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?

Whoops - apology for the lecture! And the terrible repetitive grammar. I'm a bit cream crackered tonight.

'I personally am very grateful that there's such good medical care out there for myself and baby and I'm happy to take it'
Yes me too and I'm very happy with the NHS care I got,during my pregnancy and home birth. I believe I did the best for myself and my baby by being at home,and I took advantage of all the expertise/knowlegde/equipment I needed.

belle the issue for me is that lots of research suggests that for low risk pregnancies, the outcomes compare similarly for both home and hospital births.

If this is the case, and you know that the outcome is as likely to be as successful at home as in hospital, then why criticise those who choose home.

I haven't heard anyone here saying 'i have done my research and found out that home birth is much riskier than hospital, but I like my toast done ' just so', so I am going to stay at home anyway, and to he'll with my baby's welfare. People are deciding based on the expected outcome, not the fact that NHS don't provide Duchy Organics jam.

"I looked at my experience of shoulder dystocia a different way"

I shit myself (not literally), is there really a different way ?
After 3 other babies had made there way through that particular exit it must have been quite ... er stretched and roomy I'd imagine, no doubt that's why I avoided the giant episiotomy, but quite honestly I don't know what else they could have done, if that's what you need then that's what you need.
Yes people dashed into the room, but i was glad to see them and they repositioned me and out he popped, with an agar score of 1, still they let the cord stop pulsating before they cut it, we stayed in the water for the third stage, all very calm.

I have had rubbish hospital birth experiences too but i think the way to make it easier, better for yourself is to be prepared and educated where ever you give birth.

"quite honestly I don't know what else they could have done, if that's what you need then that's what you need"

I didn't make my point well. I suspect that s/d's that occur at home are more likely to be successfully resolved without recourse to an episiotomy - because protocols are less likely to be adheared to in an unthinking way as they are in hospital.

Sounds like you had great care, but I know people who've experienced s/d in hospital who've been really traumatised by the way it was managed in that environment.

But would agree with you that understanding as much as possible about the many different ways birth can pan out is very helpful.

but I know people who've experienced s/d in hospital who've been really traumatised by the way it was managed in that environment.

I'm not surprised it is a traumatic event, I can't imagine where it takes place makes much difference.
The point I was making, badly no doubt, was that for all my experience, hypno birthing, reading and 3 previous births still something unexpected occurred which hadn't crossed my mind at all.

I had a fabulous home birth, after a lot of research. Best decision we ever made. My sister-in-law is a very senior hospital midwife, and the fact that she'd had a home birth was one of ther decisive factors for us. My community midwifery team were 100% behind my decision and the midwives who attended were absolutely wonderful. If we ever have another baby, all else being equal, I would definitely want another home birth.

tittybangbang, those were excellent facts and a great lecture! thanks for posting it...

Two further thoughts from me:

1. there have been a number of posts saying that people ought to consider how they may be tying up resources if they opt for a homebirth. Hospital births are, of course, much more resource-intensive. Around the world, people are trying to shift lots of care out of hospitals because it's expensive, the outcomes aren't great, the safety isn't all it could be, and the experiences patients have are all too often pretty crap. There are many patients and many treatments where people should be in hospital, but there are many where they should not, whether it's low-risk mothers who want a baby at home or diabetics whose condition should have been managed more effectively in the community.
2. No hospital in the UK, so far as I know, comes close to offering 24/7 consultant cover for its obstetrics service. There's much harrumphing and reluctance to push even vaguely towards that, not least because the only way to do it that's financially feasible is to have fewer hospitals doing births, each in more places.
3. Bringing 1 and 2 together, speaking personally, I would like to see London at least move to a model on the lines of what is happening in stroke care -- routine low-risk births at home or in midwife-led units such as the Edgware birth centre or the Barkantine; more complex births concentrated in somewhat fewer hospitals who have the volumes to be able to sustain 24/7 cover and the full panoply of backup required. I say London because the case is more clear-cut than in other areas where travel times etc differ.

