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 considered a home birth for dd2 but the transfer time felt outside my comfort zone. In the end I had a 3 hour labour in hospital and was home a few hours later. For both dd1 and dd2 a home birth would have been fine but you can only know that 100% after the event IMHO. I had an amazing birth with dd1 and pretty fab with dd2 also - marred slightly by a stupid mw who kept trying to push pain relief I didn't want and draping me in a sheet to conserve my dignity. It was a hot night at the end of May and I was boiling and didn't need a darn covering. And dignity - ha don't make me laugh. I was having my third vaginal birth - dignity is a long forgotten concept.

Fascinating article Wo, and what is really interesting to me is how many women whose labours have ended in emergency CS have mentioned that the reason was a back-to-back baby with an "unbirthable" presentation (brow for example). Surely, SURELY if a woman is lying on the bed, on her back (and strapped to something like a monitor), her baby is hugely more likely purely due to gravity to end up with its spine to her spine? I know that if I lie down in bed on my back, it only takes a short time for my baby to rotate away from the top of my tummy and end up lying back to back (I am currently 37 weeks). If I have no trouble figuring this out by having a little feel of my own tummy, why can't any experienced midwife do the same if a woman's labour suddenly and inexplicably slows down at nearly full dilation? I've read a number of accounts where quick re-positioning of the mother allowed baby to right himself and descend properly. I think this brings us back to the same difficulty of having so many midwives who are not confident and/or experienced to be dealing with these issues on busy wards with multiple women to be looking after at the same time. It is unfair to the midwives and the mothers and babies. The end result is that women are left to labour alone, without any advice about how to naturally cope with pain and avoid back-to-back labour, etc. Mother becomes tired and overwhelmed and demands pain relief, and so begins the cascade of intervention which might otherwise have been avoided. Surely that lack of personal attention by a midwife is the pre-cursor to the very reason that many women choose to have a homebirth, that is, to avoid unnecessary intervention.

Absolutely sarahbluff. With DS1 I ended up in hopsital due to 'failure to progress' - the MW tried to get me on my back (he was B2B all the way through) I wouldn't lay there and insisted on being on hands and knees but had had it drummed into me by 2 excpetional MWs that you don't birth laying in 'stranded beetle' position.
I had a relatively quick (40 mins) 2nd stage for a 1st timer (DS2 was 6 mins & DD 7 mins) and no perinial tear. If 'i'd gone into hospital earlier and not planned a HB I think it would have been very different.
My other two were born at hime after really quick labours . I wouod never have made it to hopsital, especially not after waiting for child-care unless I left DH with older children and laboured on my own adn even then I would probably have ended up giving birth in the ambulance/car. Nice choice huh? [hhmm]

This is a topic I feel very strongly about and I hate all the scare-mongering and misinformation that surrounds it. I also wish women had the confidence in and knowledge about their bodies and childbirth that should be their birthright.

My brow baby was wedged in pretty firmly, I had PROM and I am quite certain that in my case, I didn't progress because of the malpositioning rather than because I was on my back - I had 3 days of painful latent labour with waters gone and spent all but the last few hours at home, mostly mobile/on my birth ball.

DS's head was LOT and I had also had 3 days latent labour with him, much more bearable though with waters intact. Because of the previous crash CS, when I didn't progress with him, I firmly refused the kind offer of giving me an epidural and breaking my waters.

DS's cord bloods showed he was getting distressed by the time they did a CS at my insistence and the cheeky bitch of a consultant gave me stick about not really trying for a vaginal birth. I'm sure it was just because I tried for HB, they would have been itching to take me for CS if I had been in active labour 6 hrs with a VBAC in their labour ward.

I was so grateful that one of the registrars told me his blood results and agreed the CS was done at the right time. I really took offence at being accused of 'not trying' hard enough - all I wanted was to avoid another crash section and I think we would have ended up with a repeat if I had been bullied persuaded. I am a gobshite quite assertive though

Totally agree with you Wo about scare-mongering. Somehow a portion of society appears to believe that modern medicine has enabled women to have a completely safe and blissful pain-free birth via drugs, and that any woman choosing not to take this route is masochistic and irresponsible. The truth is, childbirth is a complex process that is not the same for any two women and each woman ought to be allowed and enabled to make an informed choice about how she plans to enter into it. Therefore we needs carefully researched facts to base our choice on, not blanket policies (like induction at term+10) and damning statements (like "I/my baby would have died..."). I think it is fair to say that all of us are grateful for the privilege of modern medicine when an emergency situation arises, but this shouldn't prevent us from doing what we can individually to protect ourselves from ending up in that position.

