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?

They monitor the decelerations to see whether they are dangerous or not. Once the heart stops coming back or persists then it is a c-section. It obviously is a complex issue, because there are many more c-sections performed than necessary and I do think the NHS has a responsibility to reduce the number and also to make giving birth a more pleasant experience (I did feel a little like a piece of meat).

"Decels may also be more common in hospital because usually if a woman is in hospital there is a reason why she is there"
Maybe this was a bit of a strange way of putting it but if a birth is high risk then the mother will be in hospital to begin with.

I guess I am finding it a bit of a struggle to express myself clearly. The whole hospital experience is quite complex and there are so many confounding factors that it is really difficult to know whether the causes are iatrogenic or not.

You are also right tittybangbang - HB would not be for me. I am not sure my body liked the experience particularly.

Sorry haven't read whole thread, but for the record I was transferred from hb when having ds as second stage was too long and they needed to do ventouse delivery. However being able to do most of the labour at home, not having to worry about going to hospital and being sent back again (happens here) and so on helped the first stage to be very comfortable, and probably faster as more oxytocin etc. and the transfer was sensibly done and smoothly managed after careful monitoring by the mws. If I had another dc I'd certainly try it again. Horses for courses perhaps!

Ali you ask what point I make about independent MW or doulas at a hospital birth.

I was just pondering if any of those who are not pro-HB on the thread had employed one because I know the one-to-one MW care I had at home made a huge difference to me and my labour. Well as much as I can tell.

And I wasn't sure if I had a point really. Just curiosity. Funnily enough your (perfectly sensible and valid) reasons why you had an independent MW are exactly my reasons why I feel safer at home with the one-to-one MW care.

But I don't think anyone is going to say feeling scared, out of control and ignored is going to be a positive birth experience. So it really is about where you feel comfortable and best quality of care for mother and baby should be available at home and in hospital.

And I thought the going over due dates concern was about the placenta degrading but I'm not a medic.

Very useful and interesting thread. I am hoping to have a home birth second time around because I don't want to give birth in a busy, bustling, noisy and over-lit place, and I don't want to lay myself open to unnecessary interventions. Had DS at hospital: he was induced on due dates because of hypertension. If my BP seems to be going that way again, we'll act accordingly. But it's because of my 'previous' that I am using an Independent MW this time round - I don't want to find that I tick certain boxes because of last time and would automatically be channelled towards over-monitoring. My MW (and I!) are on the look-out for any adverse symptoms.

I've been having wobbles about a HB recently (not sure why) and this thread is helping me regain my balance, so thanks.

I'm not sure how a MLU unit can be a 'middle ground' unless it is attached to a hospital. Surely the expertise and equipment at an MLU is the same as you would have at home? I'm not sure what the benefit (other than proximity to a hospital) of a MLU is over a HB? Sorry, not trying to criticise the point, just genuinely wondering.

For me the nearest MLU is 15 miles away and further away from the hospital than I am now.

I worry when full maternity units are replaced with MLU because unless the provision for those with complications is the same of better than before there is the risk that another part of the demographic will be failed.

I forget who but someone further up the thread raised the point around better quality acute care and pooling of provisions.

I've not had chance to read much of this thread - very interesting though as DP and I are currently trying for No2. I will come back to it but i do have a question that hopefully someone wise can answer:

DD was born by emcs after being induced a week early cos my waters broke and I was positive for strep B and labour did not start. They kept wanting to increase the drip but DD's heart rate shot up when they did and they insisted labour had to be speeded up. Then then went for emcs.

it was, frankly, horrific (not the process as such but the impatient/pushy attitude of the hospital and consultants)and two years later I am still not over it.
If DP and I get lucky, is there anyway I would be considered for hb? I think hb is fantastic and I trust my body more than the doctors!

Marchpane, there are very few free standing birth centres in the country. Most birth centres are built alongside CLU's. They would never replace full maternity units with an MLU, unless there was a larger CLU nearby.

Interestingly enough, you only get lower c/s rates in MLU's when they are free-standing. Alongside centres seem to have similar rates of intervention to CLU's.

I believe my local hospital maternity unit is turning into a MLU in January, with no CLU AFAIK. If there were any complications you would have to be taken to the hospital in the next city.

If what you say is true I do wonder what the benefits are of MLUs? Though I have heard of people being transferred to an MLU after birth, so maybe from a recovery POV, if you weren't quite up to going home, struggling with BFing etc. they are probably a nicer place to be than a hospital, with no compromise over safety by then.

I found this article by Irvine Loudon, apparently both an eminent historian of medicine and a trained and practicing clinician, on 'Maternal mortality in the past and its relevance to developing
countries today'. Rather interesting:

" Historical data show that maternal mortality rates were lowest for home deliveries undertaken by trained and supervised midwives with no exceptions. ...

