Homebirths: Why / Why Not..?

[ICindigo]

HI Everyone
I wonder if anyone can help me. I am a student (waiting to hear if i have been accepted for a midwifery degree) and am in the process of writing an assignment.
The topic is why more women don't have home births. Anyone who hasn't had a home birth or wouldn't in the future - can you tell me why..? You dont have to go into detail i just need to know the main reasons..

i would be very grateful for your thoughts!!
Thanks, kelly x

hi - recently had a homebirth - excellent experience overall and was supported by all local health professionals I came across! I guess I was lucky..I can give you more details tomorrow, if that helps, but crying baby calls!

I have a friend who had an unplanned homebirth. Things got moving rather too quickly (and her DH had 'popped' into work and was longer than he thought) and the ambulance driver arrived to literally catch the baby as it came out! . She was quite traumatised by the whole thing!

I had planned a home water birth right from the start of my pregnancy. Community midwife was supportive. Have done all kind of courses together with my husband and had rented a pool.

However, with less than 2 weeks to go, I have been advised that I am at high risk of post partum haemorrhage due to position/size/type of fibroid. I only found out by getting second opinion from private consultant, NHS consultant had not spotted the danger and given the go-ahead for the homebirth. I feel very disapppointed but suppose I should feel lucky that I have found out in time, because I could potentially have been in great danger if I had proceeded with the homebirth. I think that it is really important that women who are offered a homebirth get a thorough risk assessment, if they are with NHS midwives then the NHS should be obliged to carry this out and not leave it to a woman's gut feel that she might need a second opinion somehow. Not sure how this works with independent midwives, do they carry out a risk assessment? TBH I am not totally sure what the risk assessment would consist of, but surely doctors/consultants/midwives could get together and agree on that. If I was now in the same position as at the start of my pregnancy I would now be much more reluctant to have a homebirth, and if asked would be inclined to warn women who consider a homebirth, whereas I would not have done so say a month ago. It has been a hard lesson and has definitely undermined my confidence in NHS consultants/midwives wrt safety issues.

I did have a PPH and having birthed normally at home was in hospital within 10 mins. I don't think for me there was any more risk from being at home and it couldn't in my case have been predicted.

meant to say, depair, good luck though. Hope it goes well and sorry to hear you couldn't get the birth you'd originally planned.

Yeah, Despair, good luck. I agree that more screening should be done as standard for those having a home birth (or hospital birth come to think of it). I only had a 20 week scan and blood tests and bp done. The only consideration I was told about was that my iron levels needed to be good. But then had something gone wrong I could have been in hospital in about 10 mins - which was a consideration - so treatment would still have been almost immediate even in an emergency.

I've had 2 homebirths and you prob know this, but statistically, planned homebirth is AS SAFE as hospital birth. Marjorie Tew's book on the subject explains why. I bet a lot of people don't have them because:

• Many consultants don't like them. Mine tried to tell me I couldn't have one first time despite it being a straightforward low risk pregnancy
• Perception of risk as opposed to the reality of risk mentioned above - so people think hospital is safer although it isn't necessarily
• De skilling of midwives means that some hospital midwives may not feel confident about home birth

Sorry, just realised you wanted to hear from women who didn't have one but I've typed this now so I'll post it anyway!

For me it had little to do with perceived risk, and everything to do with not having to worry about my environment. I know you're supposed to feel safer and more confident at home, but in hospital I could make as much and as bizarre noise as I wanted, without worrying about the neighbours, I didn't need to worry about mess, or about tidying up, and, particularly with my second child, I didn't have to jump straight back into being mum - in hospital I could rest as long as I wanted and be as isolated from others as I wanted to be. Ds certainly throve on the 3 days of almost undivided attention that he got from dh - far better than having to deal with me sharing attention with a little interloper. Similarly, people came to visit us, brought food, and left. I didn't have to be any sort of hostess.

Right well I have had one hospital birth and one home birth, and am subsequently a big advocate of home birth.

My reasons for having DS in hospital:

• basically it is the done thing - I didn't know anyone who had a home birth
• I thought it would be better to contain the mess etc at the hospital That's it really. Nothing very compelling. I never intended to have an epidural and didn't end up with one. I had no pregnancy complications to speak of - low blood pressure was about it.

