Ever wonder why so many women are scared off by the thought of a home birth?

[foxytocin]

These questions [[
store.aqa.org.uk/qual/gcse/qp-ms/AQA-3561-H-W-QP-JUN09.PDF from AQA]] give an insight into our mindset.

3 (a) Suggest four advantages of having a hospital birth.
...
1 .........................................................................................................................................

............................................................................................................................................

2 .........................................................................................................................................

............................................................................................................................................

3 .........................................................................................................................................

............................................................................................................................................

4 .........................................................................................................................................

............................................................................................................................................

(4 marks)

3 (b) Name three types of pain relief usually available in a hospital.

1 .........................................................................................................................................

2 .........................................................................................................................................

3 .........................................................................................................................................

(3 marks

Where was the mention of home births here - or the disadvantages of hospital births.

"Nope - but opting for a home birth doesn't guarantee you that."

Of course - there are no guarantees. But you ARE increasing the likelihood of optimal care, as recommended in the NICE guidelines, by putting yourself in a situation where one to one care is a given.

"They are consistent risks, about which information should be given."

As long as these risks are contextualised that's fair enough. In other words - making it clear to women that OVERALL those giving birth at home have better health outcomes. And to be entirely balanced, you'd also have to point out the additional risks (severe PPH, hysterectomy etc) that come with major surgery, which women are more likely to end up with if they have their baby in hospital.

"I don't think that is precisely how it works"

I was commenting on how often the issue of carpets is mentioned in any debate on this subject here on mumsnet!

But I take on board what you're saying about being able to relax in the environment you feel is most appropriate for you - which for most women will be hospital. The view that you go into an environment where everything and everyone is focused on birth, rather than in the home, where life may appear to carry on around the labouring woman.

But a woman's state of mind and how it might influence her labour isn't the only thing that needs to be considered when we're thinking about how birth environment impacts on outcomes. There's also the issue of care. I was recently talking to a first time mum describing her experience of her hospital birth - how the midwife was so rushed, made no eye contact with her, appeared too tired and pre-occupied to give her any emotional support, made no suggestions as to the things she could do to help get her baby out, just wanted her to have pethidine and stay on the bed. This mum felt that the midwife's inability to engage with her properly contributed to her having a very difficult birth. I think this sort of situation is much, much more likely to happen on a labour ward where a midwife might (and often is) be under huge pressure to spread herself too thinly, may be exhausted and pressured. I think that the working conditions a a home birth make it much easier for a midwife to engage with a mother - to use her midwifery skills to the full to assist the mother to have the easiest birth possible.

I think there's also an issue with midwives having to follow hospital protocols around the timing of labour, which make truly responsive care difficult at times, and lead to unnecessary interventions such as ARM, directed pushing and augmentation - all sometimes linked with birth complications.

"The ensuite facilities have never been added, so when I delivered my stillborn DD I had to go out into a public corridor straight afterwards to go to the loo and clean myself up"

I feel the same anger. It infuriates me that my local maternity unit won't even provide pezzi balls for women on the labour ward, but have leather sofas and special mood lighting in the birth centre next door.

I had a high risk pregnancy (gestational diabetes, and had had cerclage) and ended up paying for a private midwife to ensure one to one care in labour, which you are only guaranteed in my local hospital if you go into the birth centre (which I didn't have access to because of my health problems )

Curlybug - I'm so sorry you're walking this long and painful road after what happened with your Alexander. We're in a similar situation, maybe a little further along, after our DD2 died in utero at 36 weeks after I became ill.

I'm now expecting DC3 and, again, trying to decide the best place to give birth. I don't know what we'll do. I don't know if we'll know before I go into labour. At the moment we're taking it as it comes and playing it by ear - and using IMs so that we have continuity of care, more care than the NHS can offer and will be supported to make an informed choice.