Wow, sorry for the garbling...the end of point 1 was supposed to read "fewer hospitals, each doing more births than today"

"I'm not surprised, it is a traumatic event, I can't imagine where it takes place makes much difference"

If a baby is damaged during the birth then I'd agree with you. But given that it's usually resolved without an injury to mum or baby, how it's managed can make all the difference as to whether or not it's experienced as a traumatic event. There are set 'drills' they're supposed to follow in these circumstances, but there are always debates about how these should be adapted for use at homebirths. Midwives DO work differently when they're at home and the atmosphere is different. I think this can impact on a woman's experience and memory of the event and make it less traumatic (if it's managed well).

And in my personal case, I'm convinced that having doctors rushing into the room pumped up with adrenaline (possibly with a student in tow) would have terrified me. So glad for me that I was at home with confident and competent midwives who were able to manage it themselves! (it took 6 minutes to resolve me s/d so had I been in hospital there would have been plenty of time to fill the room with medics).

I took part in some research whilst PG (not related to homebirths) and the researcher told me the consultant in charge of obstetrics at our local hospital (John Radcliffe) is really supportive of homebirths for low risk pregnancies. The general consensus there is that if more low risk deliveries were dealt with in the community (and we are lucky to have great community support where I live) then it would free up resources within the hospital to deal with more complex cases.

I don't think the team at the JR are particularly "touchy feely" or overly conconcered with the mothers homecomforts after birth . I am sure they are basing their opinions on their experience and what the research tells them.

I had my first baby in hospital, second two babies at home and fourth in hospital. The home births were wonderful experiences, it's true that it is completely wonderful to be tucked up in your own bed with your baby within a couple of hours of giving birth. With DC2's birth, DC1 slept through the whole thing and walked into our bedroom the following morning to find her baby sister had appeared

I decided to have my fourth baby in hospital as DC3 had a very slight shoulder dystocia. The midwives sorted it out straight away at home and it was no problem, but just made me more nervous about the birth of DC4. I shouldn't have worried though as DC4 turned out to be more than a pound smaller and virtually flew out after a 40 minute labour If I'd had him at home the chances are the midwives would not have arrived in time as with my other homebirths it took around an hour for them to meet and get what they needed from the hospital before coming to my house.

With DC4 I had decided if all went well I was going to go straight home from the labour ward as my house was only five minutes away. I had to really stick to my guns over this - the midwives were not happy about it at all. After a home birth the midwives leave within a few hours so I really do not see that it's such a problem to leave the hospital after a few hours and get back to your own bed... but they do not like it!! I had to take DC4 back to the hospital the next day to have him checked over there (whereas our GP was allowed to come round to the house and do it with the two home births!) and they made us wait around for about five hours, I felt deliberately because we hadn't done as we were told the previous night!

So difficult to know. I've always been pro home births and quite wanted one for dd1 DH wasn't keen for first baby so we had her in hospital - all straightforward in the end, no intervention so felt I may as well have been at home.

Second time round I had twins so for various reasons followed advice to have them in hospital, again totally straightforward delivery,no pain relief (not my choice like OP) fed them etc then a couple of hours later haemorrhaged and ended up being rushed to theatre, given a general anaesthetic and spending the rest of the day on HDU. The thought of what would have happened if I'd been at home is something I try not to think about.

Yes childbirth is natural and I still love the idea of a home birth but things can go not according to plan and however unattractive a hospital environment can be (well and generally is in my experience ) at least the facilities are there if you do need them.

I have had two homebirths and am planning a third in November. Both truly fabulous experiences.

With first baby I had a very supportive antenatal midwife - a community midwife with 35 years experience - who confirmed for me what I suspected from my (extensive) reading - that I was at no greater risk being at home than in hospital. Big city hospital was 10 mins max away from the house, less under a blue light. Could have transferred any time. As it was, DD was 'perfect' labour - 6 hrs start to finish (that was a shock, was expecting much longer), TENS and birth pool, m/w arrived when I was 9cm and I got straight in the pool, had her within an hour. By 7am all tucked up in bed. 8am neighbours (and very good friends) came round for a quick peek - they hadn't heard a thing in the night. No tears, no stitches.

