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

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

I wasn't scared off.

Far from it actually - even for my first - but we do have an exceptional midwifery team here (somewhere north of Liverpool).

DH just wasn't up for it. And I would have really needed him to be up for it. And I was sufficiently committed to the project to force the issue.

As it turned out, I needed and EMCS for crazy positioning with my first, semi-elective with DD, then V2BAC for DDS2. But my hospital birth with him was fabulous and I would happily have stayed in a night or two.

Jolly - I think you would encourage people to take the safest choice? Which for identified low-risk births is at home (check the official stats).

giving birth at home isnt' the stone age (thank you) - i had a constantly topped up water bath, computer app to help me time contractions, music playing on the sound system, gas and air, 2 fully qualified midwives with equipment at hand at my side at all times, a doula, my partner, hot or cold food and drink whenever i needed it, hospital a phonecall away, car ready to take me if i needed to go.... it was incredibly happy birth, despite my screaming (yes screaming) - it does get a bit intense you know.

I might as well say to you - what i didn't have was back problems from being asked to push when i couldn't feel due to an epidural, experiencing tears and a forceps delivery due to an inexperienced in natural births/gung-ho consultant because my cervix didn't open properly at first and so it all took longer than we thought, having to wait hours for anyone to check on me or to receive the pain relief I'd asked for, looking at somebody else's blood stains/shit on the floor, listening to somebody else scream, being told to wait/go home before i could be transferred to the birthing suite because i wasn't 'ready'/it was full, having to send my partner home immediately after giving birth because it was the middle of the night, having to wait for food because it wasn't ready to be served...

But i won't. I'm delighted you got the birth you wanted and it was safe and comfortable. It's about individual choice, and what makes you most comfortable. I just wish more funding was put into making it an actual choice, not a 'what are you most afraid of/let's use it to guilt-trip you into a hospital birth' game.

Sheesh, jollyjollymom:

1. "Well, I wouldn't encourage anyone to have a home birth, cos, things can go wrong at any moment even if you are low risk and each and every birth is different."

They can go wrong in hospital, too. And they do.

1. "I also wonder why would someone risk their own and their child's life by giving birth at home."

Erm, because for low-risk births there's no appreciable difference in risk between hospital and home, and it's much nicer to give birth at home?

1. "I just wouldn't do it.."

And the good news is, no-one will make you. But if you're a low-risk category, don't kid yourself that you're safer in hospital. Statistically, you're not.

1. "Hospitals and medicines are there for you, when you need it, and why should these women go back to STONE AGE when it comes to giving birth, would they not feel guilty if something happens to their baby.....??"

A. Your likelihood of needing (and indeed wanting) medicine is higher if you are in hospital. B. Describing a modern homebirth as "STONE AGE" is insultingly absurd to midwives and mothers who choose this route. Midwives are extensively trained and turn up with a load of kit. Neanderthals were not that au fait with aseptic techniques, so far as I know. C. Sadly, mothers whose children are harmed during birth often do feel guilty. This is true irrespective of care setting and whether the injury was conceivably avoidable.

1. "after all (agree or not) home is a place for happy dwelling, not a place for screaming and suffering..."

Homes are for living in. Birth is part of life, and frequently (thankfully) a joyous part of life too. My home is all the happier for my daughter having been born there. I can't really remember being happier than being curled up in the minutes post-birth with her and a glass of champagne, while the midwives pottered around for the ten minutes it took them to clear up. Oh, and there was some groaning but no screaming either -- from mother, daughter or father.

The study Tangle linked to from NHS Choices has since been discredited by many experts because a) it included data on accidental homebirths and b) lots of the data came from the US. You can't compare the US and the UK - they are two completely different systems. In the US the maternity system is quite fractured and the midwives and hospital staff often don't work as a cohesive team to facilitate transfer from home to hospital in the event of an emergency, so their outcomes are much worse. Some of these births will also have been attended by lay midwives, who don't have formal recognized training.

The most recent study out of Canada, where they practise in very much the same way as here, showed that planned home birth is as safe, if not safer,
than planned hospital birth. Link here.

