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?

Don't feel guilty, anyone having a bad birthing experience wherever it occurs is entirely beyond your control.

I had a hospital birth which saved my life and my child's life, so maybe that is colouring my viewpoint also. But I think it is folly to throw away the opportunity that millions and millions of women throughout history and still today would have give their eye teeth for - to have a baby on the very doorstep of the people who could just possibly save their life, their womb, their baby's life, their baby's brain etc. etc. should something go wrong and require immediate attention.

I am starting to feel a little patronised and comments like "But I think it is folly to throw away the opportunity that millions and millions of women throughout history and still today would have give their eye teeth for - to have a baby on the very doorstep of the people who could just possibly save their life, their womb, their baby's life, their baby's brain etc. etc. should something go wrong and require immediate attention." is another way of scaremongering women who might be reading this thread looking for impartial advice.

The people who initially guide you through a safe labour and invariably take full responsibility for it and would probably be able to do a better job of it without the intervention of obstetricians (sp) or hvaing to look after several women at once are the same midwives who are by your bedside for hours, potentially days if you labour at home...I had complete trust and faith my midwife to deposit me at the steps of these people you talk about at the 1st sign of things not going exactly to plan, which she was able to monitor as I had her full and undivided attention

You see, this is exactly what I mean by being forced to defend my decision of having a homebirth because I was 'selfish' not to have a hospital birth (but this time because of other women across the world who have no choice)

Note to anyone reading mumsnet for impartial advice: if a post contains the words "I think" within the first sentence or paragraph, please do not consider the opinion stated therein to be free of partiality, personal preference, or liking

Come on Deliakate - by calling homebirth 'silly' you are implying that those women who opt to have their baby out of hospital are being naive, selfish and frivolous.

Women who give birth at home are NOT giving birth without medical back-up. Midwives have medical training and are ready to transfer the minute it becomes necessary.

You are suggesting that women who give birth at home are rejecting the opportunity of emergency treatment if needed - this is simply not the case!

And if you are going to argue that the best outcomes for babies are for those born in hospital, then how do you account for the fact that research which compares tens of thousands of babies doesn't show this to be the case? In fact the research supports the idea that babies born to mothers who book homebirths as a group are more likely to be born in good condition and less likely to need admittance to SCBU? Not to mention the fact that women who have homebirths as a group are much less likely to sustain serious birth injuries than those birthing in hospital.

I'd be really grateful if you could address this point, because so far you seem to be ignoring the facts.

officially leaving the room

From my own experience, I do believe that the overly medicalised way birth is handled in many hospitals does contribute to things not going as planned. During my hospital birth. I didn't know any better and went along with the mw who got me on the bed as soon as I arrived, provided the gas and air while I lay flat for my labour and broke my waters when I started to push. I would have had an epidural if I hadn't have been in such established labour, which then may have, combined with my position, have led to labour slowing and possible intervention to deliver the baby.

At home, I remained mobile and relaxed throughout, not even delivering on my back. My birth took the same pattern 2nd time round, except that I was calm and in control. My waters finally broke at the last minute, assisted by the fact that I was stood up and had gravity in my favour

I am not naive enough to think that sometimes a birth would never go as planned without intervention, of course there will always be times when this will be the case no matter how 'prepared' you are. However, I firmly believe that if women were allowed and supported to birth more 'naturally', whether at home or in hospital, then we would see less incidences of emergency intervention.

and as a result, less incidences of what girlwiththemouseyhair rightly calls scaremongering. What is needed is more impartial advice for any woman looking into the best place for her to birth her baby

Was that research by, oooh, I don't know..... the nct by any chance?

The figures are totally skewed, because women identified as being at risk of complications before going into labour are not allowed to have home births in the first place. So by taking them out of the picture, of course you are going to have a group of women who have easier births. They have been selected that way.

In hospital there is at least the option of lots of POV from different sources ie doctors, surgeons as well as MW.

During my hospital birth I had two doctors and three MW having a look at one point and debating the progress and options etc. At a home birth there is the (admittedly good) opinion of 2 MW but there isn't that 3rd, 4th and 5th opinion/expertise from a doctor on hand if necessary.

If there's a problem then surely a hospital is the place to deal with it most quickly and efficiently. Sometimes problems arise very quickly, or even slowly but maybe aren't spotted as quickly as they should be.

Home births are judged good after the event when all has gone well.

Some make the point that hospital births lead to more intervention such as forceps or ceasarean sections but given a choice of that, or less intervention but a small chance of bigger and worse things happening then I would choose the hospital birth.

"Was that research by, oooh, I don't know..... the nct by any chance?"

Ummm, no.

Comes from a range of sources.

Read about it here:

fully referenced

"The figures are totally skewed"

Well, duh, the research takes that into account. So all the studies referenced in the BirthChoiceUK information compare MATCHED groups of women for outcomes - low risk mothers planning homebirths with low risk mothers planning hospital births.

And included in the outcomes for planned homebirths are those babies whose mothers transferred in labour - those mothers who had problems in childbirth that necessitated hospital care.