In contrast with the above findings, maternal mortality rates were very high in countries, states, regions, or areas where most deliveries were performed by physicians, especially in the hospital.
Maternal mortality rates were also high when maximum surgical interference in normal or potentially normal labors was
encouraged or advocated.

Another unexpected finding related to maternal mortality, which was the basis for the second question raised at the beginning
of this paper, was the inverse relation between maternal mortality rates and social class. Here the evidence comes almost
entirely from Britain. Infant mortality is known to be strongly
related to social class; the highest rates are found among the
working classes, whereas the lowest rates are among the professionals.
From at least the 1830s, however, the risk of dying in
childbirth was higher in social classes I and II (the upper and
professional classes, respectively) than it was in social classes IV
and V (the skilled and unskilled laborers, respectively). An
example of this is shown in Table 2, which gives data for
1930?1932 (16). The only plausible explanation for this social
class difference is that the upper classes were more often delivered
by physicians and, therefore, more likely to suffer unnecessary
interference, whereas the lower classes were delivered by
midwives, almost all of whom were trained by 1930?1932."

He also concludes that, rather to his surprise, malnutrition was not a cause of maternal or neonatal mortality.

It's a very interesting article, with some slightly grim bits on 19th century 'advanced' practice that I didn't include here.

The most local MLU to me transfers to nearest town but people can go back afterwards for postnatal care- only 6 beds so a bit different to the 40 bed unit I went to to give birth to DD. Unfortunately, it is about 50 mins away from me and so I don't think would take me, plus I couldn't contemplate that length of journey in labour.

I am still watching this thread and finding all the different views really helpful. I am still unsure as to what to do..I am veering between definitely wanting a HB and going into hospital.

FWIW having read some of the comments, my hospital experience, although I found it difficult, was fine ONCE I got to the delivery suite. Had good midwife, dimmed lights, no VEs, handheld doppler, helped at end to push due to back to back baby born with her hand at her head with no major tear (although put on my back at end which was very painful, this was actually to get her to finally rotate). BUT I was left alone in early labour and treated like a nuisance on the ward, not offered any pain relief either than 'pethidine or nothing' - told not far enough along for birth pool, then suddenly too far along. Requested epidural repeatedely, but none available and once it was I needed to push. Postnatal care was indifferent, mainly as they were so busy.

I am having a doula this time around regardless of where I end up. I would love to have a more positive experience than last time, but in order to feel safe and secure I have to reassure myself I'd feel that at home as well as in hospital. Must be said last time around I did not feel safe but frightened and out of control. However, I do feel I could have a more positive experience in the same hospital with the support of a doula to advocate for me - e.g. no-one actually insisted on the birth pool, DH felt intimidated etc.

My DH's grandmother is a retired MW and loves the idea of me having a HB.

Sorry so long, trying to sort out reasons why I've suddenly started doubting desire to have HB.

That's interesting titty that there are lower intervention rates from freestanding MLUs, and not ones alongside CLUs.

From my own experience, bumper, having my first baby in a freestanding MLU about 18 miles from hospital, it probably wasn't any different from a HB in terms of technicalities like pain relief available (gas and air) and the equipment (resuscitation kit etc).

However, we lived in a very small house at the time, which I didn't feel was conducive to HB, and also, being the first baby (and in the days prior to paternity leave, so my DH was back in work two days later!) I wanted the benefit of being able to relax there for a few days, meals cooked for me, cup of tea made for me whenever I wanted - that's the difference between a short staffed postnatal ward and a MLU!

As you rightly say, many mothers are keen to transfer to MLUs after the birth because the quality of care postnatally is often far superior. However, I know that in my local MLU, which only has about 8 beds, there was never any guarantee of transferring back from hospital, because priority was (quite rightly) given to women booked in and due to actually deliver in the MLU. So, if there were only a couple of beds free, and someone wanted to transfer back from the regional hospital, and a few women were due to give birth around that time and booked in at the MLU, then the woman at hospital would have to stay there. That was definitely another factor in my decision to deliver in the MLU, because I didn't want to either have a long car journey back to the MLU straight after delivery just to get the benefits of a much nicer environment, or even worse, be told I couldn't come back!

Titty I campaign for better antenatal care and one of the things we look at when there is a threat to maternity services is what will be the new provision? There have been instances where trusts have tried to withdraw some acute provision and replaced it with mlu. Which isn't the same level of provision.

It's just one of the things we look at - and sometimes the plans just need a bit of tweeking but sometimes they need the obvious pointing out to them.

I don't know much about what provision there is already for mlu vs consultant led care but I do know that all new plans must give at least the same provision. And sometimes they don't for one bit of the local population.

