In two minds about having a home birth

[ViolaCrayola]

I had a horrible hospital induction 1st time around (have posted about this before), now 31 weeks with DC2.

Have been seriously considering a home water birth - have terrible SPD and water really helps. Plus all the other pros about home comforts, privacy, 1-1 care etc.

But I am very unsure that I actually want to have a baby at home! People seem to often be either very definite about home births one way or another, but I just feel undecided. Has anyone else felt like this? How did you decide eventually? Time is running out! :)

WhatTheHell

I am aware that there are different types of midwife in the USA - I referred to their system as a mish-mash.

This is a UK based website and I doubt whether the vast majority of women giving birth in the next few years are going to up sticks en masse and move to the US, so what happens there is interesting, but isn't going to be all that helpful in informing their own birth choices. I don't think that Amy Tuteur is unbiased - her comments on her website that 2 out of three babies which died at home, would not have died had they been in hospital, most emphatically does not apply to the UK, as the findings of the Place of Birth Study show. The RCOG supports homebirth for low risk multiparous women; not a body known for advocating home birth at all costs. So are we to ignore their findings because Dr Amy doesn't agree? The USA does not have a particularly good record as far as maternity care goes, but why that is, would be better debated on another thread.

I believe quite strongly that Dr Amy is a bit unbalanced and there are much better sources of information out there for people to rea up on the various pros and cons of home birth.

Dr. Amy is essentially against CPMs attending home births, which is hardly unreasonable. I don't think that makes her unbalanced.
I am aware that not all of her arguments apply to the UK, but some of them do. I think you'd all be better off reading the full blog with an open mind rather than basing your judgement on one article. Majority of her articles are an analysis of research articles and guidelines, and they are excellently explained and always supported by evidence.

LaVolcan

Exactly, what do you wish to discuss about about varying rates of intervention without (what you perceive as) no added benefit to the baby? Remember that the only time we can be certain that an intervention was required is when it's too late. Once we have a healthy mum and baby with us, it's very easy to look back at the interventions used and question them or call them unnecessary. What we will never know is what would have happened had they not been used.

Amy Tuteur has fished up all sorts of 'evidence' to prove that homebirth is associated with higher rates of neonatal morbidity and mortality. She then uses that to justify the extremely high rates of maternal morbidity that women birthing in obstetric units in much of the US experience.

Despite being rare, the loss of a baby is so awful that according to her it justifies the massive, massive overkill on the intervention front that is taking place in obstetric settings in the US in order to save a very, very tiny number of babies.

TBH it's the kind of argument that has you thinking: where will this end? Elective c/s for all at 39 weeks?

"Remember that the only time we can be certain that an intervention was required is when it's too late"

Which is why we'll probably one day end up with an 80% c/s rate like parts of Brazil. And what a good thing that'll be for womankind. Not.

Blogs like Amy Tuteurs are the best argument for home birth EVER.

The woman has 'zealot' running through her like a fucking stick of rock.

"Dr. Amy is essentially against CPMs attending home births, which is hardly unreasonable"

The only person you want attending you at a homebirth is someone with a very strong understanding and plenty of experience of physiological birth and very, very good midwifery skills. What you wouldn't want is Amy Tuteur, as she'd probably be more likely to kill you with her meddling and unsafe hospital practices than a second year midwifery student from the UK.

i thought that america has higher rates of infant mortality and maternal death than most other 'western' countries and most DO have their babies in hospital, so its not like their hospital system is providing a better, safer alternative.

WhatTheHell Not my perception - the findings of the Place of Birth Study.

Direct quote from the key findings of the report: For women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother.
For multiparous women, there were no significant differences in adverse perinatal outcomes between planned home births or midwifery unit births and planned births in obstetric units.
For multiparous women, birth in a non-obstetric unit setting significantly and substantially reduced the odds of having an intrapartum caesarean section, instrumental delivery or episiotomy.

We agreed that the mother's health was important. It seems perfectly legitimate to me to ask how we can optimise the benefit to women. Why not ask how we can reduce EMCSs, instrumental delivery or episiotomy? If we are going to ignore the findings of major studies then why commission them?

WhattheHell I did read a few articles and I did have an open mind because, unlike you, I have no preconceived ideas about these so-called experts because I am not an advocate for either birth style, nor an HCP, just a 2nd time mum looking to have a safer, more comfortable birthing experience this time, so interested in open debate, not throwing insults around.

