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! :)

i dont think anyone is saying they would refuse intervention if it was needed for them or the baby but yes we will question! i myself questioned and stood my ground in some of my labours when drs were wanting to intervene, even just to have me flat on my back moniter constantly attached as there was NO good medical reason to do so. i was fine, baby was fine (with intermittent monitering) and the midwives were also happy all was fine, the drs however wanted me to do things THEIR way, so yes i questioned and said no. i wasnt putting myself or my baby in any danger by doing this, thats not what women want.

we want to be able to make an informed choice! and have our view listened to, respected and adhered to unless their is good medical reason that things need to be done differently and then i would expect an explanation as to what is happening, what needs doing and why.

I had an episitomy 20 years ago.
No questions, no consultation, just a midwife with a scalpel

A very young midwife who had also told me off for walking around and making a mess on the floor and who gave me an inco-pad to stand on.

Took an hour to stitch me up. They didnt tell you what degree tear you had in those days.

It wasnt until I gave birth to my DS, two years later, that I felt a huge weight being lifted from my shoulders. I had him in hospital but under the Domino system with ONE midwife who was supportive and kind.
I had him at 11 in the morning with no complications but I had to stay in hospital until late that evening purely because there was no Pead available to discharge me.

Is there any wonder I prefer homebirths?

Again I mention OBEM wher the mw was encouraging woman with twins to accept an epidural with all the associated risks, not because the woman wasn't coping with the pain but because the mw knew that the consultant on shift had a preference for delivery of second twin that without an epidural would be very painful.

If that woman had been on someone else's shift she may not have 'needed' an epidural. The sad thing is that she had birthed before and KNEW she had a preference for not having an epidural.

StarlightWithAsteroid

I am not saying that. I am simply saying that infant mortality is a measure of paediatric care, whereas perinatal and neonatal mortality are measures of obstetric care.

Usually the death of a five year old will have little to do with how he/she was delivered. Of course in some rare instances it might, but if the delivery is to cause complications they would make themselves known within 28 days to 3 months of the birth in most cases.

Wonder why they phased the Domino system out? It seemed a good system and would address many women's needs. (Domiciliary In Out for those who have never heard of it before.)

Not as in pizza delivery!?

i had an episiotmy with ds1, but it was offered after i had been pushing for 3hrs! and it was done with scissors! which i think they use routinely now instead of a scalpel, i will forever be able to remember the noise of that snip!

it was not a nice experience but i am forever grateful to the midwives who let me push that long and tried everything, different positions etc rather than rushing straight to forceps, ventouse etc. the episiotomy wasnt great but it did mean i then delivered ds1 quickly and easily, he just kept pushing out a bit and then going back up and i didnt have the strength to push him out. i did however state for the rest of my births that i would rather tear than be cut, purely because tears heal better and that has been my experience as i tore with ds2.

and as mrsdevere shows a birth where even if the intervention is 'small' like an episiotomy can make a huge difference to the recovery of a mother both physically and mentally.

Not as in pizza delivery!?

lavolcan they did the domino system until fairly recently in my area, certainly it was offered when i had ds1 and ds2, tho it wasnt guaranteed but they certainly tried.

actual european perinatal stats. Netherlands better than UK still

the reason it was reported as having a high rate was due to a study that had deaths from outside study area reported-in.

5madthings

I never once said I don?t support informed decisions or that I don?t believe in a woman?s right to refuse any procedure she doesn?t want performed, be it an episiotomy or a c section or anything else.
I myself have a long list of interventions that I would question and likely refuse(eg; forceps). I myself am making an informed decision to have a c section for my first baby, so I would hardly judge you for making your choices.

What I am objecting to is the dangerous trend of labelling as ?unnecessary? interventions which may well have been helpful. Routine practices such as lying flat on the back, stirrups, fetal monitoring etc. are one thing(one can be quite certain that they are rarely medically necessary), but procedures such as c sections or inductions are different. It is easy to label them unnecessary in retrospect, but it is impossible to be certain of what may have happened had they not been performed.