Personally speaking I'm glad I was in hospital when they realised dd1 was back to back and stuck and I had to have emcs or we'd both have died. There's no way on this earth I would risk giving birth at home.

Yeesh, that is terrible ghoulish, that a HCP would say something so thoughtless and obnoxious! And another example of how very often the mother who is actually experiencing the labour has a good idea of what is going on, but is not listened to.

I personally think that until you know how YOUR body is going to react to giving birth, then a home birth is a potentially disappointing experience. I know two people who have planned and failed to have a home birth with their first dc. I know other women who have had them with their first and it's been fine. It's the luck of the draw. I had one with dc3 and it was amazing, but............................
What the hell is it with home birth midwives not checking the woman. It's all this airy fairy stuff about "you know when to push, let nature take its course" etc etc, and yes, lots of us do, lots of us are built like that, but we do not know until after having our first baby. A good friend of mine was pushing for 2 hours and they only found out when she was blu lighted in to hospital that she was only 6 cm dilated.
I personally would not recommend any woman to have a home birth first time around.

My DD was back to back. I pushed for 4 hours, she did not roatate and was born under threat of forceps with a large and extended episiotomy (and was 6lb 7oz)
Four of my first clients as a doula had back to back babies and ended up with episiotomies and other interventions.
I have spent 4 years learning techniques to help malpositioned labours (like Spinning babies etc) and I now truly beleive the majority of labours can progress without intervention with the right antenatal care and support in labour.
That is easier at home than in hospital because it is easier to relax and stay mbile and empowered.
Selina

..and the stats back you up selina - with half the number of c/sections from low-risk pregnancies, it becomes apparent that babies are being born at home with minimal intervention which would otherwise have gone for EMCS.

exdrinker - 60% of first timers that plan a HB, give birth at home. The other 40% transfer in, usually for pain relief - not a disasterous end result, essntially the same as going in late which some hospitals will make you do anyway when they are busy. A woman giving birth at home for her first gives herself a much better chance of an intervention-free delivery than otherwise.

Dawny - this would have been picked up at home long before it was critical and you would have been in hospital sharpish.
I'm glad I planned a HB with DS1 as if I hadn't I reckon I would have been pushed into a CS because it was taking so long and in hospital they have certain time-limits.

EvilAllenPoe: Yes, and the stats are even lower for transfers amongst 1st time HBs attended by IMs.

exdrinker: "What the hell is it with home birth midwives not checking the woman. It's all this airy fairy stuff about "you know when to push, let nature take its course"

Did you hire an IM with a non-interventionist approach when you would have preferred more instruction? I don't see where you're coming from otherwise.

In the UK Independent Midwives are qualified, experienced midwives under the same supervision as NHS midwives and bound by the same rules and regulations. They don't have the option to be "airy fairy" if there's a need to intervene, expecially since they currently have no indemnity insurance and could be held personally responsible if things go wrong.

By hiring an IM, I guaranteed that I had a birth attendant with 20+ years experience (backed up by two others with 30+ years each) who was able to produce a track record of birth outcomes, statistics and references for me to check at the interview stage.

An important deciding factor for me was that my IM's views aligned with mine on the practice of evidence-based labour and birth practices. I was confident that there was a good reason for everything she did. She checked baby HB regularly, encouraged movement and changes of position, checked dilation at my request etc.. She did actually guide me through pushing step by step (after 10 mins of disorientation during transition I had no idea whether I needed to push or not) and made a very good job of it. It only took another 10-15 mins, I had no tears / cuts, minimal bleeding and an extremely alert baby at the end of it.

You may be lucky enough to get an equally great MW in hospital. But you may also draw the short straw and get someone very inexperienced, personally unpleasant, or just so rushed off their feet that you don't get the attention you need.

The "airy fairy homebirth midwife" is both a cliche, and, I suspect, doesn't represent the norm for most IMs. Don't hire a cliche unless you want one.

Quick correction and apologies for being a dozy moo. I slightly misread ex-drinkers post and thought she was talking about independent midwives rather than all midwives who attend homebirths including NHS. (Sorry, had a much too early start this morning and far too many deadlines to meet before 10am with a dancing baby clambering all over me...)

I'd just add that the NHS midwives attending homebirths are required to be more experienced than the minimum for attending births in hospital.

My comment about choosing midwives obv. also doesn't apply to most NHS homebirths.