5madthinga I also understood it was due to poor women not having access to antenatal care and because a lot of home births are down to lack of insurance rather than choice.
So basically women are giving birth unprepared and unsupported.
It seems the choice is that or highly medicalised.
But I am no expert.

yep i think thats the case mrsdevere and given the changes they have just made to their health system and regulations re insurance etc it doesnt look like its going to get better anytime soon!

our nhs may not be perfect, but at least we have it and we have a choice where to give birth, i know which system i prefer!

I just wish we could move away from this notion of a 'home birth debate' with two sides, for and against. It's like some awful Oxford Union-type debate with spotty gobshites using emotional manipulation, anecdotes, hypotheses and the odd twisted statistic bunged in for good measure.

Dr Amy is a serial offender when it comes to dogma and more qualified people than me have judged that to be the case. To be fair there is also plenty of dogma on the other side too, although it doesn't get much of a hearing in the media.

The discussion I would rather have is one based on hard evidence that is specific to the UK, specific to my circumstances, and produces nuanced conclusions. A more boringly English debate perhaps

I am another person with an open mind, as I veered wildly in my pregnancy between wanting a cs and as natural a childbirth experience as possible due to my previous birth. However, the fact remains Dr. Amy really isn't reporting evidence in an unbiased or even-handed fashion. My personal favourite is an article on waterbirth where she links to "evidence" that it carries increased risk of legionella, streptococcus etc that is reported anecdote (not a controlled case etc) and then discounts a large scale observational study because it is not controlled! She tends to discount all midwifery evidence and evidence from other countries when it shows positive outcomes, but will highlight each and every example of poor outcome and inflate the risk exponentially.

What I find most difficult to accept is the complete and utter intolerance of ANY risk related to natural childbirth (yet absolute faith in cs etc), when as unpredictable and potentially dangerous as childbirth is, it is infinitely safer than putting your newborn in a car in real terms. She sees no risk with epidural, cs, not breastfeeding etc.. but homebirth is akin to murder? We should all support and not shame other mothers for their choices e.g. not to breastfeed, to have an epidural.. but if they have a baby by homebirth and there is any complication, it is the mother's fault? It is highly inconsistent and I find it very difficult to take seriously, despite having no particular belief that homebirth is better than hospital birth.

Surely the safest place is where you feel the most comfortable?I have read a lot of alternative books that say that just walking into a hospital increases the risk of you having epidural s,sections etc,but not everyone walks into a hospital scared shitless,some people find reassurance once they get to a hospital and know they are going to be cared for,and would seriously freak out if they went into labour at home and couldn't get there.From what i have read that makes a big difference,from my own experience i felt most comfortable and in control at home and my 3 births went without a hitch,i actually enjoyed them!I know people who have had wonderful natural hospital births.

WhatTheHellJustHappened,

The thing about interventions is that they are just not either "required" (improving the outcome) or "unnecessary" (medicalising the management but not affecting the outcome). There is a third outcome of "disbenefit" which may not be immediately apparent in an individual case. This is where some short or long term harm is caused to the woman and/or her baby by the intervention. This damage may be physical or emotional.

I am old enough to remember when all UK first time mothers were required to have an episiotomy because of the firm belief of obstetricians that this prevented pelvic floor injury (without evidence but routinely taught). It took years to change this and it is still routine in many countries. But most women at the time accepted the advice of their doctors. The rejection of this practice started when women objected to the violation, long before any trials of its effectiveness were conducted.

in the 1980s, women were instructed by midwives to put babies on their fronts to sleep, as a safety measure (!). It took years before the association with this practice and the increased incidence of cot death was detected through large scale retrospective case analysis. At the time midwives were taught that this was best practice (though there was no evidence base).

So what we or our HCPs might fervently believe to best and safest practice might be overturned by evidence and/or womens opposition. See the recent controversies over breech delivery or the current promotion of VBAC.

Good post mayhew

Cuddler

"I know people who have had wonderful natural hospital births."

AND there is plenty of people on MN who have also had " wonderful calm, lovely", ELC's!

Also - ghastly HB, ghastly - hosp births and ghastly CS.

shagmundfreud

"Despite being rare, the loss of a baby is so awful that according to her it justifies the massive, massive overkill on the intervention front that is taking place in obstetric settings in the US in order to save a very, very tiny number of babies."