My reasons for having DD at home:

• I came on Mumsnet and was more aware of it as a valid option (doubt I would have gone through with it without support on here)
• I hated travelling to hospital while in well-progressed labour (was 9 cm when first examined) and it is a long way to our hospital
• with DS I inadvertently ended up laid on the bed which I think led to contractions reducing so ended up on a drip with legs in stirrups which didn't help me to deliver a 9lb 10 baby and I ended up with an epiosotomy and a lot of stitches. Decided I wanted a more active birth
• I didn't like being stuck on the post-natal ward with very busy midwives and limited attention. Decided it would be much better to be in my own bed with DH attending to me. Also knew I didn't want to stay long because of DS and didn't fancy the journey home shortly after giving birth.
• I knew I had managed to give birth to a large baby with the use of G&A so this gave me confidence that I would cope at home.

I had a fab home birth with a brilliant midwife in attendance. My DS got to meet his sister when she was minutes old. It was a lovely spring day. And my modern box of a house now has some history!

Prettycandles - My sentiments exactly!!!

Not read the whole thread... I'm due for a homebirth in the next couple of weeks, but as its getting closer, Prettycandle's reasoning is sounding more and more appealing.

I was desperately lonely in hospital with DD though, which was my main reason for wanting to stay home, but the more I'm thinking about having to deal with visitors, the less appealing it seems.

Torn, and probably won't decide either way until I'm in labour!

Thanks everyone for your comments i am certainly going to have a lot to write up!!!!

After ds was born I was on a crowded, noisy ward and I was very keen to get home. After dd was born I managed to get an amenity room and was keen to stay longer because of the peace and quiet. I did worry that I might be bored and isolated, but it didn't work out that way at all. Instead I had all the time in the world to gaze into my new daughter's eyes and curl up with her and feed in peace. I wasn't bored or lonely at all.

Fear about complications played on my mind 2nd time. But mostly, fear of the neighbours hearing the whole experience.

If I had a 3rd, think I would be braver though.

I am sort of in the Prettycandles school too. It's not to do with risk for me at all... home just doesn't seem the place for birth to happen. It's almost like having somewhere special to go is a part of the 'ceremony' of it all... and the bubble that you're in in the middle of all that new stuff feels a bit more protected. From all the things pc mentions... it's the only time I will have alone together with my 2nd baby and I am actually looking forward to that as an experience in itself. It wouldn't have to be a hospital to satisfy my requirements - and our local one is a midwife led unit, so I'm as happy as I could be with that - but if there was a 'third way' that was a special giving birth place that wasn't really a hospital at all but had fab relaxed midwives, big sunny windows and clean sheets that would be my dream!

That's exactly it, spots. With my first, my dad was concerned that I had chosen to give birth in hospital - not that he wanted me to give birth at home, far from it! But, as he put it, "You're not ill, so why should you be in hospital with ill people and surrounded by the mindset of looking after ill people." He wanted me to go to a Maternity Home, and couldn't believe that such things no longer exist.

My mum always talks lovingly about the maternity home where my sister was born - the big windows, a view of the lawn etc.

I just remember feeling so cut off in hospital - I had this new child that I had no idea what to do with, no-one told me what the ettiquette was for going to the toilet etc, and I was all baffled... did I take my baby with me, did I leave her behind? I was in a private room as I had a funny turn after the birth, so I couldn't even watch the other mums for guidance, and I felt foolish for asking. I missed DH dreadfully because he was only allowed there for the set visiting times, which although were longer for dads, they still didn't start until about 10.30, and when I'd been up since 6am with the heat, that seemed like a lifetime!

All those fears come back to me now when I think about hospitals (tbh I still have no idea what the toilet ettiquette thing is!!!)

Tough one, the toilet thing... If anyone could shed any light on that it might come in handy for me becoming a midwife... haha.

flamesparrow - don't worry about the tidying up! My midwives did it all (think it was tidier than before they arrived tbh!) Nothing beats the feeling of already being at home with yr new born babe, trust me! We didn't feel isolated either - plenty of visitors to fend off in the first few days! Good luck!