And there really is no mess! The midwives clean it up, and they don't care if your house is untidy. They aren't giving out any good housekeeper awards.

It is more dangerous to give birth in a US hospital than in any other first world country I believe- it's basically illegal to have a home birth in some states yet they have the highest maternal death rates for hospital births which is horrific :(

I wasn't scared off, but I chose to have dd1 in hospital. My mum had 2 stillbirths, and I wanted the reassurance that there would be resuss equipment etc on hand. AS it was they lost dd1's heart beat at one point, and although everything ended up fine, I was relieved that they were able to hook her up to a monitor.

I have no objection to HB in principal, but my 3 hospital births were very relaxed (gas, air, pool) and I was home very quickly afterwards, so I felt I had the best of both worlds. I also live 30 mins from the hospital, so wouldn't be keen on the idea of having to transfer when I (and possibly the baby) was already distressed. Once I am in well-established labour the thought of going anywhere doesn't appeal- with dd1 I had to be moved to a delivery room with a monitor, in a wheelchair, and the being moved was the worst bit of the whole experience.

I only have one close friend who had a home birth, and she ended up transferred to hospital when her placenta became retained- again, not a great time to have to up-sticks and be shuffled about in ambulances, just when you are trying to bond with your new baby.

I did consider a HB with dd2, as everything was straightforward with dd1 and DH was away and possibly not going to be back for the birth. I discussed it with the MW, who said I could request it, but whether I got it or not depended on whether there were actually MWs available at the time- which was far from likely. I think there is a definite reluctance on the part of many MWs to recommmend HB's- firstly because if you opt for a HB they have to be "on call" for 2wks before your due date, and potentially 2 weeks afterwards (according to my MW) I think some of them are also nervous at the thought of not being able to call immediately for help.

In countries where HB is more the norm, I suspect the MWs are more practised in difficult or awkward deliveries. In this country, I think there is a definite trend for MWs to immmediately involve doctors/ consultants as soon as things get tricky, and so they may not get so much experience with things like shoulder dystochias/ breech deliveries. That would worry me slightly

exactly, shilly !

I don't get why people have this notion of a homebirth being attended by some aged crone, who'll bite the cord and tie it off with dirty shoe laces.. ok, i exagerrate, but 'stone age' ?

the MWs who attend home births are as well trained as the ones in hospital, they bring pain relief - gas & air or meptid /pethidine( you need to get a script for it in advance sometimes ) they are trained in neo natal recuss and other emergecny care.

they don't turn up with a pair of gloves and leave you to do it, it's insulting to imply that community midwives are somehow less able or trained as hospital midwives or women are asking to be attended by people without the right training at their homebirth

and for me, it always comes back to - hospital births can and do end in catastrophe. as can home births.

each woman has to make an informed choice, which you can't do if you think that a MW attending a home birth is not trained etc etc etc

should women who deliver in hospital and something bad happens also feel guilty?

in a home birth , with one to one continous care - try getting that in an understaffed labour ward - at the first hint of a problem you'll be advised to transfer in

Yes I think mw have been consistently disempowered in this country - 30 years ago they would have dealt with, and been trained/empowered to deal with a lot more themselves.

My issue with gynaes/consultants (and it is a personal one which I admit is not scientifically informed - happy to hear from any consultants) is that i can't help feeling they have lost the connection to what happens AFTER the birth. Local MWs would stay in contact with mums post-birth (and often as not deliver the next one too) and so knew the consequences of episiotomies etc on the women and thus their families. The decisions consultants make are not informed by what the quality of life is going to be for the woman and her family post-birth, they're in the moment and everyone's on a bit of a conveyor belt. I'm not saying anything should be put before the safety of child/mother but knowing the personal outcomes of highly medicalised deliveries or even ones where you are often in a position that's useful for the doctor,not necessarily for you (eg years of back pain/incontinence/pain during sex) might positively affect the way labours are dealt with and thus the outcomes for everybody?