My experience with hospital consultants since DD2 died is that they can be all sweetness and light until such time as you suggest something too far out of their comfort zone - and then they switch straight into a very dictatorial "I'm the Dr, I know best, you're not allowed to do that" mode. I don't want to ignore their advice - I have great respect for their training and experience - but I also want to be able to understand the reasoning behind their advice and not feel as though my thoughts and opinions are worthless. Obstetricians may be holistically trained, but that does not mean they practice in a holistic manner and nor does it mean that they will treat the women under their care as mentally competent adults. I don't want to discount their views, but if I cannot have a rational discussion about them then I will start to give them less value as I can't understand them.

Most (if not all) analyses have found HB to be cheaper than hospital birth - it may make more demands on MWs but this is more than counterbalanced by the saving in overheads (hospital beds and all the support staff that go with them, etc). Also, there is not a shortage of trained MWs in the UK - there is a shortage of jobs for the glut of trained MWs that we have.

I would not advise a woman to go ahead and have a HB against medical advice just because she wants to - but if she isn't happy with the recommendation for a hospital birth then I would advise her to do a lot of research and ask a lot of questions. The recommendation to stay in hospital is often made at a population level and considering factors in more detail may mean that an individual is not as high risk as their gross stats would make them.

For us, maintaining as much control of the situation as we could and making decisions (even though that usually just meant asking lots of questions so we could understand the advice and then agree with it) was very important to our mental state when we left the hospital without DD2. The circumstances meant that some choices were no longer available and for us, if anything, that meant that those that remained were even more important.

I'm sorry - from the way you write it sounds as though the birth of Alexander is still quite recent and you're still coping with a very raw, overwhelming type of pain. I don't intend to make that worse, and I hope you can be gentle with yourself.

EdithWeston
"for mothers who have to be transferred from home to hospital, the stillbirth rate is 14% higher than the national average (one survey, quoted in The Telegraph last week)"
Do you have a link for this? I've had a quick google but can't find it and would be interested to read it :)

Without having read it, the first thing I'd like to know is what the comparison group was - I have seen studies before that compare the outcomes for that subset of planned, low risk HBs that required transfers (ie those births where you would expect outcomes to be poorest) with all planned, low risk hospital births. To be meaningful the comparison needs to be to those planned low risk hospital births that developed complications. I'd be very interested to know whether that is how these statistics have been calculated as, up to the last time I looked, those data were not available.

"It's not really much better today - you can bleed out before an ambulance arrives, let alone before you get to hospital. This risk is one of the reasons behind the 1960s policies to encourage hospital births."

I think, and I reserve the right to be wrong :o, that the risk of PPH was why it became standard practice to administer oxytocic drugs during the 3rd stage - to force the uterus to contract down quickly and reduce the chances of catastrophic PPH. Oxytocic drugs can be used in either a home or hospital setting. They do not remove the risk of catastrophic PPH, but they do reduce it significantly.

"I think it is right that HCPs point out these specific additional risks of catastrophic outcomes. Some mothers may be "scared off" by them. But this is an important part of informed consent. It could perhaps be tempered with reminders that birth is never risk-free (in any location), and with 'count the kicks' information."

I agree that all women should understand the risks of birth, and that some risks may be increased depending on location. My experience of trying to plan a HB on the NHS is that the MW was extremely clear and vocal about the possible catastrophic consequences of being in a home environment - but she was markedly silent on any risks that might be increased by being in hospital... It very much felt as though she was trying to scare us off a HB - by using scare mongering tactics. And that I don't agree with.

Thank you for your support, especially mrsgboring - sorry for your loss :( and the experience sounds terrible. Also sorry to Tangle for your loss :(
Things are recent and still very sore, life up and down anyway.

There was a lot of talk of induction the week before and I was advised that it wouldnt work and I would have to have a caesarian, so of course I went with the advice. Hindsight is great though...

In my area, the NCT did not disseminate advise, they pushed strongly for it and asked questions like 'list reasons why intermittent heartbeat monitoring may be harmful' - thats not balanced. List pros and cons may have been more useful. The whole course was like that. Given that people generally pay for these classes, the people who are more likely to have home births are better off therefore and so will tend to have better outcomes, even if everyone is deemed low risk in studies. Middle class people are more likely to put more effort into maximising the health of their pregnancy.