Eg i heard about a hospital consultation where they proposed closing a maternity unit and adding a mlu, with the idea that the reduction in clu provision would be addressed by dramatically improving another nearby clu. So far, so good. Except they had failed to realise that in this part of London about 20% of the women expected to use the new improved clu had no way of getting there on public transport and this was in a deprived bit of London where cars were not common to
every household. It was gently pointed out to them during the consultation process

That's a good point violet, I guess it's your 'home from home' experience when your home isn't appropriate. I'm not sure what MLUs are like in terms of settings, but I rather strongly suspect that our maternity unit will not change much and the MLU part just means less resources

I also suspect, Bumper, that the paternity leave issue is quite pertinent. It really wasn't that long ago that paternity leave didn't exist, so most fathers would be back at work the next day, or certainly within a couple of days. I would imagine these days, more women are keen to get back home because the father can have two weeks off. For me, it was a case of being in hospital about 20 miles from home, with my DH at work (about 20 miles the other way!) and having to do a 40 mile drive after work to visit me and newborn, or being a couple of miles along the road where I felt well looked after, and DH could visit more easily. DD1 was born on a Sunday night and was back at work on the Tuesday. Being in the MLU meant I was happy to stay in til Friday, then DH picked me up after work and we had the weekend at home together to get used to having a newborn.

The quality of postnatal care in the MLU was second to none - even down to having the midwife making me night time drinks and sitting and chatting while I bf, which isn't the sort of thing you hear about in busy hospital wards.

Sorry I meant DH was back at work on the Tuesday!

I'm assuming my sister (who manages a gynae / obstetric dept) knows what she is talking about and am quoting her when she told me that the reason is because there is usually insufficient amniotic fluid surrounding the baby over 42 weeks, and it is the amniotic fluid that provides the baby with nutrients directly. I think the amount of amniotic fluid is directly affected by the placenta. That is why 42 weeks is usually the time they start inducing. Of course, my understanding could have been lost in translation or my sister could be talking bollocks.

To be fair, I can completely understand why people opt for HBs - having all your creature comforts must make the whole experience much more relaxing and pleasurable. I do think there are problems with having a hospital birth as well as there is obviously a "chain of intervention" and unnecessary procedures are performed (although I am sure that there are some which are necessary). Also, I am sure that hospital MWs are probably (generally speaking) less competent than those that do HBs (that was definitely my experience).

However, I can't see my changing my view on the subject much as you are all doing a good job of trying to persuade me otherwise. I will never think that a HB is as safe as a hospital.

The "creature comforts" aspect is interesting, because it is often part of the accusation that HB is "selfish". It didn't really influence me at all, unless you include avoiding infection with MRSA and CDiff as a "comfort".

I didn't get into "my own bed" in fact I recall loading the washing machine not long after giving birth. I did get to vomit in my own Sainsbury's carrier bag but I'm not sure whether that is what people are referring to when they talk of creature comforts .

I was totally influenced by the fact that HB were less likely to result in intervention than hospital births and rather less concerned with so called "creature comforts".

Ali HB aren't recommended for over 42 weeks anyway. You have to be between 37 and 42 weeks here.

I would love to do a homebirth. However I loved my epidural so passionately last time that I don't want to forgo it the next time. So HB is out, but I do think it's a fantastic concept.

I can see where you're coming from niggle.
Although I found the MLU very comfortable and like a home from home, it was the wish to avoid intervention which was the driving factor in my choice rather than the comfy bedroom furniture!

Not in a million years. I would be FAR to scared about being the person that the unanticipated disaster happens to eg. Major haemorrhage.

Your uterus has a blood supply of 600ml/min. Your total circulating blood volume is about 4.5l. Ergo you can bleed your entire blood volume out in 8 minutes. No midwife with a 500ml bag of Gelofusine is going to fix that.

This doesn't happen often but happens often enough in my professional life to make me scared.

I would however go for a MLU near a Consultant unit and I wouldn't be begging my colleagues for an epidural without being damn sure it was what I wanted.

"This doesn't happen often but happens often enough in my professional life to make me scared."

So I take it that you don't attend home births in your professional life either..."

Great article. REally sums up how I feel about home births. My first birth was in hospital and second at home. THe amount of friends that called me brave (which I am not - hypercondriac as dh tells me) and also some who looked at me side ways as slightly mad/hippy.
THe main thing for me during my 2nd was not to have to travel in labour as I had in my first. To know from the start where I would most likely give birth. It's natural that for the best results labour should be as calm and none scary as possible. My first labour was long and would probably have been long whatever but the stop startyness of it I think has alot to do with the 40mins in the car to a birthing centre and the 25min ambulance ride to hospital because I had not progressed. The fact that hospital policy is to stay at home as long as possible and then get into a car and drive when it's really starting to hurt. Does nothing to help relax or stop the out of control feeling you have, especially with your first.

nigglewiggle

I threw up in my own bucket during my hb