Perhaps you'd like to run your eyes over some of the research before commenting on it here again.

One other thing - as I said before, the RCOG and the RCM support homebirth as a 'safe' option for low risk women, and one which has 'considerable benefits' ('safe' and 'considerable benefits' are their words, not mine). If there is no good quality evidence to back it up then why on earth would two such respected bodies take this view? I'd really appreciate and answer to this question from you.

Ta.

I've c&p'd it for you just in case you can't find it on the site. But you'll have to go to the site itself to follow up the references:

"Research about Place of Birth - Home, Hospital or Birth Centre

Birth Experience - Home or Hospital

The largest recent study on home birth6 compared the results of 4,600 (largely low-risk) women who planned a home birth with 3300 equivalent women who planned a hospital birth.

* Women who planned a hospital birth were twice as likely to have a forceps or ventouse delivery, or a Caesarean delivery than those who planned a home birth.
* Women who planned a home birth were much less likely to use drugs during labour than women planning a hospital birth:
      o 53% of women who planned a home birth used entonox compared to 72% for planned hospital birth.
      o 8% of women planning a home birth used pethidine compared to 30% for planned hospital birth.
      o 3% of women planning a home birth had an epidural (all transferred to hospital) compared to 11% for planned hospital birth.
* Women who gave birth at home were much more likely to use upright positions for giving birth.

Birth Experience - Birth Centre or Hospital

A review of the research comparing "home-like" birth centres with conventional hospital care27 concluded that women giving birth in a home-like setting were:

* less likely to need pain relief
* less likely to have their labour accelerated
* more likely to be mobile during labour
* less likely to have babies with problems during labour
* more satisfied with the care they received 

As can be seen from the research, women giving birth at home or in a birth centre were likely to have a greater satisfaction with their maternity care. It is possible that these benefits arise partly due to the way maternity care is structured for these women - with a greater level of continuity of care.

Safety Issues

In this country, there is a general assumption that is safest to give birth in hospital. However there is no research evidence to show that this assumption is true. In the UK, for a healthy woman with a normal pregnancy (including women having their first baby), a planned home birth is as safe as a hospital birth.1,2,3 However, it should be acknowledged that despite the research evidence, there remain a number of health care professionals who do not support this view.13

There is some controversy over the safety of home birth for higher-risk women, including women with breech babies or those expecting twins. One study in Australia14 records a comparatively high perinatal death rate associated with planned home births in that country. The authors speculate that this may be due to the high proportion of higher risk women planning home births, possibly combined with a lack of skilled practitioners.

Other studies from the UK and Europe6,16,18,19 show that the safety of planned home births among selected low-risk women is equal to that of hospital births of a similar low-risk group.

Clearly, there are situations where a woman or her baby will be safer if the birth takes place in hospital. For example, where medical complications such as placenta praevia exist (where the placenta covers the cervix) a woman would require a Caesarean delivery in hospital. Where it is known that a baby will be needing immediate special care, it will be safer for the baby to be born in hospital.

What does seem to be clear is that where a woman is intending to give birth at home, that woman must be attended by a midwife who is skilled in home birth and who is prepared for any problems which might arise, including having any necessary equipment both on hand and fully functioning.6,15

[This research summary includes information from the following leaflet produced by MIDIRS:

Informed Choice for Professionals No.10 - Place of birth

For details on how to purchase the Informed Choice leaflets go to the Informed Choice website.. For copies of the leaflet phone MIDIRS on 0800 581009]

For more research information about home birth, visit the Home Birth Reference Site

Excellent post tittybangbang - personally I, like you, would rather stick to the facts and evidence rather than scaremongering.

I have not read the entire thread, but has anyone mentioned the difference between the medical needs of birth, and the need for careful nursing in early labour and after the birth?

Many women are just abandoned on the nursing front, and it is in the respect that home wins out as they are more carefully and respectfully looked after and nurtured, whereas in hospital they are treated like passengers on a long haul flight with all the associated losses of privacy, decency and convenience.

I find it astonishing that more attention isn't paid to this, and the price we pay is rampant infection rates in hospital as well as very depressed mothers. I am sure we could do better.

"whereas in hospital they are treated like passengers on a long haul flight"

I like the way you put that! I'm remembering my first labour - the horrible lighting, the plastic covers on the mattress, the over-heated room, the sense of being on a journey that felt like it was never going to end....

You are so lucky in the uk to have the choice to birth at home. And that is all it is, a choice, not one that suits everyone but one that should be there for the women who it is right for. In Australia they have almost succeeded in taking that right away from us. We now have to have an ob sign off on us to say we can have the right to birth at home. Most of my family in the uk has birthed at home with no complications. I was lucky enough to have had my last baby at home a month before they changed the laws in Australia. For me it was the right thing to do and the most amazing experience of my life. I loved being in my own home, with people I knew and trusted. I live over 20 mins away from the nearest hospital and have never been scared to birth at home. In fact with my last one the local hospital refused to allow me to transfer if any complications came up because I had gone into labor before 37 weeks so the next closest hospital that would have me was over an hour away. I had my baby at home in 5 hours, no complications, no stitches and she was having a cuddle with her big sister later that morning. If it is what you want to do and you are low risk, it is the right thing to do. We need the right to choose as women what is the best way for us to labor and give birth. It is different for each of us as we are all individual and have different needs. To anyone thinking of birthing at home, if you know in your heart it is right for you, stay strong and go with it. You are not putting yourself or your baby at risk, you are doing what you think is the most nurturing thing to do.