Regarding the oxytocic drugs to reduce haemorrhage, the NCT class had a push against those too, asking wouldnt we rather not be jabbed with a needle during those first few precious moments with our baby. Im starting to sound really anti-NCT now, but all their advice quickly became irrelevant for me and they have been pretty useless for giving help in my/our situation.
Its true that scaremongering tactics shouldnt be used. Also, balanced information should be given otherwise people cant make informed choice if it is available.

Regarding the number of unemployed midwives - in that case, the government should not train more but should employ them, which I also appreciate costs money.

If things are so much safer at home, why dont high risk deliveries get done there too? Why will the (absolutely gorgeous) midwife led unit (currently 4 beds, lots of equipment, beautiful lighting and music and usually only one lady at a time with full staff) not accept high risk births?

Tangle: the 14% statistic: I've had a look too, and cannot find it on line (and have slung my hard copy). From what I can remember, it was a recent survey by a doctor (cannot remember the name, but would recognise if I saw it again - began with a P) of existing literature. The report did not say how many home births require transfer for any reason (eg including analgesia beyond what could be provided at home) nor within total transfers, how many were for reasons of foetal distress, maternal haemorrhage or unexpectedly poor condition of infant (where you might expect a higher than typical rate of poor outcome). So it's difficult to tell if the findings are statistically significant and if the survey was conducted rigourously enough. It is however suggestive that research could usefully be done in this area - the RCOG website also says that there is insufficient data on reasons for transfer and outcomes. So my apologies if I have overstated this possibility.

I think the PPH does stand though. Major PPH is rare, but cannot be controlled by oxytocin.

And I also think we are broadly in agreement - pros and cons need to be pointed out in as dispassionate and evidence-based way as possible.

Regarding major PPH, I lost 3000ml (about half normal blood volume) fortunately in hospital - they sprinted me to theatre. I have since learned that some of the major uterine arteries have blood flow around half a litre a min so worst case scenario is that you could bleed out in a matter of minutes, & it is one of the leading causes of maternal death in developping countries. I feel I can't "condone" home births cos of my experience but objectively I do respect individual informed choice, so I am interested how would major PPH be managed at a homebirth (assuming no prior known risk)? Could a mother still make it to hospital in time/what is the timescale for an emergency transfer? & are all planned home-birthing mothers tested for clotting disorders?

"There was a lot of talk of induction the week before and I was advised that it wouldnt work and I would have to have a caesarian, so of course I went with the advice. Hindsight is great though..."

Really - your teacher shouldn't have given you any 'advice' at all. NCT teachers aren't medically trained. What you should have been given was information about the likelihood of induction succeeding, and what might happen if it didn't. Failed induction followed by c/s in first time mums with an unfavourable cervix is very common, even though the overall c-section associated with induction for post-dates isn't any higher than for pregnancies that are allowed to continue.

"and asked questions like 'list reasons why intermittent heartbeat monitoring may be harmful' - that's not balanced"

No it's not balanced. But then cultural expectations in this country of what's needed for a safe birth aren't balanced either. They're very much biased towards the view that instant access to doctors, hospitals and technology are essential for even healthy, low risk mums to have a safe birth.

And what actually happens to many women when they go to hospital isn't 'balanced' either: they are often continuously monitored despite the fact it's a) not necessary for low risk mothers and b) proven to be harmful in that it increases the risk of c/s in this group, without improving outcomes for the baby. It's done for institutional reasons, not medical ones, and it's responsible for a lot of difficult labours.

It's all there in the NICE guidelines, midwives know it, doctors know it, but parents DON'T know it. Unless they've been to an NCT class. So I've got A LOT of sympathy for the NCT's approach on this one. It's something I wish I'd known before I had my first baby.

But as far as the over-all NCT approach goes, I can imagine that the focus of the class on normal birth would, from where you are now, feel completely inadequate and wrong.

I'm wondering if there would have been anything your teacher could have done which would have made your experience more bearable, which would have also met the needs of the rest of the group. Did you cover interventions? The prospect of loss?

