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.

Tittybangbang, there is 2:1 care for homebirths and a much lower ratio in hospital.

If there was 2:1 care for all births, I would feel differently. If one woman's choice diverts resources away from another woman's choice (and might potentially cause an issue e.g. if it results in someone having to transfer too far away in the case of an emergency) I am not comfortable with it.

I have a friend who has been told she has to have a hb next time as her first labour was 2 hours from start to finish. I have no issue with this at all. However, I would be uncomfortable with thinking that my personal choice to have a hb might result in a delay of care to another woman. I would be more inclined to choose a hb if I had the finances to choose to provide at least one of those midwives, levelling the inequality a bit more..

I don't agree with Lizz or arses.
You should have the right to a homebirth on the NHS. every time, without fail.

the fact that there are fewer midwives than are needed is a direct result of people agreeing to a hospital birth when they wanted an HB.

The only way to guarantee that every woman gets the care that she needs/wants/is entitle to is everyone insisting on the birth she wants.
Not to be bullied by consultants who don't want the risk (which isn't the case, they just don't want to pay the extra money...) and to employ more women as MWs and doulas.

Not wanting to sound on about the past, but you know when we wanted the vote? did we sit back and do as we were told by the men because they knew what was best for us? No, we got out there and protested and won the vote. This is the same thing - it's about women knowing what's best for them and their babies. and we should have the right to whichever venue we choose.

Pickledbabe, you should be able to have therapy three times a week for language problems after a stroke but you can't get it. You should be able to get a lot of things the NHS just can't provide.

ex-drinker: "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"

IME I did not want anyone doing a VE with my second birth because the experience the first time experience of birthing five yrs ago was so bad, I have issues with VEs even today.

There are other external ways for experience midwives to assess how far a labour has progressed without a VE.

VEs won't tell how much longer a labour will be because women do not dilate evenly over time. So all it does is to introduce the likelihood of infection and make women anxious that they are not 'progressing fast enough'.

They have cut the midwives hours at our local, recently modernised very plush maternity unit.
You can now have an en suite room but less midwives to care for you in the hospital, you cannot tell me that is in the woman interests, if I was having any more it would be at home with 2 members of staff sat watching my every move.

arses I don't know where you live, but certainly here in bucks the midwives who do homebirths are not from the same pool as those who work in the hospital so it would never decrease staffing on the wards.

It's the community midwives who are on call for homebirths and there is only ever one pair on call, so if there is another homebirth going on when you go in to labour you have to go in to hospital. They only cover about 10 homebirths a month so clashes are not too common, seems fair enough to me.

Same here PrivetDancer. I don't have an issue taking up the community midwife's offer to attend me at a homebirth if that is what she already there for!

arsees: "you should be able to have therapy three times a week for language problems after a stroke but you can't get it. You should be able to get a lot of things the NHS just can't provide."

can't or won't...
I wouldn't campaign for 3 times a week, but yes, you should be able to have language and speech therapy after a stroke.

I'm not arguing as to whether this or that would be preferable on the NHS. I'm saying that all medical treatments that are reasonable to expect should be available on the NHS.
and if they're not, that's what we campaign for.

Best clinical outcomes are for 3 times a week. Therapy effective for years after stroke etc but most trusts offer no language/communication therapy after stroke at all.

Maybe you've missed it but budgets are squeezed at the moment. Huge efficiency savings, posts not being refilled, "churn" etc.

There's so much to campaign for..

in that case, then, yes, I would campaign for 3 times a week (my comment was mainly on the basis that I know most NHTs don't do it at all, therefore once a week would be an improvement)

Yes, budgets have been cut, but that shouldn't mean that you lose choice.
What you should lose is the number crunchers and middle management who take up the valuable £s that should be being used on nurses, midwives, and other staff that are necessary.

Agreed.

If I had opted for a hospital birth then my daughter would have been born at the side of the M1. I am glad that I had a homebirth and it was safest option for us.

Mothers need options and to work out what is safest for them.

Is this a race to the bottom? Some people get poor service, so others should turn down a service that satisfies them?

If people wish to campaign for more MW in hospitals, I am happy to support that, but I am happy with the service that would be provided for me at home, so I'd be grateful if people didn't try to drag that service down into the gutter.

I wouldn't deny my baby the safety of having 2MWs just to make a personal political point by going into hospital.

Also, didn't someone suggest that HBs were less expensive than those at hospital - has this been refuted since I last posted, or are people just making an assumption about costs based on staff in attendance?

"Is this a race to the bottom? Some people get poor service, so others should turn down a service that satisfies them? "

No.. but I would feel strange if I thought my choice stopped another woman from being able to use a ward. Fear of bad karma vs anything else.. it's the same reason that I wouldn't take up any other service I felt I didn't need if I could pay for it. I didn't grow up using the NHS though so that may cloud my thinking: I expect to have to pay for medical care.

Obviously in other areas it is better set up meaning this would never arise, so that's different.

