Are your children’s vaccines up to date?

Set a reminder

Please or to access all these features

Childbirth

Share experiences and get support around labour, birth and recovery.

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

269 replies

foxytocin · 19/10/2010 01:29

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.

OP posts:
Are your children’s vaccines up to date?
EvilAllenPoe · 24/10/2010 14:48

answering an earlier point: denying women homeborths is unlawful -

it would be restricting a womans freedom of movement - and amount to false imprisonment- to insist on her atending ahospital whilst in labour.

to refuse to send a HCP out - would be culpable negligence.

if a woman wants a HB for twin, breech, VBAC or other high risk birth - then her choice must be respected. The alternative is to deny women basic human rights.

reallytired · 24/10/2010 15:03

Goodness its a can of worms. Homebirths are great, in fact my dd was born at home with an NHS midwife.

HCP have rights as well. I do not think a midwife should be forced to attend a homebirth in a situation that they do not feel happy with.

The problem is what is considered high risk. In my PCT the criteria for homebirth was quite clear. Provided the woman meets the criteria then I think she should be allowed a homebirth.

"if a woman wants a HB for twin, breech, VBAC or other high risk birth - then her choice must be respected. The alternative is to deny women basic human rights."

What about the rights of the baby? There are some circumstances where its plain stupid to have a homebirth. A birth experience is not just about the mother. Life is not fair.

If a mother is really insistant on a homebirth in really stupid circumstances (ie. footling breech) then she should arrange and pay for an independent midwife.

It is no different to having rules on funding IVF. People get denied IVF for reasons that are bitterly unfair.

EvilAllenPoe · 24/10/2010 15:11

there are conditions not considered - some people are genuinely terrified of hospital, have lightning deliveries, etc etc. fact is until the baby is born, the mother makes the decisions for her own life and babies- after birth the mother can make consent for (or deny) all medical treatment decisions for baby too.

Sometimes you might not like that, but i don't see a better way.

reallytired · 24/10/2010 15:23

The nhs will send out a midwife to an unplanned homebirth. Unplanned homebirths are not that unusual with mothers who have had more than one child. My sister in law had an unattended hospital birth in the car park as her labour was so fast.

In high risk cirumstances I imagine the midwife would send for an ambulance. What is the point of a mother having medical care if she chooses to ignore medical advice. You cannot make a health professional attend to you. They have human rights as well.

Certainly a mother can choose to give birth unattended, but its likely that someone who CHOOSES to have an unattended birth (by refusing a a hospital transfer) when medical personal have advised a hospital birth would be followed up by social services.

Mothers do have rights, but they also have responsiblities.

tittybangbang · 24/10/2010 19:29

"What about the rights of the baby? There are some circumstances where its plain stupid to have a homebirth. A birth experience is not just about the mother. Life is not fair"

No - so lets deny the mother pethidine in labour as well perhaps.... Wink

I had a 'high risk' home birth. Was perfectly willing to listen to obstetrician and midwife, but in the end felt I was making the right decision to stay at home. I think the midwife has a responsibility to care for the mother and her baby to the best of her ability, as long as her own safety isn't at risk. If the mother REFUSES to come in then the midwife has a duty to attend her.

EvilAllenPoe · 24/10/2010 19:53

..well this is it. parents make choices for their kids - and that extends well beyond birthing decisions. doing otherwise could lead to - e.g complusorary vaccinations etc.

reallytired · 24/10/2010 20:46

When parents make really reckless choices, they are punished. Quite rightly so.

For example I do not allow my 18 month to play out in the street unsupervised. I am sure that social services would come down on me like a ton of bricks if I did.

However it is parental choice to allow an 8 year old to walk to school unaccompanied. An individual assessment of risk needs to be made. Different families are happy with different levels of risk.

There is always risks in life and birth is no different. A hospital birth for a low risk is not 100% safe and never will be. In some circumstances a homebirth is safer as there are not risks with travel and you get more attention from midwives.

I am glad that in this country we have a range of birth options and different types of antenatal care. It makes for a package that best meets the needs of different families.

IMoveTheStars · 25/10/2010 19:37

ScroobiousPip Oh, sorry that's not what I meant. I meant in the horrible rare occurrence when something uncontrollable happens (not cascase of intervention/increased monitoring etc)..