I know, right? it's just someone's baby! Who cares if a tiny number of babies die?! Certainly not you. I guess the "every child counts" argument hasn't made it's way into your head yet.
I've got news for you- the loss of a baby is the most awful thing that can happen to a parent. It doesn't matter if it's one baby or 100 babies that die because they all count. Callous attitudes like yours are a bit disgraceful.

"Which is why we'll probably one day end up with an 80% c/s rate like parts of Brazil. And what a good thing that'll be for womankind. Not."

So what would be a good thing for womankind then? An 80% homebirth rate like we had in the 1800s? Or a 30% homebirth rate like they have in the Netherlands, which by the way also has the highest rate of perinatal mortality in western europe? What point are you trying to make?

I am not in favour of unnecessary c sections, nor am I in favour of women being forced to give birth in a way they find inappropriate. But attitudes like yours which go after c sections and epidurals, all the while championing homebirths and VBACs aren't really helping. Guess why? Because as hard as it may be for the likes of you to believe, some women actually want to give birth in hospitals and get epidurals while others (gasp) even request c sections. If you really were for choices in childbirth and women having satisfactory birth experiences, then you'd be equally supportive of ALL choices, not just the ones you agree with.

What would be a great thing for womankind is if we could just be left the fuck alone to give birth in the way we want to, not the way the doctor, the government or the rest of the world thinks is appropriate.

"The only person you want attending you at a homebirth is someone with a very strong understanding and plenty of experience of physiological birth and very, very good midwifery skills. What you wouldn't want is Amy Tuteur, as she'd probably be more likely to kill you with her meddling and unsafe hospital practices than a second year midwifery student from the UK."

Umm.. no my dear. The person you want attending your homebirth is someone who actually has medical training and the capability to deal with emergencies. The "meddling" may just be a lifesaving intervention that may save your baby. Unless of course you'd rather have the scented candles. Who cares about your health or the baby's life right? The important thing is to avoid hospitals and c sections at all costs.

5madthings

"i thought that america has higher rates of infant mortality and maternal death than most other 'western' countries and most DO have their babies in hospital, so its not like their hospital system is providing a better, safer alternative."

Firstly, infant mortality is the wrong statistic- it is not a measure of obstetric care. It refers to children around the age of 1 and in some cases even 5.
If you wish to measure obstetric care you need to look at perinatal or neonatal mortality(babies from 28 weeks of gestation to 28 days post birth), and the USA actually has one of the lowest rates of perinatal mortality in the world.

Secondly, even in countries like Greece and Italy, most babies are born in hospital under the care of obstetricians. Greece has a c section rate of close to 44% and Italy of close to 40%. YET, Greece has the lowest rate of maternal mortality in the world at less than 2 per 100,000 whereas for Italy it is 4 per 100,000. The rates of perinatal mortality in these countries is also impressively low.
Several other countries with low rates of perinatal and maternal mortality have mainly hospital births- Qatar, Singapore, Belgium and Korea to name a few.
Don't believe everything that Hairspray girl said in The Business of Being Born.

mayhew

I am not referring to outdated practices like routine episiotomies or twilight sleep.

I am referring to the current trend of referring to all interventions as "unnecessary" even if they were actually helpful and labelling all obstetricians as "evil" because they "meddle" and don't "trust birth". It's becoming a bit of a fashion trend to think like this.

"Wonderful, natural, hospital births"

Yes, I've had two pretty good and natural births in hospitals. Water birth with dd (DC1). Would have preferred to have a birth pool available again for ds(DC2) - and not to be asked to get up on a crazily high and narrow hospital "bed"
Not transfering to hospital in late stage 1 would have been a bonus too.
But other than that, not bad.

Thanks to all who made it a good experience. And to everyone on here hoping to make it as good or better for other women in the future

Whathehell, are you denying that infant mortality at up to age 5 can have anything to do with obstetric care? Because that woukd be very dodgy indeed.

Whatthehell - I'm not callous.

Shame on you to deliberately interpret my comments by way of trying to prove your point in debate. Nobody would ever say baby deaths don't matter - the point I was making was about how the issue of risk is being represented and how the possibility of tiny additional risks to babies is being used to frighten women into accepting medical practices which are harmful to them, and may often result in increased risk to subsequent babies.