I find the idea of HB hard to get my head around. I have read a number of studies claiming it is nearly as safe and some that say it is much more dangerous.

Obviously, people talk about the "cascade of intervention" and there is clearly some truth in that. On the other hand, some labours do go wrong with no intervention. I know that the protocol for a crash C section is 5 minutes from "calling" it to the baby being delivered. I cannot see how you are ever going to get anywhere near that if you have to be transported from home to hospital before having the operation.

And, although there are some fantastic midwives (we are lucky to have one of the best), I cannot see how when things do go wrong/get complex, any midwife can have the same level of skill as a consultant obstretician.

I can see why some women choose to have home births and that, for an uncomplicated birth, they are not "that" risky and some people make a rational choice to take that risk in return for a pleasanter experience. On the other hand, I struggle to see how people can say they are as safe as a hospital birth.

Larrygrylls: "On the other hand, I struggle to see how people can say they are as safe as a hospital birth."

Because we read, and make sure we understand, all the available research and statistical analysis on the issue. (You can read the summaries of the findings of various studies earlier in this thread and on previous homebirth related threads.) This is what the overall evidence tells us. For many of us who choose home birth it isn't actually an emotionally driven decision.

A couple of other points...

Where does your 5 min deadline come from? According to info on the NICE and RCOG websites the recommended "decision to delivery" interval for EMCS is 30 mins and this is only met in around 66% of cases (of whom most will be have been in hospital to begin with).

A good midwife doesn't try to be an Ob. Part of their job is to recognise problems and get medical attention as needed.

I think that some people have an idealised and non-evidence based view of the care they are going to get in hospital (attentive midwife not distracted by 4 other labouring women, junior doctors sufficiently experienced to recognise and refer emergencies upwards, Consultant on site 24 hours a day, operating theatre also on 24 hour standby etc..). In the real world, this is not what you get, especially if you give birth at night when most Consultants and operating theatre staff will be at home.

If an emergency arises at home, the MW will call an ambulance, phone ahead to the hospital (NB they will already have been aware that you're in labour) so that they can start calling in staff and prepping theatre etc.. and accompany you on the way.

If you live less than 30 mins from the hospital, I don't see that your chances of getting into the operating theatre quickly from a homebirth are much different from a hospital birth.

Have to say that I quite fancied the idea of a home birth with my first but decided ultimately that if I was in hospital I was in the very best place to get me & baby help if it was needed. Good job I did, manual removal of placenta and transfusions required after being in labour for 48hrs-I literally watched the clock when the first lot of pethadine wore off.
I've had four altogether and I made the hospital decision every time-even opting to go to the main hospital over the 'cottage' hospital that was closer with baby number 4. Had great births with all bar DS1 although still retained with DD1, DS2 span last minute & came out back to back(ouch) & shoulders got stuck with DD2 but no real problems.
I was home asap with all of them bar DS1. I was curled up on the sofa with hubby making breakfast and the others all fussing over their new sister within 5hrs of having DD2. What I'm trying to say(badly)is that every birth is different, but regardless of how many you have (and where) I have always found the midwives fantastic and I highly recommend saying 'yes' if you get asked to have a trainee assist with your labour & birth as you nearly always get the totally unflappable 'Yoda' of midwives along with her/him.
It's my genuine belief that if you can go into hospital you should as I just don't see how the benefits of being at home outweigh the potential risks for Mum & baby but that doesn't mean I would vilify those that don't.

I had a HB for dd1 and am planning the same for dd2. I assessed the risks and going into my nearest hospital meant increased risks of caesarean delivery (32% at this hospital v. 24% nationally), and a high likelihood of instrumental delivery and/or episiotomy. According to the statistics under 25% of births in this hospital are "normal" and that's just not how childbirth should be, it implies that people who are low risk and straightforward end up having interventions they don't need, which can have serious ongoing consequences. There's also no 24 hours access to BF help, so the prospect of being in a large post-natal ward without help meant that BFing would quite likely not start successfully.

Plus the hospital had an outbreak of norovirus a couple of weeks before my EDD.

Having weighed up all these risks, we considered that the very very small risk of something disastrous happening was one we were more willing to live with than the much higher risk of a medically complicated birth plus the potential consequences of that plus the risk of norovirus meaning no access for DH to visit/baby or me possibly getting ill.