Second baby, 21 months later, was done and dusted in three hours at home. Labour/pushing much the same, TENS and pool, birth fine too. Had some heavyish bleeding after the placenta, so m/w called ambulance, which was there within two minutes, but in the end didn't need it as a double dose of synto stopped the bleeding. They were back on the road within 15 mins.

In response to those who say 'you're brave' to have had a home birth I have been known to respond that actually you can be getting better care at home than in hospital, in that you have two midwives for you (and in my area they are community midwives, a separate service, not taking midwives away from the hospital) that stay with you - if you transfer in a midwife comes with you, and if you deliver at home they stay for a good length of time after the birth to help with feeding/clearing up.

There is some good evidence that women's perceptions of pain are that it is less at homebirths - that is, women who've had homebirths consistently report lower levels of pain than those in hospital. Having not been to hospital I can't compare the two, but would say - and am aware that I am very unusual and perhaps just lucky - that I did not experience childbirth as painful. Intense, yes - but not painful. I have had appendicitis and remember that as much worse, likewise I have had meningitis and a spinal headache as a result of lumbar puncture and would say that was far, far worse than anything I felt during labour or birth.

I was very persuaded in my view of birth (and my expectations of it) by the second half (the science bit) of Ina May Gaskin's 'Ina May's Guide to Childbirth' - some fascinating stuff in there about how women's bodies respond to their environment, emotions and the attitude of their caregivers. And her birth records are enlightening.

A very good friend of mine is the editor of this book - which might be helpful reading for anyone thinking about a homebirth. It's more of this thread really - real life women's experiences of homebirth: here

Thanks comixminx, I haven't had a HB yet so none of thesecondcomings points should be directed at me.

My ire was directed at MissBonpoint's post which was judgemental and inflammatory. Badkitty who obviously went through a really traumatic experience managed to post calmly and objectively on the matter. Insulting people who chose homebirths doesn't really add to the argument. For the people who have had things go wrong at a HB which has led to problems for their child I wonder if some of the posters on here tell them to their face that they were naive or chose their rights over their responsibilities?

This thread focuses very much on the dramatic, the severe complications which arise out of nowhere and have a very very very tiny chance of happening.

The Guardian article made the point that most women who aim for a home birth but subsequently transfer to hospital do so because they are finding the pain too much to cope with and want an epidural. In other words, not a medical reason, but a choice about pain relief. I think that's a really important fact that it's important not to overlook. Not being judgemental - if that's your choice then fine, but it isn't technically a 'medical' reason, in that the birth could still have occurred without intervention.

Of course, the intervention then makes further interventions statistically more likely, and can slow labour down etc etc.....

Sometimes it's impossible to say with certainty what the cause of a particular outcome was, because once you start the ball of intervention rolling, there are a lot of knock-ons.

I haven't had a HB, but one fact I find interesting is that out of my NCT class, 8 of us were told we had straightforward textbook labours and had the option to deliver at the MLU (or home of course). (The MLU was about as near as you could get to HB - only midwives there, no doctors, gas and air).Only 2 of us opted for MLU - the other 6 'normal' pregnancies opted for hospital. What was interesting was that the 6 made this decision on the vague feeling that 'it's a hospital, so it must be safer'. No evidence for that at all (in fact the MLU had never in its 25 yr history lost a mother or baby or had a child with brain damage from birth so you can't get safer than that!!)

The 2 of us at the MLU had natural births. The 6 in hospital all had fairly significant intterventions, most had forceps or ventouse, all but one had epidurals, one had a CS after labouring a long time. Now, you could say, goodness, how fortunate that the 2 who opted for MLU ended up with natural births, and what a good job the other 6 were in hospital for all that intervention they needed. But that would be a bit of a coincidence wouldn't it, considering all 8 of us were 'low risk', no medical complications? Far more likely that if some or all of those 6 had given birth at home or MLU they would have had the healthy babies they ended up with without the interventions.