An analogy which may help - every time you take a baby in a car in the US you are putting them at risk. Would that justify someone who ran a train company trying to terrify women out of using their vehicles by constantly flagging up the likelyhood of an accident?

And really - I'm going to shout a bit here: WOULD YOU FUCK THE FUCK OFF WITH YOUR NONSENSE BOUT PEOPLE SAYING 'ALL' INTERVENTIONS ARE UNNECESSARY!

Because nobody is saying this! Or even implying it.

That goes for you too Ushy with your rubbish about people saying c-sections are ' bad'. Seriously - you must be lacking a decent argument if you're having to distort the debate in that way.

Oh - and there's not a lot of labelling of OBS either. (apart from Amy Tuteur who is always putting herself forward to be punched).

Obstetricians save lives and we are all hugely grateful to them for doing this.

Forgive me, the following is from memory...

I thought that whilst holland had the highest perinatal mortality in western europe, it also wasn't hugely different to the UK with the system we have?

Can someone try and find some figures for that?

I DO know that maternal mortality is higher in the Uk than in the Netherlands.

And I recall seeing something about perinatal mortality in the Netherlands being closely related to immigrant population and an inability to speak Dutch being a barrier to getting good care - perhaps something thats more important than place of birth.

There is a lot of evidence to say that high CS rates are not directly related to lower maternal deaths. Look at the US for that. Its down to overall care, and practises rather than place or type of birth. Again, the UK scores poorly with other European countries with higher rates of VBs.

I'm not able to have a good ole google fest to check the above out tonight, but if someone else is feeling enthuastic, theres a couple of points to double check and see if my memory is playing silly buggers or not.

In short maternal deaths and perinatal deaths only have so much to do with the type of birth that is favoured in a country and only have so much to do with the location of birth. There are other factors at play which are having a much bigger impact.

Therefore in my opinion its very difficult to compare one country with another, and its very relevant to put what is best for each individual case ahead of saying well "this is safer" cos its WAYYYYY more complex than going homebirth v hospital birth.

WhatTheHellJustHappened
They only became outdated when women rejected them or the evidence discredited them. At the time they were best practice. Some of the things we accept now will be outdated in 10 yrs time.

It is the nature of a debate involving life/death, womens bodies/ babies well-being, medical hegemony/ womens self determination that people will take up passionate and extreme positions. It is political in a way other healthcare is not. Its just where we are in our culture at this point.

My point is that it is often only in retrospect that we recognise that a practice was not as helpful as we believed at the time. With 30 yrs NHS experience, I have learned to be cautious and humble about all well-meant interventions in physiological processes. I have had to do a lot of unlearning and relearning. As a midwife, I try to marry managing risk with breaking what doesn't need fixing, I " wait watchfully" with the consent and understanding of my client.

WhatTheHell
Because as hard as it may be for the likes of you to believe, some women actually want to give birth in hospitals and get epidurals while others (gasp) even request c sections.

This is a straw man argument. The OP asked about the pros and cons of home birth, so it's legitimate for the thread to concentrate on that, which the majority of us are trying to do. At the moment a CLU birth is the default for the majority, so fine, what's your argument? It might change as the NHS runs out of money but that is a different issue.

The person you want attending your homebirth is someone who actually has medical training and the capability to deal with emergencies.

The person you want attending any birth is a trained attendant - which is why a significant number of women ask for a homebirth. It doesn't matter how good the hospital is, if they are too full to admit you, and you have to drive up the motorway to the next, you are unattended. Last time I looked there weren't any obstetric facilities on the motorways.

Ah yes, we then had a little meander into midwifery in the US. How was this relevant? Midwifery in the UK has been a registered profession for over 100 years, since 1902, and I believe that when the NHS came in, unqualified midwives, 'bona-fide midwives' as they were called, were allowed to continue to practice, with the last of these retiring in (from memory) 1949.

I am not referring to outdated practices like routine episiotomies or twilight sleep,
Twilight sleep might belong to the Victorian era but episiotomies most certainly don't - they were part of parcel of giving birth in this country up to 25 or so years ago. They probably would still be if, as Mayhew pointed out, women hadn't kicked up a fuss. She made the perfectly valid point that they were introduced because it was assumed that they were beneficial, which was subsequently questioned.