When my Mum was having my sister the cord prolapsed - luckily my Mum was in hospital when her waters went and she was immediately wheeled down for a crash section.

She might have been OK at home but I guess because this happened to my Sister, I personally couldn't take the risk.

mrsbigw · 25/10/2010 20:43

I don't see how it can be negligence for the NHS not to send a MW out to someone who refuses to attend hospital. If the NHS clearly advised that this service would not be available & offered alternative ie hospital then they have attempted to provide care.

If somebody was having a heart attack but refused to attend hospital & insisted that a consultant cardiologist treated them at home would that be neglectful?

If the NHS home MW team are supposed to (by their own policy/ NICE guidelines) transfer certain cases to hospital they would be putting themselves at huge risk of litigation by actively trying to home deliver.

Incidently I am not against home birth but as a HCP I do feel sympathy for anyone who feels out of their depth to be pressured into something such as high risk home delivery. And I do wonder why anyone would want this, I would be terrified if I knew that even my MW was worried!

ScroobiousPip · 26/10/2010 10:27

Jareth - yes, I see your point at a personal level. Absolutely for freedom of choice. I was just extrapolating nationally - the results could be that some mothers end up having unnecessary medical emergencies who would otherwise have had a safe and healthy birth.

Thankfully, we are lucky enough to live in countries which preserve our rights to choose. Wink

IMoveTheStars · 26/10/2010 11:40

Ah, I see what you're saying. :)

tittybangbang · 27/10/2010 14:56

"I don't see how it can be negligence for the NHS not to send a MW out to someone who refuses to attend hospital"

Because the midwife has a duty of care to the baby as well as the mother.

The baby has a right to a birth attended by a health professional, where ever that happens surely?

And there's no risk of litigation unless there's been malpractice surely? If the midwife has informed the mother of all the risks attendant with a high risk homebirth and advised her as to the safest course of action then she's met her responsibilities hasn't she?

mrsbigw · 27/10/2010 16:27

I think the duty of care would be met by the trust if they attempted to compromise & meet the mother & babies needs as much as possible whilst maintaining safety & in an ideal world a compromise could be reached.

But duty of care is about acts or omissions & to actively try & deliver a baby at home against strong medical advice would leave a HCP in a very compromising position & would IMO constitute bad practice whether or not anything actually went wrong & regardless of whether the risks were explained.

I know we are talking in extremes & hopefully the situation wouldn't arise in RL but if a trust refused to facilitate very high risk home birth & the mother refuses to accept medical advice/ care offered then I think the mother would be hard pressed to prove the trust failed to provide care.

tittybangbang · 27/10/2010 18:33

"to actively try & deliver a baby at home against strong medical advice would leave a HCP in a very compromising position & would IMO constitute bad practice whether or not anything actually went wrong"

But using force or threats to make a patient comply with trust protocols is also bad practice - unethical and probably illegal. The midwife doesn't have to 'try' to deliver a baby at home. She has to be there if the mother chooses to have her baby out of hospital - the baby will deliver itself usually, and the midwife is there to provide care if things go wrong.

As for 'very high risk' - never mind home births with breech twins or mothers with type 1 diabetes. Many trusts are unwilling to accommodate women who want to VBAC at home, have diet-controlled diabetes, marginally high BMI, or who are carrying postdates babies. Very difficult if you're in that situation - as I was.

The legal issue of NHS responsibility in providing a homebirth service is complicated though: birthchoices

mrsbigw · 27/10/2010 20:18

I agree the trusts do seem to have some offkey ideas about high risk, someone told me that maternal age of over 35 is high risk for home birth?!
It would be interesting to hear from any MWs/ mums whether any very high risk mums do actually even insist on home birth, ie mum who has clotting disorders, poorly controlled epilepsy etc as it is those extreme cases where I would feel very sorry for anyone trying to assist without medical support.
I wonder if there will ever be adequate provision for any HBs within the NHS though as it is a patriachal system that by nature doesn't like supporting autonomy.

Curlybug · 24/07/2011 23:12

Im sorry but i am very very irritated by a lot of the posts above.