"If things are so much safer at home, why dont high risk deliveries get done there too?"

Because high risk women may need medical technology to give birth safely: a drip, a catheter to measure urinary output, continuous monitoring of their bp and their baby's heart rate. The home isn't an appropriate environment for this. But it is a suitable environment for a birth which needs no medical input or additional monitoring.

"Why will the (absolutely gorgeous) midwife led unit (currently 4 beds, lots of equipment, beautiful lighting and music and usually only one lady at a time with full staff) not accept high risk births?"

I often ask myself this question - why does the labour ward have to be SO different from the MLU? I hope in the future we will start to address the emotional and physical needs of high risk mums in labour, at the same time as offering them quick access to medical care. If our maternity care is to be designed to promote the best outcomes then this has to happen. I honestly think it's a scandal that high risk mums are getting less one to one care than women in birth centres. It's not right.

But it is the way it is. And until they change practice on some labour wards, the NCT is right to encourage low women risk women (the majority of whom currently end up giving birth in a CLU) to consider birth centres and home births. And also to question the interventions which are being used routinely and without clear evidence of benefit.

"I feel I can't "condone" home births cos of my experience but objectively I do respect individual informed choice, so I am interested how would major PPH be managed at a homebirth (assuming no prior known risk)? Could a mother still make it to hospital in time/what is the timescale for an emergency transfer?"

The time scale for emergency transfer will vary, won't it?

It's quite feasible that a mother could bleed to death following a catastrophic PPH at a home birth. But it's an extremely unlikely scenario - basically because women having their babies at home are at very low risk of PPH compared to women in hospital. So - from the UK Home Birth reference site: "A famous review of quality studies of home birth (Olsen, 1997) looked at outcomes for over 24,000 women and found no maternal deaths. The National Birthday Trust Fund study looked at around 6,000 planned home births in the UK, and found no maternal deaths. I have yet to find a report of a woman dying from a postpartum haemorrhage after a planned home birth in the UK in recent years."

I should think the risk anyway is balanced out by the lowered risk of having a thromboembolism, which I think accounts for more maternal deaths now than any other one cause, and is a risk associated with c/s.

"pros and cons need to be pointed out in as dispassionate and evidence-based way as possible."

Yes - absolutely, but I reiterate, while the risks of home birth need to be made clear, it also needs to be made clear to women that going on current evidence, there are no proven clinical benefits for low risk women/babies as a group in giving birth in hospital, (other than to access epidural analgesia), and that there's a much stronger likelihood of their needing surgery to deliver their baby if they opt to give birth there.

The Olsen study study had no maternal deaths in the hospital or at home in low risk women. At present I cant find how exclusive 'low risk' women are in Denmark. All it proves is that it is safe (for the mother) in general to give birth in Denmark if you are low risk. The problem with the studies are that they are not randomised - that brings in bias as to where people select to give birth.

A mother who mobilises in hospital should not have a higher risk of thromboembolism simply due to the presence of an obstetrician, operating theatre, neonatal team. A well informed midwife and mother can exist as easily in either environment. Any study that suggests that thromboembolism is caused by the hospital is likely to be biased. Higher chance of having a caesarean is likewise not caused by being in a hospital environment. A mother can refuse intervention in hospital as easily.

You should really stop saying 'increases the risk of caesarian section'. It maybe that c/s may be done innappropriately and unneccessarily occasionally, but they are not done involuntarily unless the mother is unconscious. Therefore the risk of a capacitous mother who did not want a caesarian section whilst in hospital should be 0.

Regarding the safety of birth in general, are you saying that babies of 'low risk' mothers never need to be urgently resuscitated after birth? I dont accept that it is easy to identify who a 'low risk' mother is, from the point of view of the life of the baby. Having a low APGAR score is scary anywhere but I would rather it happen with equipment and a paediatric team nearby.

"The problem with the studies are that they are not randomised - that brings in bias as to where people select to give birth."

Well - isn't that always going to be the case with place of birth studies? No way round that.