It's a case of how risk averse you are, and for us the very very small risk of a very bad thing was outweighed by the quite high risk of something that could easily be avoided.

togarama I have to address your points, I'm afraid. I have given birth twice at night-the middle of the night in fact and my care was exemplary.
When DD2 got stuck I was in the pool and there was a veritable plethera of midwives in my room within seconds when that alarm went off and when I had the manual removal that was at night too. True to say that my consultant wasn't available but there was one there to explain that I may or may not end up with a hysterectomy. His team literally ran me down the corridor and into the operating theatre-I don't see how me having to be blue lighted for even 15 minutes would have improved my situation.
Besides, ambulances take time to arrive even when it is a midwife that has called them, so lets add another 10 minutes to your half an hour, plus transfer time-no need on a rolling bed and give ourselves an 'in the real world' timescale.

sorry, cross moment over

The reason people look at statistics rather than anecdote, is that ancdotal evidence often leads to incorrect conclusions, as they are only about one person in one place, rather than many people in many places - then you get some kind of basis for a general conclusion.

The statistics tell us that a planned home birth is every bit as safe for both mother and baby as hospital birth. For second deliveries, they are safer.

So stop saying otherwise!!!

I agree with Lizzzombie's point: if you want a hb (and there is no medical reason for you to need one e.g. a previous ultra-fast delivery), you should have to pay.

When I was 41 weeks pg, the local hospitals had to close wards for a night because of a lack of midwifery staff. I was suspected breech at the time and my midwife told me that there were four home births scheduled for the night that contributed to the ward closures, meaning some mothers had to be transferred 15 minutes out of area to give birth.

I don't really agree with this. It is a luxury IMO.

Sorry, 50 minutes!

anklebitersmum: Very good - I'm glad that it went well for you personally. However, I'm talking about the overall pattern, not individual cases. The experience of one person doesn't necessarily say anything about the bigger picture or the experience that others are likely to have.

There is recent published research (summarised on the NHS site here) that indicates that there's a much higher risk of things going wrong with births at night (e.g. night births have a 47% increased odds of newborn death compared to day birth).

Re ambulance timings, again you need to think clearly about the different influencing factors. It isn't only the travel time of the woman that counts. It's the combined time to bring together woman + consultant and/or surgeon + theatre team + anaesthatist etc.. This is going to be highly variable across the country and in different situations. Original location of birthing woman isn't always the most important influence.

e.g. The woman can be travelling from home simultaneously as the others are being brought in and prepped. In the 10 mins that it takes for the ambulance to arrive, the consultant and/or surgeon and anaethatist are being called in from home. You also have to include their travel and prep time in many cases at night, no matter where the birthing woman is coming from.

It isn't standard practice in the UK to have Ob consultants on-site overnight and 24 hour ready operating theatres except in high risk units.

Togarama,

There is a difference between an emergency c and a crash section. I think it is termed level 1 on the RCOG site. I was told about the 5 minute protocol by our midwife but cannot find a reference to it. Maybe it is hospital specific. Those are the situations when you see teams sprinting down the corridors. My brother lives in Paris and his son's heartrate flatlined. They got the baby out and revived it and there is no way he would be a bouncing 3 year old had his partner had a home birth.

Clearly, if you are lucky enough to live next door to a hospital, a home birth is as safe as a hospital birth. Not many people do, though.

"I agree with Lizzzombie's point: if you want a hb (and there is no medical reason for you to need one e.g. a previous ultra-fast delivery), you should have to pay".

Why? If homebirths over-all cost no more than having one to one care in hospital? Or do you think women should be charged for using birth centres, as they generally get one to one care there as well?

I'd agree with that ONLY if women wanting epidurals in hospital for non-medical reasons were also charged for the cost of the procedure. Some women need to give birth at home to emerge from the experience of childbirth emotionally intact. Ditto some women with epidurals.

"Clearly, if you are lucky enough to live next door to a hospital, a home birth is as safe as a hospital birth. Not many people do, though".

There are some very rare obstetric emergencies such as a cord prolapse or a placental abruption where getting the mother to theatre within a few minutes is crucial, so there may be some babies who are born at home who die because they don't have fast enough access to medical care. However, the fact that over-all no more babies die at home suggests that there are babies dying as a result of their mothers birthing in hospital who wouldn't have died if their mothers had given birth at home

Tittybangbang,

Your last point is not true. There was the Dutch study which showed homebirth fetal death was the same as hospital fetal death rates. This has been used by HB supporters. However, it was subsequently pointed out that the tudy was not normalised for the "riskiness" of the labours. All home births are low risk. Hospital births include the highest risk categories. So, if the fetal mortality rate is the same, it implies that it is HIGHER for low risk births than those in hospital, as clearly the v high risk births will have a higher mortality rate.