Surely no professional would suggest a caesarean/episiotomy etc if not required ? it is bad for the mother and makes more work so surely less desirable for the medic too. Doctors are trained holistically (looking at the curriculum and exam contents on the net) and dont have to be authoritarian or ignore psychological/spiritual elements and certainly dont treat childbirth as pathological.

I would think that pushing for home births was poor use of services too ? would you insist it was your right to have a surgeon visit you at home for an operation because it was 'low risk' (eg mole removal) or a teacher teach your child at home, when there was already a shortage of staff? By all means campaign, but go for training more midwives only and then realise that this means the country can afford to do less of something else eg treat diabetes less well. This is the real world.

Tittybangbang, your comment 'Because the midwife has a duty of care to the baby as well as the mother' doesnt make sense to me as the mother is making the choice on behalf of her baby. You cant say, I refuse to go to hospital, but take my unborn baby if they need it. You dont know what the baby would decide. Legally, an unborn baby has no rights apart from not to be aborted after 24 weeks. A mother with capacity can refuse to go to hospital, even in a life or baby-threatening event but this shouldnt have to be different to other healthcare. Some people would say that a midwife should breach the mother's autonomy to reduce harm to a baby, but that is not the legal position in the UK. If people refuse going to hospital, there is nothing that ambulance crew can do about it in most other situations - the responsibility is the persons and they can choose to risk their life. In less life threatening senarios eg a normal birth, the choice should only be given because its 'nice' not because it is a 'Right'.

In my antenatal NCT classes, there was a HUGE push towards home births and the great risks of pain relief drugs. We looked up all of the research from the footnotes and found most of it to be by the same couple of people, and to have many confounding factors - I can add links if you like with explanations, if I work out how to. I can see why giving birth at home is appealing though.

My situation is that I was a very low risk pregnancy, that ended in a 41+1 week stillbirth of a perfect baby boy. I did this in hospital and was given no choice at all - in the shock of death, I asked for a caesarian (as most in my situation do) and was refused it, having to give birth 'naturally' (I hate that term too - when is little electric shocks or inhaling untested substances natural, when morphine from the poppy isnt), with 1 to 1 care lucky me.

Is a low risk planned stillbirth included in the statistics of low risk hospital births? (I Hate statistics now - 1 in 200 doesnt happen to you does it - EVERY baby matters, please remember that, people who talk about risks and consider how you would feel if it happened to you, as 11 stillbirths happen a day).
I didnt have the choice of a home birth did I? In the research, people self-select into hospital or home births as you cant force people one way or another - this affects the risks on its own - people who choose home births are more likely to be middle class, better health, less alcohol and drug use etc. Are they the same ethnicity, have the same number of previous births?No, not according to the Dutch study. Are these variables controlled for in all of the studies? I am sure there are factors that I and you havnt considered, not being an expert at obstetrics, before I get shot down.

Talk of choice is useless to me as I have little choice about my care if I want a healthy child in the future. My Alexander could have been born alive if I had gone against non-intervention advice a week earlier and I kick myself that I didnt push for intervention. I cant exactly relax after 12 weeks now.

I appreciate this is a long pissed off rant and I could keep going the rest of the night, as it is strangely helpful, but I will leave it there for now.

Curlybug · 24/07/2011 23:27

Apologies for being so sensitive

EdithWeston · 25/07/2011 07:39

Curlybug - you're making an important point.

No-one wants to contemplate a stillbirth - no-one plans for one, or believes it could possibly happen tp them.

I think it is vital that anyone planning a home birth takes the time to think (and I mean really imagine) what would happen if it all went wrong. One sad stat is that 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). My big worry is PPH, which can occur to anyone with no prior warning (or clear risk factors). A schoolfriend of mine grew up motherless because of a PPH when her mother had her 3rd low risk baby at home. 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 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 see this is thread is a few months old - and predated the latest DoH announcements on a policy to encourage home birth.

spudulika · 25/07/2011 08:34

find it really interesting that there are people out there who would happily trade off the reduction in risk of a c/s for the opportunity to keep their floor clean.

my mind is boggling.

how much mess do people think there is at a homebirth? I had the messiest one of all time and the worse that happened was that my duvet needed dry cleaning afterwards..... Grin

spudulika · 25/07/2011 08:52

Curleybug - Sad

Were you offered an induction nearer your due date, before it was discovered that your baby had died?