I don't think it's my problem to worry about other women and the resources available to them during my labour. It is the NHS's problem to ensure that all women receive adequate care. Why on earth are we blaming birthing women for staff shortages?

As we've already addressed on this thread, HBs cost less than births in hospital. So by that thinking, maybe women who go into hospital should be the ones who pay!

"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"

No, you are wrong - the UK studies the current RCM and RCOG recommendations are based on compare outcomes for low risk mothers only, in both hospital and home settings.

"However, I would be uncomfortable with thinking that my personal choice to have a hb might result in a delay of care to another woman".

As a low risk woman, if you go into hospital you have about twice the chance of ending up needing to have a c/s or an operative birth. Would you feel guilty knowing that you may be blocking up the operating theatre for high risk mothers who really can't avoid c/s?

In any case, the second midwife tends only to be there for an hour or so of the birth. Plus homebirth midwives generally DON'T WANT to work in hospital - because it's so often a crap environment for them as well as the mothers they're looking after.

There will always be women who have unplanned homebirths. Certainly for me my labour was so fast that giving birth in a hospital was not going to be an option.

I took up about three and half hours of community midwives time with my labour. 40 minutes of one to one care during labour and then the second mdwife came after the baby was born. The two midwives left after about two hours.

In comparision women in hospitals often stay a night on a postnatal ward. They have meals provided and there are cleaners, porters, doctors and midwives to be paid for. Our local hospital insists that mothers stay at least 6 hours. I am sure that plenty of women who go to hospital had more time from midwives than I did.

Maybe hospital births are more dangerous for low risk women because all the good midwives are attending homebirths!?

"Maybe hospital births are more dangerous for low risk women"

Hospital births are probably more dangerous for low risk mothers because we're mammals, and moving any labouring mammal into an unfamiliar environment, restricting its mobility and sticking fingers/foreign objects into its vagina at regular intervals, is quite likely disrupt the normal hormonal cascade and lead to a more difficult birth.

We know this is the case with all other mammals, we just ignore it when it comes to human mothers.

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).

Yes but this is not just births, the reason operating theatres are not open all night anyway is the stats of people dying on the table after 10pm is much higher. The human body isn't as resilent at night.

"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."

Not an Ob consultant but an ob reg and a anthetistic reg WILL be on-site 24/7 and tbh they probably perform MORE EMCS than consultants do, who tend to do the daytime electives.

I haven't yet seen a cost comparison to a HB vs a non-drug birth in a hospital and out after 6 hours on this thread, the only comparison I saw was HB vs Hospital with epidual.

What I really don't understand are all these arguments about not moving around in the hospital, having monitoring etc - it's up to YOU being in a hospital doesn't rob you of your ability to say NO or your ability to walk around.

arses as already discussed, HB is the cheapest way for a woman to give birth. More HBs = fewer sections, epidurals and other expensive operations. Saves the NHS cash.

it's just as safe

It's cheaper

Why do people find this hard to believe?

"it's up to YOU being in a hospital doesn't rob you of your ability to say NO or your ability to walk around"

Why then do so many women give birth in supine positions in hospital compared to women at home? Is it because somehow the physiology of birth is different for them? Or is it because they're being cared for by midwives who are used to delivering women in these positions, and who subtly discourage mothers to adopt more helpful postures?

And women are exposed to 'one size fits all' protocols in hospital that they're not exposed to at home.

It's very hard for women, particularly first time mums, to say 'no' to continuous monitoring. At our local hospital they were still doing entrance traces on low risk women until very recently, despite it being against hospital protocols and NICE guidelines. All down to pressure of staffing. It's also the case that if there aren't enough midwives to allow for intermittent monitoring every 15 minutes during labour, as advised by NICE guidelines, you're quite likely to end up stuck on a monitor.

"arses as already discussed, HB is the cheapest way for a woman to give birth."

No it hasn't what has been offered is HB vs hospital WITH epidural - which isn't the same thing.....

"Why then do so many women give birth in supine positions in hospital compared to women at home? "

I wonder if it's because women who tend to ask for HBs are the type of women who tend to educate themselves about labour beforehand. Or are you now arguing it's the fault of the midwives that so many hospital births end up with interventions?

"I wonder if it's because women who tend to ask for HBs are the type of women who tend to educate themselves about labour beforehand".

Yes - that may well have something to do with it. But it doesn't explain all the differences. You can know as much as you like - won't necessarily impact on how your labour is managed, unless you're VERY confident and assertive, which most of us aren't in labour.

"Or are you now arguing it's the fault of the midwives that so many hospital births end up with interventions?"

Sometimes it is - poor practice, lack of patience. I think midwives who attend a lot of home births may have a much better understanding of how to facilitate a physiological birth - mainly because they see more of them than hospital midwives!

More than that though. I think it's partly intrinsic to the hospital birth experience - as I said earlier when I was talking about the normal hormonal cascade involved in labour. The simple act of going into hospital can interfere with this.