"A mother who mobilises in hospital should not have a higher risk of thromboembolism simply due to the presence of an obstetrician, operating theatre, neonatal team"

The higher risk of thromboembolism goes with the higher risk of c/s.

"Higher chance of having a caesarean is likewise not caused by being in a hospital environment. A mother can refuse intervention in hospital as easily."

What else accounts for the nearly doubling of the rate of emergency c/s for low risk mothers who opt for a hospital birth then compared to those who opt to give birth at home?

It's very clear that the use of CEFM is linked to higher rates of c/s in low risk mothers, and despite recommendations to the contrary, CEFM is STILL being used inappropriately in CLU's because of staff shortages. Women in CLU's are also less likely to get one to one care in labour than homebirth mothers, and again, this is something that is clearly linked to higher rates of emergency c/s. It's all there in the NICE recommendations: CEFM and lack of continuous care are both linked to higher rates of c/s. Both these things are more likely to happen in hospital.

As for mothers 'refusing intervention' - yes, in theory. But it doesn't happen very often in practice because women in labour are vulnerable and afraid, and are highly likely to do whatever they're told is best for their baby.

"You should really stop saying 'increases the risk of caesarian section'"

Would you prefer "increases the likelihood of an emergency c/s'? Because it does!

"Regarding the safety of birth in general, are you saying that babies of 'low risk' mothers never need to be urgently resuscitated after birth?"

Yes - sometimes this happens at a homebirth. It happened to my d/s. The midwives carry resuscitation equipment and were able to get him breathing.

" Having a low APGAR score is scary anywhere but I would rather it happen with equipment and a paediatric team nearby".

Understandable. But the fact remains: your baby is less likely to end up needing a trip to scbu if you opt for a homebirth, and over-all there appears to be no evidence of higher rates of infant mortality and morbidity, even when the outcomes of 10's of 1000's of births at home are examined.

Should a woman having a homebirth be within a certain distance from a hospital so that if an emergency transfer is needed it can theoretically be made within an acceptable timescale? Or can this not be specified because the worst case emergency would mean being right next door to the hospital so anything else is meaningless?

I am just interested to know about some of the facts a woman/family might use to evaluate the decisions. As a natural parenting type I know many women planning or who have had a home birth but I can only ask so far in real lief otherwise it seems like I am personally attacking their decisions & bringing a right downer on everyone!

I have read lots of thread but not all. I just wanted to add my voice to the view that the most valuable resource in birth is the MW and if homebirths are taking the most experienced cohort of this scarce resource away from hospitals to provide vastly enhanced care to a minority of women I do not think it can be the correct option for birthing mothers as a whole.

I have had 2 drug and tear free labours in hospital (one in the UK and one in the US) and so for a low risk birth if you know your own mind I do not accept that medical intervention will be forced on you. Due to my age I am consultant led for my 3rd pregnancy and have just had my final scan with my consultant; having checked everything looks as it should they did not seek to push any options other than standard delivery on me.

I have quick labours and so would doubt the ability of the MW to get to me in time for a home birth and I can get to hospital in 15 minutes.

There are a lot of things about a homebirth that really appeal to me BUT...my epidural while having DS remains one of my favorite things in life.

I'm only slightly exaggerating.

Howabout, have you read any of the posts that talk about the very well documented fact that homebirths are far cheaper for the NHS?

This comes up a lot, that women shouldn't want homebirth because they get one-on-one care. But it's cheaper, overall, because the NHS saves on hospital equipment, auxiliary staff, real estate, etc., and those funds can go into hiring more hospital midwives.

"There are a lot of things about a homebirth that really appeal to me BUT...my epidural while having DS remains one of my favorite things in life.

I'm only slightly exaggerating."

There is the argument that epidurals are one response to the challenges of labour. And homebirth is another!

I've had a hospital birth with an epidural and a homebirth (and longer labour) without one. I found my labour unbearable under hospital conditions but manageable at home.

"I have read lots of thread but not all. I just wanted to add my voice to the view that the most valuable resource in birth is the MW and if homebirths are taking the most experienced cohort of this scarce resource away from hospitals to provide vastly enhanced care to a minority of women"

Women having their babies at home don't have 'vastly enhanced care'. They have what's recommended in the NICE guidelines for all mothers: ie, one to one midwifery care.