Having said that, my gp told me, in her personal experience, she couldn't deny you got a faster return to pelvic floor/good sex life after a caesarian. so she was thinking about my life after birth

Lulumaam- I appreciate that the MWs at Hbs are as well trained as the ones in hospitals, but I kind of feel they actually need to be better trained than the ones in hospitals to be able to deal with tricky deliveries themselves, that's kind of my worry.

The trend to call for the consultant as soon as things get less than straightforward MAY (and I'm only conjecturing here!) have led to MWs having less hands-on experience of such deliveries. Experience, not just training, is a huge factor, and as long as hospital births continue to be the default setting, I'm not convinced MWs are allowed to gain this kind of experience easily

The thing for me would be the inability to have an epidural tbh and yes, that scares me, knowing what I know now having had one vaginal delivery.

I was a low risk pregnancy- 7lb baby, good health, right weight, good position, normal blood pressure, very fit, yoga all the way to 40 wks. I was ticking all those boxes. I was all signed up for being a birthing ninja and doing the drug free thing. I had extremely good, continuous midwife support but still could not cope with the pain.

I'm sure I would have survived a home birth so I'm not disputing the safety but I dont think I'd have another vaginal delivery if I hadn't had the epidural. I actually wanted to die.

There's been so many recent threads where people have posted links to the latest research on birth risks. I'm not going to repeat all of it.

In summary, current evidence indicates that for low-risk pregnancies, perinatal death risk is the same for hospital and home births when comparing groups of women matched for age, health, socio-economic status etc..., and categorising by planned rather than actual place of birth.

Other birth-associated risks (tears, episiotomies, PPH, PND etc..) are much lower in HB groups.

The findings above are likely to apply only to countries like the UK which have a fully integrated professional midwifery network as part of the broader medical system.

Studies which include data from countries with very different medical systems (e.g. the USA, where midwifery is not fully integrated, and actually remains illegal in a number of states) do not necessarily have any relevance to the UK model.

A certain high profile study which was reported widely in the media earlier this year included data from a number of different countries including the US. It found that HB perinatal death rate was 2-3 times higher than the hospital death rate. However, as the HB death rate in certain American states is actually 6X higher than the hospital rate (and will include data from unassisted HBs, HBs attended by unqualified, unregulated midwives, HBs without any medical backup for emergencies, and amongst large religious communities who refuse antenatal scans etc..) including US data is an excellent way to skew the overall result.

Both the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives support HB for low risk pregnancy.

Foxytocin: thanks for flagging this up. I'm intellectually offended enough by the biased and misleading wording of this exam question to write to AQA cc' RCOG & RCM to ask whether those setting the 2009 Home Ec. GCSE questions knew anything about the subject of birth risk in different settings or just picked this out of the air.

Sorry if i sound like I'm on a rant but statisticley the morbidity and mortality rate for planned home births are equal for normal low risk pregnancies in the uk and if you on your 2nd or 3rd the risk is less at home. did you know that the statistics often quoted to put you off include all home births ( home birth is defined as any birth not occurring in a specific delivery unit, that includes concealed births, births in ambulances and cars and unplanned births at home from 24weeks gestation. yes many people will say that they or their child could have would have died if not in hospital and of course I agree that does not mean that home births are more dangerous. there is in fact evidence that the opposite is true that if you don't live in the middle of a forest on a mountain covered in ice and snow and are like most of us living with in a few miles of a hospital your risks are low and your do your research that your less likely to have a poor out come the problem is that if you do it is a risk but then its a risk in hospital.

you all need to make a truly informed decision based on what is best for both of you things can go wrong in hospital.
( do i dare quote the lady (a nurse) who was given the incorrect medication during labour died in a consultant lead deliver unit. I am not a raving hippy who thinks we can all give birth at home with a bit of aromatherapy and a nice candle but scaring people in to believing they must give birth in a hospital other wise they are neglecting their baby ( which is what is implied so me times) is wrong

Did anyone else see this information - that babies born in Scotland out of normal working hours (9-5, Mond-Fri) are more likely to die? The argument of being in a hospital to get instant attention from a consultant falls down if there isn't a consultant avaialble.

