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?

And I had two independnent midwives with me at home which is a lot more attention than a part of an NHS one. www.birthcentre.com/

Moonstone - ask for a second opinion from the Supervisor of Midwives at your hospital. You'll get a very different picture.

If you see your midwife again, ask her for some facts to back up her comments about the risks of homebirth.

I reckon she's got no confidence in her own practice and this is reflected in the way she spoke to you about homebirth.

Violethill -You don't know what you are talking about. Floppy baby would get the paeds (or rather the neonatologist) crash bleeped. They probably would be there within five minutes and once there, would have far superior resus skills to a midwife.

Foreverastudent - Have you not heard of the Working Time Directive? Dr's generally only do 12hour shifts now.

No obviously I don't know what I'm talking about.

I've only had one baby in a MLU, one very prem baby in hospital, and one VBAC

The facts: HB/MLU births are statistically at least as safe as hospital.

If you prefer hospital, fine, just accept that it doesn't mean safer.

Yes, I've had a productive uterus too.

What does that have to do with how crash bleeps work?

I didn't mention crash beeps at all. You did.
I am simply quoting the fact that statistically HBs and MLU births are AS safe as hospital. And for 'normal' births, which form the majority by a long way, HB and MLU births result in far lower intervention rates and lower birth injury rates.

Violethill, the woman was taken to hospital to deliver.

Homebirths may appear statistically safer because anyone 'at high risk' is advised not to have one.

So the programme you described showed a home- hospital transfer? Yes, that happens sometimes, no one has said they don't, though the majority are because the woman wants more pain relief rather than any medical need involving the baby.

The evidence clearly shows that comparing like with like, HB and MLU births are every bit as safe as hospital.

You stated "it's a total myth that everything is on hand in hospital". I'm pointing out that in resus situations hospitals are far better equipped, then I'm giving you an example of the timeframe in such a situation.

And you'll say "but HB's are soooooo safe".

Which is of course possible, but one cannot deny Hospitals are better equipped for emergency situations.

It's a choice. HB's may be safer, but more catastrophic if things go badly wrong, hospital births may lead to more interventions which have their own issues.

It's down to risk perception. For me, knowing how badly things can go wrong and how quickly (no matter how strong, calm,prepared or 'centred' you are) hb is never a risk I could take. YMMV.

Yes, it's down to risk perception, exactly. Not actual risk. I quoted the example earlier of my friend who drives to scotland each year to visit her parents rather than fly. She knows that statistically she is safer flying, but she FEELS more comfortable driving.

That's a good parallel with giving birth. The statistics may tell you that a HB or MLU is as safe for a low risk situation, indeed, the evidence shows that in a 'normal' situation, the optimum birth for the baby is non- intervention, no epidural, c section , forceps etc- however, you will always get some women who opt for hospital, because their perception tells them that's what they want. Which is fine. It's having clear unbiased information about the risk factors of various interventions and situations which is important . without it women cannot have true choice. The article the OP refers to was excellent in showing the detail behind the raw figures - eg showing that the majority of home hospital transfers are nothing to do with foetal distress or emergency, its because the woman decides to have an epidural. That's the sort of information that needs to be transparent, otherwise how can women possibly choose properly?

Great article - I can fully identify with it all from my own experience of 1 hospital birth and 1 home birth. Both births thankfully complication free, but the home birth experience was totally relaxed, far easier to manage and something I would encourage all mums to be with complication free pg's to consider.

"Homebirths may appear statistically safer because anyone 'at high risk' is advised not to have one."

Actually the research which appears to show similar rates of neonatal deaths and morbidity compares matched groups of women - low risk mothers - giving birth in hospital and at home.

"HB's may be safer, but more catastrophic if things go badly wrong, hospital births may lead to more interventions which have their own issues."

Perhaps it's because we're blind to iatrogenic illness and injury when it comes to maternity care.

"hospital births may lead to more interventions which have their own issues"

I really like these comparisons that the RCOG produce, to help us understand the issue of risk.