You also need to consider that midwives who do home births have often chosen a different career path from midwives working on a CLU or in a birth centre. They are not being 'taken from the labour ward' because they're not there in the first place. They don't want to practice the sort of midwifery which involves them spending most of their time siting cannulas, monitoring supine women having CEFM, and accompanying mothers into surgery. Caring for mothers at home requires midwives to develop a different skills set. And there is a view that if home births no longer happened it would be a huge loss to midwifery knowledge, as it's mothers having their babies out of hospital who teach midwives the most about physiological birth. These midwives would say that as soon as you move a labouring mother into an environment where she needs to adapt her responses and her behaviour to the smooth running of a large and highly structured institution, then you are putting up a challenge to the normal physiology of birth.

"I have quick labours and so would doubt the ability of the MW to get to me in time for a home birth and I can get to hospital in 15 minutes."

The biggest danger to the babies of women who have precipitate labours is being born outside, where they may become chilled (one of the main reasons babies born in these circumstances end up being admitted to SCBU). It does happen. I personally know someone who had her premature twins on the pavement outside the primary school where she had just dropped her older child off, and someone else who delivered on the back seat of the car on the way to hospital. Also have never forgetten the story of the editor of SHE magazine who delivered her baby on a side street in Islington, between the two open doors of her car while passers by helped out......

Midwives round our way strongly recommend women who have exceptionally fast labours to opt for a home birth, because it's usually safer for the mother who is labouring in this way to stay indoors and wait for help.

Tortoiseonthehalfshell - I think we are a long way from the scale of homebirths which would see the ability to reduce the fixed resources required to run maternity units and so that is why I question the validity of apportioning these costs to hospital births and not home births especially given that hospital facilities are there as a back up for home births as well.

Spudulika that may be the NICE guidelines but I do not know many women who get that level of dedicated MW resource in hospital at the moment. I would ideally want hospitals to be able and expected to provide the same level of care as at home and as you will see I did have 2 "natural births" in hospital not supine or tied to a monitor. I would like the most highly skilled MWs to be available to the maximum number of women and free to use their skills and pass them on.

I take your point about quick labours so I will just have to hope I don't get caught short in the playground or give birth on the bathroom floor with only my children around me as happened to a friend of mine.

"but I do not know many women who get that level of dedicated MW resource in hospital at the moment."

No. And not because there aren't enough qualified midwives - but because the government is not willing to spend tax payers money on providing the sort of staffing levels which would make one to one care a reality for all women.

"and as you will see I did have 2 "natural births" in hospital not supine or tied to a monitor.

You were lucky. The majority of mothers giving birth in hospital will have interventions.

"I would like the most highly skilled MWs to be available to the maximum number of women and free to use their skills and pass them on."

I repeat - whether midwives are at home or in hospital, they can only practice in an optimal way if they are able to provide one to one care.

I really, really don't want midwives looking after 'the maximum number of women' in hospital. I want them looking after the 'optimal' number of women. IE, one!

spudulika - by maximum I meant one at a time without the time taken to move from house to house between births. I think we are on the same page really as I agree the best option would be for the government to spend money on providing the appropriate staffing levels to make one to one care a reality for all women. I think this would also be cost effective in the long run as it would cut down on the number of preventable interventions and complications.

I also think as with breastfeeding a lot could and should be done to educate and reduce the latent fear of childbirth which most women now seem to have and which I am sure does not promote optimal labour.

