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! :)

tbh i dont see what a woman would gain from consultant led care if htey are low risk? the reality is that consultants deal with high risk pregnancies and rightly so, that is what they KNOW. tbh the consulatns i have met have been in the main clueless about natural birth and were heavily on the side of c sections and intervention despite the fact i had NO need for them! they spoke to me like a was a schoolchild, failed to read my notes half the time! and essentially tried to scaremonger me.

i am sure there are some great consultants out there, but they deal with high risk day in day out, its their bread and butter, so they see pregnancy and birth differently and want to deal with it accordingly, not helpful for the average low risk mum to be.

btw i was offered consulant led care actually and gp led care for my first 2, tho in subsequent pregnancies my new gp surgery didnt do the gp led care, but i am pretty sure it is available in some areas. oddly enough i chose midwife led care as that is what i needed and it is the best option for most women.

I had consultant led care for DD. it seemed to be automatic then.
I had no risk factors.
It was a bloody drag tbh.
Up the hospital every four weeks seeing a succession of different shos and the occasional reg.
There seemed to be no point to it at all.

Even those who have consultant led care because they actually need it it rarely see the consultant themselves. Let alone for every appointment. The amount of consultants required to provide Antenatal care for low risk women would be phenomenal. And could pay for at least three times as many midwives. Part of the problem is many people just don't recognise that a midwife is the best person to see when having a low risk pregnancy. They and they alone are the experts in low risk pregnancy, consultants (although more likely registrars and their SHO's) are experts in abnormality, problem solving and high risk. You can't have one person for all things. It doesn't work like that.

Just out of interest those who are advocating consultant led care for any who want it, low risk women included what would you expect from that?

NHS obstetricians diagnose and treat problems in pregnancy and birth. They perform surgery.

They have no specialist training, expertise or experience over and above that of midwives that would justify them providing routine antenatal care.

You know the funny thing is when I'm reading all this is I'm Pro-ELCS. But at the same time in looking up facts and figures and stats about the pros and cons of ELCS I looked at homebirths and other VBs.

In a lot of ways it would be nice for me to find evidence that said "yep ELCS are the best way and the safest way", but there just isn't the evidence for it. But equally there isn't the evidence to the contrary. There is a lot to say, that actually there is little difference between VBs and ELCSs, a lot to say there is little difference between home and hospital births ultimately and a great deal to say that women who get their preferred choice fair much better than those who do not.

There is also a hell of a lot to say, that there is a lot of bad practice out there. Stuff like figures from I think it was 2008 that one hospital in Nottingham had rates of episiotomy which were over 40% and yeah others had rates which were far far lower than that. Differences in figures that could not be explained by differences in demographics alone.

One difference between the UK and some other countries mentioned is surely the highly trained midwives we have and the different role divisions between consultant and midwife. I don't see why that would make midwife care a less preferable option. If we're in the UK, we don't need to worry about the competence of midwives elsewhere, do we?

I was one of those high risk women who had consultant care. What it actually meant was that I saw a consultant occasionally, about the medical aspects of my pregnancies, and a midwife at all other times. If I hadn't had the medical problems, there wouldn't have been a lot for the consultant to do, because the midwife was already doing it. I never got the sense that the consultants knew more than the midwives about the ordinary everyday aspects of delivering the baby, though they were clearly very expert in questions of blood pressure and intra-uterine growth retardation. The midwife was perfectly competent in checking my bp, proteins etc and then deciding whether I needed an extra appointment to see the consultant.

They want things like scans, blood tests, fetal monitoring, epidurals, pain killers, and IV drips you can get all these things WITH midwife led care!

and yes consultants or registrars do come in and help with difficult births, so you get the expertise when you NEED it.

midwives are well aware that birth can be complicated, they dont just trust blindly in natural birth and they can and do explain all about pain relief options, as do the nhs birthing classes that you can go to.

with regards to GD actually you dont always see or need to see a consultant with this, as there are specialist GD midwives trained to offer the support you need, tho you will see a consultant about birthing options as the birth may need to be induced, you may need a c section and they may want you on a drip and the baby will need extra monitering etc.
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no-one has said that low risk women CANT have complications and nor has anyone said that high risk women will ALWAYS have complications, statistically you are more or less as risk tho. either way you will get the care you need when problems arrise.

yes consultants have more training for dealing with high risk pregnancies but they do not have the experience or dealing with low risk pregnancies as that is what midwives do. it makes sense to allow consultants to spend their time dealing with the women that NEED them, rather then every low risk woman.

and when i saw consultants (had consultant led care for a while with ds2 till i realised what a pita it was and said no thanks) all your regular checks were carried out by the midwife and THEN you saw the consultant afterwards who checked the notes, saw all was ok and let you go or saw there was an issue that needed to be addressed and dealt with it.

do you really think women need to go see a consultant to have their blood pressure taken and their wee checked, or that the consultants would even do that? no it would still be done by a midwife or a nurse and the consultant would deal with the issue they need to.