"Very common 1/1 to 1/10 - A person in family

Common 1/10 to 1/100 - A person in street

Uncommon 1/100 to 1/1000 - A person in village
Rare 1/1000 to 1/10 000 - A person in small town
Very rare Less than 1/10 000 - A person in large town

If you take the following risk and extrapolate them to other situations where we're trying to work out the likelyhood of something happening to us - winning the lottery, having our children kidnapped by a predatory paedophile..... Very interesing.

Risks of C/S

Serious risks include:
Maternal:
● emergency hysterectomy, seven to eight women in every 1000 (uncommon)
● need for further surgery at a later date, including curettage, five women in every 1000 (uncommon)
● admission to intensive care unit (highly dependent on reason for caesarean section), nine women in every 1000
(uncommon)
● thromboembolic disease, 4?16 women in every 10 000 (rare)
● bladder injury, one woman in every 1000 (rare)
● ureteric injury, three women in every 10 000 (rare)
● death, approximately one woman in every 12 000 (very rare).
Future pregnancies:
● increased risk of uterine rupture during subsequent pregnancies/deliveries, two to seven women in every 1000
(uncommon)
● increased risk of antepartum stillbirth, one to four woman in every 1000 (uncommon)
● increased risk in subsequent pregnancies of placenta praevia and placenta accreta, four to eight women in every
1000 (uncommon).
4.2 Frequent risks
Frequent risks include:
Maternal:
● persistent wound and abdominal discomfort in the first few months after surgery, nine women in every 100
(common)
● increased risk of repeat caesarean section when vaginal delivery attempted in subsequent pregnancies, one
woman in every four (very common)
● readmission to hospital, five women in every 100 (common)
● haemorrhage, five woman in every 1000 (uncommon)
● infection, six women in every 100 (common).
2 of 5 Consent Advice 7
Fetal:
● lacerations, one to two babies in every 100 (common).

1. Any extra procedures which may become necessary during the procedure

● Hysterectomy ● Blood transfusion ● Repair of damage to bowel, bladder or blood vessels.

gothannegeddes- "Hospitals are better equipped for emergency situations" - really? did you read my post of 12:23:17?

They have oxygen and neonatal masks ready at HBs for resus- I should know they used it on my DD.

Oh and re: WTD,www.allheadlinenews.com/articles/7019487954?Cut%20In%20British%20Junior%20Doctor%E2%80%99s%20Hours%20Leads%20To%20Longer%20Hospital%20Waiting%20Time

"What is ironic is that the aim of the directive to cut junior physician?s hours is not happening. The survey found out that 72 percent of trainees and 61 percent of junior doctors still work more than the 48 hours limit because of rotation gaps"

Horses for course of course - but the tricky bit is you do not know what the 'race' will be; long or short distance and what obstacles will appear along the way. I was v. risk averse and went the hospital route - entonox was the best bit er that's it. For a second or later baby an HB might suit so why not go for it? Life is a roller coaster and if you could be in hospital within a reasonable time it should be low risk - but I would want to know and trust the midwife who would definitely be there and not risk getting a dim one who can't cope with the unexpected or make decisions...
But remember I am a self-confessed pessimist!
like everything else the olny logical course is to find out all the info you can and make an informed decision that suits you and you both can live with given the uncertainty that is life/childbirth!

i wanted a homebirth with this child im expecting now, but my husband was apprehensive. To please him i've not gone ahead with it. But if i have another child in the future i intend to have a homebirth, with or without his approval.

the only reason i had hospital births previously. With the first it was because i didnt know what to expect. With the second i went hospital and asked to be kept in as long as possible for a rest. Soon as i get home i have ppl expecting me to wait on them, usually husbands relations.

The way things are now they kick you out within a few hours, so i really look forward to hosting a dinner party as soon as i exist the hospital for ppl i didn't invite.

I've had both hospital and home births.

First was a less than pleasant hospital experience, horrible obstetrician and horrible hospital rules tempered by lovely midwife.