Ultimately it's about choice, and there will always be some women who feel happier in hospital, and also some women who choose epidurals which is a highly medical procedure and only available in hospital. But I do get the feeling that there are an awful lot more women who feel a social and moral pressure to give birth in hospital, when actually in purely medical terms it isn't going to make their birth any safer.

P.S Another point I found interesting was that when we compared notes afterwards, the NCT friend who ended up with a CS because her labour went on a 'long time' actually laboured no longer than I did! Looking at the notes, it was an almost identical number of hours! But whereas in the MLU, the midwife calmly acknowledged that this was a first labour, and that these things tend to 'go on a bit!', the hospital clearly didn't allow my friend to 'go with the flow' of her labour and pushed her towards intervention.

But violet, though I take your points in general, you do make it sound slightly as if pain relief is a choice you may want to make if you're basically a bit of a wuss.

In both my labours the contractions and intense pain have come on suddenly and were so bad that I couldn't think, move or do anything except bellow. And that was at 2cm dilated - and went on like that for 12 hours (the first time) until I got an epidural. I'll warrant that 12 hours felt a bit longer than 12 hours of slow-starting, manageable labour. I had an epidural sooner the second time. Yes, maybe they slowed down labour and led to my CSes but I still prefer that option because the pain was unbearable.

I do think the degree of labour pain varies wildly and if you haven't had it bad, you might think pain relief is just a "choice". But when you are in that situation you would give anything for it.

(I'm not just having a moan btw! :) - I'm posting this because I think it's important for people to realise their pain might be exceptionally bad and that there is help for it. Not go through torture feeling like they would be letting themselves down if they ask for pain relief.)

i agree with marine, it took me 26 hours to get to 4 cm, i couldn't take it any more and got an epidural, i am not weak, i am human and feel the pain... if you are lucky and your labour wasn't too bad, don't write off people who wasn't that lucky, and anybody: if the pain is too much, ask for pain relief, again and again until you get it

MarineIguana - I don't know why you are using the term 'wuss' - I didn't.

I was making the distinction between intervention for medical reasons, which is necessary for the outcome of the baby; and intervention which is for pain relief.

In fact I actually used the phrase 'not being judgemental' in my post! It really isn't helpful to subsequently misrepresent completely what I said.

I was simply flagging up the point that the majority of home to hospital transfers occur not because of a medical emergency or necessity, but because the mother changes her mind about and wants an epidural. Nothing wrong with that, if that's what she chooses - but it's important not to blur that with 'needing to go to hospital because there's something dramatically wrong'. The article actually makes clear that all hospital transfers are lumped together, which may mislead some women into thinking that home birth is more risky than it is.

P.S TBH I find all this talk about some people 'being lucky' or 'not having it that bad' the most judgemental thing!!

Labour hurts like hell - I should think the vast majority of women know that, apart from the very tiny number who genuinely find it not too painful, so let's lay off the 'Oh you didn't have much pain relief so you must have had it easier!'. No one else can possibly know!!

I wasn't being critical in my early post. I was merely stating the view a medical professional gave to me!

I love that we have the freedom to choose where we give birth. For me the biggest issue is why on earth the hospital option isnt made to feel as homely and human as possible. Why is it everyone bemoans the postnatal care, and why on earth this isnt being addressed! Surely there must be a correlation between people having 2nd child following a bad hospital experience and choosing a home birth. If this is something the medical profession wants to reduce (not sure it is or not) thent hey have to investigate what is putting women off their hospitals!

Sorry I didn't mean to offend violet; I just said your post made it sound like that; not that you said that. Obviously you didn't say "wuss" - I did. My point is that extreme pain is a medical reason (as it certainly is in any context other than giving birth). If you define it as something other than a medical reason, you might make people feel that needing help for their pain is just a "choice" and optional and in some senses a failure. You didn't say that, but what you wrote could still make some women feel that.