I am also alluding to the double standard that exists among many women nowadays. They talk about the right to choose and informed decisions, but somehow their crusade is only for home births and drug free labours. Their concept of choice doesn?t extend to epidurals, c sections on request, or consultant led care- these choices are always ?uneducated?, ?unnecessary? and ?a waste of resources?. In my opinion, if you champion choices and informed decisions, it doesn?t stop at home births. It should include and support ALL choices.

EgdarAllenPimms
So if the perinatal mortality rate is better (as you claim it is), does that credit automatically go to less hospital births being performed?

That's as warped as blaming the maternal mortality in the USA on their c section rates, when there are countries with higher c section rates and lower maternal mortality rates than the USA.

The co-existence of two statistics doesn't always imply their correlation.

THe domino system is exhausting for the care givers, there is already a huge amount of 'burn out' and high rates of sickness in the midwifery profession, indeed 2 midwives I trained with in the last 5 years have gone back to their old jobs after the system ground them down. For domino care to work there needs to be a lot more midwives in order to take on a smaller caseload or it just Isn't sustainable. Being on call doesn't seem like a big deal until you're doing it day in day out, unable to go to areas of no mobile signal, away on your days off and relax with a glass of wine at the end of the day and the recompense for giving up your free time in that way is minimal. On one hand domino is how many of us would love to practice, that continuity of care is priceless and enhances the experience for everyone, on the other hand there just isn't the staff to do it safely in terms of protecting the health of existing midwives.

this is a thread about HB. that's we're talking about choice with respect to HB.

And by the way,

www.bmj.com/content/337/bmj.a3118.extract

The Netherlands does have the third worst perinatal mortality rate in Europe.

Here are statistics directly from the WHO-

whqlibdoc.who.int/publications/2006/9241563206_eng.pdf

i didn't say it did.

"t the Netherlands had the third worst figures, after France and Latvia "

you mean :)

Edgar

Yes, I am intelligent enough to realise that this is a thread about home birth. Perhaps you are not sparky enough to pick upon the fact that I am referring to general attitudes that exist on mn and outside- they are not specific to this thread.

edgar

I mean that you are wrong. The UK has better rates of perinatal mortality than the Netherlands.

The Netherlands is consistently in the top three worst when it comes to perinatal mortality in Europe.

". The news item listed some of the possible explanations, for example
lifestyle factors (Dutch women have their babies late); obstetric factors
(Dutch women have more multiple pregnancies); and social inequalities
(Dutch women of non-western origin are 40% more likely to experience
perinatal mortality).

When the Peristat II results were published earlier this month the
Dutch media suggested a number of other possible explanations, some of
which might be worth some further investigation. For example:
paediatricians in the Netherlands were less interventionist in 2004 and
may have not have started treatment in extremely premature babies, which
may explain the higher than expected death rate immediately after birth
(early neonatal mortality). The media also reported that the Dutch were
less likely to use prenatal screening for congenital deformities than many
other countries in Europe. While several newspapers mentioned
specifically that the high percentage of home births was not a causal
factor."

that in the response...

frankly, unless you are giving birth in the netherlands it doesn't matter - but there have been some enormous studies done there that did not find HB to be a factor.

but France was worse..according to that report from 2004 - and the UK was in that Irish report i linked from 2006...

it will vary from year to year and the exact stat you are looking at (ie how long after birth included)

"But attitudes like yours which go after c sections and epidurals, all the while championing homebirths and VBACs aren't really helping."

What are you talking about? I don't 'go after' epidurals. Where have I said ANYWHERE on this thread or ANYWHERE else that epidurals are 'bad' and that their use should be restricted on a point of principle?

C-sections are great - when they are what a woman wants or are unavoidable to safely birth a baby.

But I have yet to meet a woman who would want an emergency c/s if she had the opportunity of a healthy vaginal birth.

"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.

Again - why why why are you repeatedly suggesting that I think that hospital birth isn't appropriate or desirable for anyone? Why?