Next two were straightforward and lovely home births, both with same lovely NHS midwife, both times off duty but insisting on attending my births as she was "my" named midwife.

Fourth was a planned homebirth that transmuted into hospital induction and crash C section. She would never have made it out alive except by C section (major cord entanglement, which if left unheeded would have killed her), and I will be eternally grateful to all the hospital staff who attended me in such a sensitive and caring way, realising how very far from my plan this birth was. The practices at this hospital were astonishingly improved on birth 1, and the whole experience was very positive.

Conclusion: horses for courses. What happened to me with birth number 4 was exceedingly unlikely, but thankfully and really by chance I ended up in the best possible place for us both.

I have had both hospital and home and would highly recommend a homebirth everytime.

I really wish i had my others at home now

I planned to have my first at home but ended up having her in hospital - which was okay, but a bit hectic and medical at the end - and then had my second at home after planning to have him in hospital. He was born on the kitchen floor with my husband and two midwives present and my daughter asleep in bed. It was a fantastic experience for me and my husband and my daughter woke up to a new baby brother. I'd thoroughly recommend it, but maybe for the second child, when you have more idea of what child birth entails and aren't so scared!!

justanuthermanicmumsday are you new?

You have a very similar name to another poster who's been around a while: JustAnotherManicMummy. You may want a different name to avoid confusion? Particularly as she's already posted further up this thread.

As you were

I was very lucky to have a close friend who is a midwife and who is very much pro-homebirth (having had her 2nd child at home and being a strong supporter of the more relaxed setting at a woman's own home), but she still suggested I go to the hospital to have my son. I think because we're friends she didn't want anything to go wrong.

However, mother nature had another idea and I had an unplanned home delivery, supported by my midwife friend, a 2nd midwife, my partner and 2 female paramedics. I was very interested in HB anyway and had researched it during pregnancy and it felt like the right thing to do throughout my quick labour. I was at 10cm after an hour of contractions and I couldn't wait for the ambulance.

It was an amazing experience, despite having no pain relief (my choice), tearing and bleeding and becoming very anaemic afterwards, I was on a high for weeks afterwards. I felt completely in control and in charge. There is nothing like lying in bed with your child and knowing they were born in this very room.

One thing I would say if you do have a homebirth is to stick a sign on your door saying 'no visitors' - people assume that because you're home, you're fine, and scores of visitors isn't what you need when you've just given birth.

Foreverastudent - Yes, I'm aware they have O2 and a mask, but hospitals also have intubation equipment and the appropriate drugs. And generally doctors who haven't worked 36 hour shifts

I think its a personal choice and everyone has to weigh up the pros and cons and decide what is best for them.
On a personal level i am never having a home birth. Not a chance. If my mum had decided on a home birth i seriously doubt i would be alive to be typing this now, as i was rushed straight into SCBU after being resusitated at birth. This is down in part to the fact i was premature so i know that in that situation you would go to the hospital anyway but I also ended up getting "stuck" in the birth canal with the cord wrapped round my neck and ended up being pulled out with forceps (along with a few other problems). I know logically the chances of this happening while i give birth are low and my mum/me were very unlucky but i just couldn't relax if i wasn't at the hospital. I'd be terrified at home that something would go wrong and i wouldn't make it to the hospital in time. Other people might feel far more relaxed at home and so it would make for a better experience for them but i feel that me all tense and terrified of something happening cannot be good for the baby. Definitely the hospital for me!

Just wanted to butt in at this point musicmadness to say that nuchal cord folds are extremely common and usually pose no problem at all. In fact they're present in about 30% of births and the midwife just deals them by slipping the loops of cord over the baby's head as soon as it's out. It's one of those things that has gone down in folk mythology as an extremely dangerous birthing event but without good reason really.

My daughter's cord entanglement was very much rarer and more serious: around her body once and five times around her upper legs, meaning that she was bungeeing off her cord (her placenta was implanted at the top of my uterus). She simply could not reach the way out- her cord was too shortened. Pesky active babies...