Hi!
I'm only 17 weeks pregnant with DC1 but I had an almost heated debate with a close friend over MY decision to choose a hospital birth. I know of too many women who have had problems or scary moments giving birth both at home and at hospital and the fact that more than half the women I know have had a dreadful experience has cast my decision to avoid a home birth altogether - even a birth at a MW led unit!
I live in a rural area. My nearest hospital is 20 minutes by car but only has a MW led unit. Any complications and it is a further 30 minute ambulance drive to the hospital, thus 50 minutes by car from my home! Another hospital is 40 minutes away but again MW led unit and any complications means a further 10 minute drive to hospital. My choice of hospital is a consultant led unit which offers ALL pain relief, C Sections and SCBU and is a 40 minute drive - no further trips if any thing goes wrong!
My friend was arguing that the second hospital that I mentioned was lovely and calm and had great MWs and I'd be fine there as it only took her 15 MINUTES from ambulance to be called to be whisked off to the other hospital because she needed further pain relief! Imagine if that was a women who had a placenta abruption or other dangerous situation??? 15 minutes is enough time for a baby to be starved of oxygen or for a woman (and baby) to suffer catastrophic injuries. For me, comfort comes in knowing that my choice of hospital does not need to ring an ambulance, wait for it and then be driven to another hospital, down a corridor and into a room where I can be seen if something goes wrong. I kept repeating myself to my friend that I did not doubt her information regarding her choice of hospital (lovely MWs, nice and calm etc, etc) but that alone does not give me great satisfaction or security over the birth of my child.
In short, I want to be giving birth in a hospital that can offer me ALL the drugs available if I so wish (I can do a birth plan but lets face it, I'm going into the unknown - for me!) and is only a trolley ride away from a room that can give me an emergency C-section/forceps/ etc if it's needed AND whisk my child to SCBU almost immediately if something terrible presents itself such as a cord around the neck.
I know a lot of people will be thinking that I am being negative, but for me, thinking the worst and planning for all eventualities as I possibly can, fills me with relief that I would have/will have done everything in my power to ensure the safe arrival of my little one - and that is all that matters to me. I have heard recently on the news that health officials want more women to give birth at home. The only person who should have the final say is the pregnant woman!

without the time taken to move from house to house between births"

Most midwives working on community or for a dedicated homebirth team will do a couple of homebirths A WEEK, if that!

Mumtobe79 - you have to go where you feel safe.

"but that alone does not give me great satisfaction or security over the birth of my child"

Have you read the thread? Do you think that women like myself who choose to give birth at home are prioritising our own experience over our baby's safety?

Would it make any difference to your view that homebirth is dangerous to point out that of the many 1000's of babies born at home in the UK over the past decade - no more of them have ended up dead or injured than babies born to similar low risk mums in hospital?

"almost immediately if something terrible presents itself such as a cord around the neck"

Just so you don't panic if it happens to you - a nuchal cord (cord round the neck) is present in about 30% of births. It usually causes no problems at all. It's normal.

Would like to add, that women who choose to give birth in a CLU are more likely to have a very poor birth experience than women giving birth in a MLU or at home, and no more likely to emerge with a healthy baby. I think you need to take that on board when you're thinking through what your priorities are around the time of birth. Your baby will benefit from having a mum in the best of health in the first few weeks of life - mentally and physically.

Have always lived in flats and wouldn't have felt comfortable giving birth at home as I'm noisy (seems like everyone on MN lives in a beautiful detached house mortgage free). Also I fancied having epidural pain relief. Had zero interest in homebirth.

"(seems like everyone on MN lives in a beautiful detached house mortgage free)"

What's having a mortgage got to do with anything?

FWIW, I live in a terraced house (mortgaged to the hilt) where you can hear the neighbours breaking wind. I cared more about having a healthy birth than about being overheard mooing or shouting in labour. TBH, as far as maintaining my dignity goes, shuffling around a postnatal ward seething with other people's partners/dads/mates, in my nightie with a giant sanitary towel between my legs was far more mortifying than being overheard in labour. Though actually none of my neighbours clocked the fact that I was giving birth at 2am, despite the bellowing and the two ambulances that we ended up calling (and sending away). DD slept right through it as well. I suspect my neighbours would have been excited as hell to have thought that there was a baby being born next door, had they known.

Sorry - meant to add, that if your priority is a pain-free labour than home birth isn't for you, and an epidural is!

The MLU I was planning to attend is being closed down, after reading the thread, I'm still not sure about having a home or hosipital birth.

Somebody tell me what to do!