Re: the research - yes, the quality of the evidence is 100%. But it's good enough for the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists to recommend home birth as a 'safe option' for low risk mothers. I think it's not unreasonable for the NCT to disseminate information on the benefits of home birth in light of this. Especially given the fact that regionally there are HUGE variations on take-up of home birth, suggesting that availability and support for this option are not consistent.

"I think it is right that HCPs point out these specific additional risks of catastrophic outcomes

There doesn't seem to be good, consistent evidence that mothers opting to have their babies at home are putting themselves or their babies at ADDITIONAL risk overall. In fact all the evidence points to women giving birth at home as a group, having much better health outcomes than women giving birth in hospital. (and that's even when you include the women who've transferred in labour)

spudulika · 25/07/2011 08:54

Would like to add, that those of you watching the news this morning would have seen the report on the deaths of 17 mothers last year, possibly linked to a lack of staff in maternity units.

Can you really blame women for wanting to ensure that they get one to one care in labour from an experienced midwife care by opting for a homebirth?

EdithWeston · 25/07/2011 09:17

Nope - but opting for a home birth doesn't guarantee you that. You will get one-to-one care, and you may get the lovely experienced midwife you met during your pregnancy. But if she's not available (already attending someone, off sick etc) you'll get whoever can be sent.

The births mentioned this morning were catastrophies (eg uterine rupture following induction, or sequelae of CS). But it was also clear these were predicted high-risk deliveries.

EdithWeston · 25/07/2011 09:22

Spideybug - I mentioned the worse outcomes for home-birth mothers transferred to hospital (when compared to low risk mothers who had opted for hospital all along). And the bleed-out time for PPH. They are consistent risks, about which information should be given.

cory · 25/07/2011 09:35

spudulika Mon 25-Jul-11 08:34:08
"find it really interesting that there are people out there who would happily trade off the reduction in risk of a c/s for the opportunity to keep their floor clean."

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

My reasoning was: the increased risk of CS in hospital is thought to be due to maternal stress and inability to relax.

However, as it so happens, hospitals don't stress me out, so I am unlikely to suffer more stress complications by going into hospital.

In fact, I would be far more likely to be stressing if I had to give birth at home, letting strangers into my house, having it presentable etc. Therefore, in my case, this risk factor does not apply to a hospital birth (but might well apply to staying at home).

On the whole, I don't relax very well at home. It's not about carpets, it's about the fact that I cannot relax and concentrate where I can see lots of jobs I ought to be doing. I need to get out of the house to write as well. People are just different.

mrsgboring · 25/07/2011 10:14

Curleybug I am so sorry about Alexander. My experience was somewhat similar except that I begged for my DD to be induced after I went over dates (family history of postterm stillbirth) and was told no, definitely not before Term +14 as no resources available. This despite the fact NICE guidelines were already for induction at Term +10. Nowadays 7 years later the Trust does have a policy of induction at Term+10 and I know so many pregnant women who are kicking against this (and demanding daily monitoring instead Angry) and it makes me want to howl with jealous frustration.

My DD died overnight somewhere between Term+9 and Term+10. It's possible that if I'd been in being monitored prior to a booked induction she might have been saved. It's maybe more likely not but nobody will ever know.

What does make me angry is locally there has recently been a huge investment in services for low risk women - home birth with two midwives on call to your house, and also midwife led units with all mod cons. By contrast Delivery Suite was built with space to provide en suite toilets to each delivery room but these were dropped from the plans at the last minute because of a budget crisis. 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. When I delivered DC#3 (who had an unrelated health problem so I was high risk for several reasons) my one midwife was covering another birth as well and only reappeared in the room five minutes before I delivered.

There seems to be a massive disconnect between being low risk - there should be a Rolls Royce service available on demand, and being high risk oh well too bad Delivery Suite is massively overstretched. But if you'd had the foresight not have serious medical problems then you could have had all this lovely care available to you.

I know, this is a rant too.