Is it because you have no answer to the ACTUAL points I'm raising, so you're just making things up to argue against?

"What I am objecting to is the dangerous trend of labelling as ?unnecessary? interventions which may well have been helpful."

Look - doctors are NOT generally cavalier about interventions. They do them when they think a baby or a mother is at risk. The point I'm tryng to get across is there is something going on in UK labour wards that's resulting in a doubling of the risk of having a dysfunctional labour for women who choose to birth there, when compared to similar, healthy women labouring in non-medicalised environments like free-standing birth centers or at home. Or even along-side midwife led units.

So it's not that doctors in hospital are intervening too quickly or doing so in a cavalier way. There is something going on in hospital that's leading to higher rates of labour dystocia and fetal distress - the two most common reasons for emergency c/s in healthy mothers. Once these problems rear their heads then of course doctors have to act. They can't just ignore it. The question is why this is happening so much more frequently to healthy mothers in CLU's than to similar mothers in other birth settings.

"Routine practices such as lying flat on the back, stirrups, fetal monitoring etc. are one thing(one can be quite certain that they are rarely medically necessary)"

Well that's the problem. They aren't usually medically necessary or helpful to the process of birth, but you know what? Even assertive, informed women end up being subjected to these practices FREQUENTLY in hospital. And do you know why? It's because hospitals are massive, busy institutions where care practices are organised as much for the ease of practice of the care giver as they are for the person who's on the receiving end of them.

And beds at heights that protect the backs of midwives and doctors, and women lying in positions where their perineums are easily visible to the staff caring for them, and monitors which enable midwives to regularly leave a woman alone so she can attend to other work - these are all things that arise from a system of care used to dealing with high volumes of women in an institutional setting.

"I am also alluding to the double standard that exists among many women nowadays. They talk about the right to choose and informed decisions, but somehow their crusade is only for home births and drug free labours."

"Their concept of choice doesn?t extend to epidurals, c sections on request, or consultant led care- these choices are always ?uneducated?, ?unnecessary? and ?a waste of resources?.

NO ONE said that epidurals or c-sections on request are always unnecessary, often unnecessary or sometimes unnecessary.

Although I would agree that consultant led care for low risk mothers not planning a c/s is - categorically - a waste of resources in a medical system where there are not enough obstetricians to provide adequate care for the many women in this country with complicated and fragile pregnancies.

Are you really going to try to make a case that low risk women should have a right to see a doctor throughout their pregnancy? Even if they have no medical need? And aren't requesting a c/s?

Why?

I am referring to general attitudes that exist on mn and outside- they are not specific to this thread.

Which general attitudes? There are always lots of threads on MN about women wanting a CS and how will they get one.

There was a long thread last year sometime about someone who said she was tricked out of an epidural. It got to a thousand posts and spawned another which went on for a couple of hundred posts. It wouldn't have been that long if the general feeling was anti-epidural.

37% of women in the UK have an epidural.

98% have their baby in a hospital or birth centre.

The national c/s rate is 26% but in many hospitals it's well above 30%.

Nationally about half of all mothers have a birth which involves one or more of the following: c/s, forceps, ventouse, epidural, augmentation, an episiotomy.

Exactly what would you like to see WhattheHell? A further lowering of the normal birth rate? More women giving birth in hospital? To what purpose?

There is on the whole not a great deal of discrimination against mothers wanting medicalised births. In fact they're quite likely to get one whether they like it or not. I have sympathy for women who want a planned c/s and would like all women to realise their choices for birth. However - there is a separate debate to be had about the best use of finite resources within NHS maternity care

The real problem is the very large group of women who don't want to have interventions in their birth if they can possibly be avoided without risk to mother and baby. It's these women who are really struggling to have access to the type of care - namely one to one midwifery care - which would enable them to have an optimal chance of achieving the birth they want.

Crusade for homebirth!?

There's no crusade. There is educating that something other than the norm is acceptable and in some cases preferable. There is no need to fight that battle for access to a CLU until CLUs become out of the norm, which is likely to be never or at least a very long way away.