Re. MW's not being available for HB, my GP used that one as a reason for not booking a HB. My argument was if women stopped booking HBs because there might not be a MW available then how could the administrators see that there was a demand not being met?

Ah Tangle, you see, I occasionally chime in on these threads with 'if you plan a hospital birth, try not to make it a night, weekend, bank holiday.' but true.

foxytocin, I couldn't agree more. People say they want a hospital birth, when what they really want is a consultant-led birth. If they started demanding that, they would find the NHS is not currently set up to help them, by and large -- particularly outside core hours.

"In summary, current evidence indicates that for low-risk pregnancies, perinatal death risk is the same for hospital and home births when comparing groups of women matched for age, health, socio-economic status etc..., and categorising by planned rather than actual place of birth.

Other birth-associated risks (tears, episiotomies, PPH, PND etc..) are much lower in HB groups. "

I do wonder tho if this is because woman who birth at home have continous 1-1 care and therfore if available the safest option would actually be in hospital WITH continous 1-1 care.

Librashavinganotherbiscuit: It could well be a significant part of the reason.

My view is increasingly that birth location is not the most important influencing factor in itself but an (often unreliable) proxy for other factors which include provision of 1:1 care in labour, time to equip and reach an operating theatre etc..

Debates on birth risk often get so tangled up in ideology and anecdote that it's difficult to drill down and work out why we see the results that we do.

That's a good point togarama - I think unfortunately some of the ideology is the NHS' own and their insistence in disempowering midwives in the process in favour of consultants, even if it makes it worse for everybody.

All school pupils should be studying this - only thing is there is nothing on bf & ff.

Ghoulysses I can't help but feel quite annoyed at your DH's attitude, though. :(

He's not comfortable with you having a home birth, but he's not the one giving birth, is he?
What happens if you get stressed because you're not in your comfort zone? or if you want to walk around, or give birth on all fours, and the hospital won't let you, because it's easier to monitor you when you're lying down?

I would say with strong conviction that thisis the one time that you don't have to take your DH's feelings into account. You're the one giving birth, not him.
Please don't choose your birth place based on what someone else wants for you. :(

I had a home birth with my 1st DC. I was not scared at all, whereas I associated the hospital as a place of stress because of difficulites following a MC. Even going in for the scans, which everyone else seemed to really enjoy, made me stressed and tearful. My HB was very calm and I was totally left to do my own thing. I had 2 MWs and a student MW (who was nearly qualified) and at one point my MW popped in to see how I was doing. I could not have had more attention. All the MWs said that they would have HBs and they complained about how in hospital they were not allowed to spend time with the Mums to be as they were doing with me. Now I was only 5 mins from the hospital so I knew that if I needed to go in it would be quick, I had also made it clear that at the 1st sign of ANY problems I was going in.

It is my view that the HB vs hospital birth 'debate' is misguided. I believe we should instead be talking about how we can make hospital births as calm as HBs can be and ensuring that all women who are in labour have 1 - 2 - 1 MW through there labour and the poor MWs don't have 3/4 women to care for at the same time. But sadly in this current economic time I know I am in la-la land :(

Opppss that should be "their labour" not there labour.

That's what happens when your baby has you up 3 times in the night!

I have nothing against home births, and have a couple of friends who have had really positive experiences with them.
However, I think they are a luxury. I was talking to my midwife about them recently, and she was telling me about the huge shortage of midwives in our area and how home births were ruled out for 6 months earlier this year as there just weren't enough midwives.

Personally, I think that if you want a home birth, you should be expected to cover some of the cost of basically having them attend to you at home. You could end up taking precious midwifery time away from another woman who is in hospital or indeed her own home.

In retrospect, I could have had DD2 at home it would have been nice.

That is assuming I had not had DD1 at home, which case I would already have bled to death.

I would never have had DS at home, if I did, he would be dead.

So maybe home birth is for some, but not for me.

It may be a qualified MW attending, but the consultant is not in the next room, and there is no operating theatre.