Tittybangbang I want to give you a virtual pat on the back for tirelessly repeating the facts on this thread in a thoughtful and measured way. I can't help but wonder though how long it will be before someone comes on to say - "I haven't read the whole thread, but clearly it is safer to give birth in hospital what with all the experts and machinery and that...." .

Seconding that for tittybangbang I think I got affected in a personal and sensitive manner by deliakate because it is the obstruction I come up against often and essentially feel I could not have had a better birth experience and therefore feel sorry for those who have had not great experiences but still feel the need to call me selfish despite my son hvaing had the very best start in life...a realxed birth in surroundings he would go on to live in, amazing aftercare with a dedicated team, breast feeding established immediately, having his father in the same bed and able to have skin to skin with him all night long if he'd wanted and same dedicated team back on our doorstep within 16 hours.

I'm so grateful to the NHS for providing me with the community midwives who made my homebirth possible and provided so much quality aftercare

Tingle, I envy you! I had an agreement with my husband that I'd have the first in hospital (on his insistence; his family have very high risk pregnancies and complicated births) and if I remained low-risk, the second by home birth.

And then they changed the bloody law. My closest, wonderful, hospital doesn't even have a resident ob, so there's no way the midwives can do that combined care arrangement thing, so there's effectively no home birth in my area anymore.

Tinglebee and tortoise, yes, I'm sure there are loads of us here saying 'god bless the NHS!' (for all the moaning I do about it, I still think we're really lucky to have a midwife led system of care for low risk mums and the option of homebirth. I love midwives and feel very grateful for what they do for us - their courage and their hard work.

I do worry though, that the training and experience of a lot of midwives doesn't equip them well to always safely supervise home births. There are a lot of midwives in the UK who complete their training having had very little experience of physiological birth - ie normal birth without interventions. And when they start bringing hospital thinking and hospital practices into the home - well, I think it's not a good thing.

Niggle and Girlwithmousyhair - I consider myself duly patted!

Another virtual pat from me.

I also wonder about midwives never seeing a physiological birth by the time they finish their training and midwives bringing hospital practice into the home.

My area has a dismal home birth rate and the community midwives in my area, even when they were forced to support my home birth, did not inspire confidence in me as they seemed to be looking for disaster to happen around every corner. In the end, I did not want them at my home birth either and as fate had it, my baby arrived before they did. True to expectation, the senior of the two midwives was very bossy and hands on and went on to challenge my doula/friend about her role at my birth. I wished they weren't there even after they turned up.

OTOH, just 15 miles in a different direction, are home birthing midwives who know what do to and are very positive about supporting and attending home births.

So don't envy us too much out there in Oz.

Same as with everything isn't it - a postcode lottery. My CMW are incredible and often have trainee midwives with them for appointments, birth and postnatal care. They're the kind of midwives who have actively sought CMW roles to keep out of the hospitals so they can fulfil what they see as their roles in labour (their words)...the small team has a bit of a turnover but the lead midwife has been there for years and inspires other midwives keen to support the homebirthing mother as she needs it.

Move to SW16 and ask for the Valley team operating out of St Thomas'!

Our second child was born at home.

We were very keen to be at home because I felt more confident in my own environment. Plus, I didn't feel a need to be in hospital since we had only spent 5 hours there with our first child.

I also sense that you get more attention at home. e.g. the full attention of two midwives. And then - of course - they visit you in your own home (lovely!)

For my birthday I asked for some luxury towels so that we could all wrap ourselves up after the birth.

(Still hurts, though!)

I think if women were given their own (clean, comfortable) rooms throughout all stages of the labour/birth/postnatal period, and a hands off approach to delivery where necessary, then most women would trot into hospital without a backward glance, tbh.

Having spend a few days on a maternity ward with SPD recently, I was horrified at how the women were treated. It was like a load of cows in a dairy mooing away in early labour behind flimsy paper curtains, while they were patronised and ignored by the staff. Women were sobbing and crying, alone, scared, uncomfortable, partners thrown out at 10pm.

It was like being in Eastern Europe in the communist period. Not England in the 21st century. I wrote to my MP about it.

Amen Boffinmum.

Michel Odent stated in Birth and Breastfeeding (I think)that maternity wards should be equipped like a home away from home so that women and babies could birth better. His maternity unit is France has tried to symathetically recreate the home environment for this reason.

Agree with you foxytocin. Being at home changes the whole dynamic of the labour and the relationships of the people involved. The fact is that when you're in hospital, no matter how nice it is, it's still a busy workplace governed by complex and detailed protocols. There's no escape from that.