I had a homebirth in October. It was a wonderful experience, no stress and no pain to speak of. There was no mess at all the midwives just bundled up the towels and stuck them in the washing machine.

Nothing can compare to cuddling up in your own bed with your new baby in privacy. My first child was born in hospital and although there were no problems I did not like the feeling of having to ask what I was supposed do. How can you feel secure when you can't leave the baby in the cot while you go to the loo and the babys dad has to wait outside a locked door until the clock says he can see his wife and child?

Kelly, most women don't have homebirths because we don't have a society where many women do it so the good news doesn't spread. In the 60/70's the NHS went out and campaigned against homebirth in the mistaken belief that it was safer to birth in hospital. Although that has been acknowledged as a mistake there are so many vested interests in reversing that policy now.
We live in a country that thinks birth itself is risky and that we are "delivered" of our babies. There is also a huge vested interest for hospital consultants to get women to go into hospital because if the majority of women who could homebirth chose to do so they would have to recruit more midwives and fewer consultants would be needed.
I've had 3 hospital births and one home birth and the last was fantastic. No mess (which I worried about too) and the ability to curl up with new baby and husband that first night in our own home with no worrying about children at home was just awesomely wonderful. You do have to be firm about visitors but I found a note on the door saying "Close family only please, we are resting" and a message on the answerphone worked wonders. It was like discovering champagne when you've only tasted asti spumante before :-)

I suppose what I want to say to you as a student midwife is, go and read the research and then when you get a chance, go out and tell the truth to women and let them make the choice. In areas where midwives promote homebirth as a safe and desirable thing to do the homebirth rate absolutely soars - Torbay and Brighton being the main beacons of hope.

As regards risk assessment, all women are "scored" and I would have failed on most of them but chose to stay at home anyway. I think if anything the NHS is thoroughly overcautious about risk assessment. Independent Midwives do also advise their clients on risk factors but support them in their choices. I do wish someone whould talk about the risks of hospital birth - there's a 60% first time mum episiotomy rate in my local hospital, eugh!! If you haven't discovered it already the homebirth.org website is brilliant for research and information. I'd also throughly recommend joining AIMS and reading their booklets.

completely agree with MT - and also want to name & not shame Windsor/Ascot/Maidenhead PCT, v supportive of home births in my experience!

Home birth in this area is really quite a normal thing.
But then i am in Mid Wales-it would appear that alot of things are different here

My FIL is a retired GP and felt that once homebirth went 'out', he also became deskilled once it came 'in' again - he said to the midwife in his team, I haven't delivered a baby for 20 years. Also a consideration IMO.

Went for a hospital birth first time 1. from fear of something going wrong and wishing 'if only I'd been in hospital' and 2. wanting an epidural to be available. Also I am with spots in the 'ceremony' of giving birth - I wanted to be the centre of attention, frankly, if necessary of the ENTIRE HOSPITAL not to mention the UNIVERSE. At hospital I felt I would have the license to behave exactly as I pleased. At home I have roles to play other than giving birth - being a hostess to the midwife? worrying about the neighbours hearing? all the stuff I usually do. At hospital I just howled like a serious banshee for an hour and never cared about neighbours.

If I were pregnant again I would hover between trying to afford a pre-booked private room (how does anyone cope with a postnatal ward, even though mine was nice?) and an independent midwife at home so I'd met her before. But partly because the first one was too fast for an epidural so I'm pretty sure I'm out of luck on that one.

Thanks for the advice MT, and honestly, thats what i aim to do.
Most of the women i have discussed this with, many of them wouldn't have even considered home births, but they would have liked to be given the option to do so. So many women seem to be railroaded into conforming to what hospitals / doctors want them to do- either due to lack of experience or staffing etc. I'm not saying home birth is for everyone but i strongly believe that each pregnancy/birth is unique and that each mother should be valued for her individuality and assessed for her own needs.
its so frustrating by the way birth is generalised. I'm glad that more people are starting to question the way things are done, and realising that they can speak up and make their own choices.