

"Regarding the nuchal cord - yes it is fine if the baby is still alive and breathing but what if, for instance, it isn't and the baby requires resuscitation"?

If the baby requires resuscitation then this is done by the midwife at a homebirth.

But fair enough if you don't want to give birth at home. It's not for everyone!