If the NHS is underfunded, women shouldn't be the first on the list to suffer and make sacrifices for it. Why is that not getting through your head? Do you like seeing other women being denied choices?

With all due respect, WhatTheHell women are not the only ones nor necessarily first on the list; the difficulties of the elderly and children with complex health needs accessing the appropriate care spring to mind.

There is a real problem in how to allocate scarce resources; it's an issue which has always been present in the NHS and it's not going to go away.

And since you are banging on about low risk women, let me tell you something.

Yes, let's talk about these. When it comes to rationing the resources who is going to get turned away when the hospital is heaving? Who has to share one midwife between two or three others in labour, who gets left unattended on the postnatal ward? It's absolutely right that High Risk cases get attention because they need it, but under the current system what is being hidden is that some women are not really getting much care at all. The current system is breaking down, how can we fix it? My concern is how can we find a way to provide each woman with appropriate care for her and her baby.

www.wandsworthguardian.co.uk/news/9794753.Hospital_patient_dialled_999_after_not_getting_drink/

is this a debate or a personal grudge against shag? Starting to wonder....

You appear to think that obstetricians are 'surgeons' who view pregnancy and birth as risky and diagnose problems. I've got news for you. There are women out there who feel similarly. They view pregnancy and birth as inherently risky and they believe that modern medicine makes it safer. They want things like scans, blood tests, fetal monitoring, epidurals, pain killers, and IV drips.
They don't think the way midwives do where birth is something to be "trusted"
and pain relief is to be avoided at all costs. They don't view it as some natural, empowering process but simply a means to an end which they want to get over as safely as possible. They have a right to think this way and to get ante natal care from someone who is like minded.

If women feel like that they need educating that thats not true.Because its not.

having had the joy being on another contentious thread with whatthehell i think she just likes to put her point across and gets a bit of a bee in her bonnet, we all have issues we feel strongly about, this along with a few others i could name! are hers :)

WhatthehellYou haven't answered what you expect a consultant to do for a low risk woman or how you anticipate this might work?

Interesting article on 'Dr' Amy..

www.slate.com/articles/double_x/doublex/2012/07/daily_beast_and_home_birth_fear_trumps_data_in_a_new_story_on_having_babies_at_home_.single.html

I once looked after a woman in labour that had paid a consultant for a care. I was under instruction to call him when she was fully dilated.
He came in, did an elective forceps delivery (there was no medical indication) with a massive episiotomy, sutured her then left. He must have been in the room for no longer than 40 mins.
I was that this 'care' had cost £3500.

An elective forceps??? Jesus. Frightening.

He came in, did an elective forceps delivery (there was no medical indication) with a massive episiotomy, sutured her then left. He must have been in the room for no longer than 40 mins.
I was shock that this 'care' had cost £3500.

And was she grateful that he had saved her baby's life?

Her baby wasnt in danger in the first place,was the way i read it.

Blimey. Did you get any feel for her reasoning?

Was this a compensatory measure for having had a rough time with an earlier birth? Who's 'fault' would it have been if spontaneous pushing had expelled the baby too quickly for intervention?

The mother in question was delighted at the time. It was a 'no effort' birth as far as she was concerned. She was less impressed when she couldn't sit down the next day.

This consultant did this regularly. He believed that that was the service the women wanted and why they paid him. Looks a bit lame if he just catches a baby for his money, maybe? Got to justify the fee.

I was newly qualified when this happened. Some of the more experienced mw's would accidently on purpose call him too a little too late. They aimed to have him arrive as the baby was crowning, they were quite good at judging it.

Benedicts Thanks for the brilliant link to the article about 'Dr' Amy, who hasn't been one for the better part of 10 years.

Yet WhatTheHell said:
She also offers very valid explanations on why sometimes interventions are mandatory and why the natural childbirth movement often hands out misinformation.

And then I was personally advised to:
... read her blog with a little less bias and more of an open mind, you may actually learn something valuable.

Dear, oh dear!

I think I'll stick with the sources I have been quoting from:
The Place of Birth Study, reported in the BMJ or advice from the RCOG/RCM (all obviously a bunch of misguided, lentil weaving, whale music loving, NCT, hippies).

Some of the more experienced mw's would accidently on purpose call him too a little too late. They aimed to have him arrive as the baby was crowning, they were quite good at judging it.

Did he still get his fee? Sounds like money for old rope, but it does highlight how vulnerable women are in childbirth. What was a midwife's salary at the time?