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! :)

Carrie - you are biased. You have admitted as such.

You are also ignorant about the evidence on the subject - purposefully so I reckon, because it completely undermines your view that hospital is the only safe and appropriate setting for birth.

shagmundfreud

"Well, yes to the first. Primarily they ARE surgeons. At least in the UK this is how obstetricians working for the NHS practice. They see women whose pregnancies are complicated by health conditions, and they perform c-sections and assisted deliveries."

Do you realise that most doctors are trained in some form of surgery or another? Even an ENT specialist is trained in various forms of surgery. Yet, we cannot dismiss their expertise and say that they are just "surgeons".
Surgery is often a part of what a specialist does, but that doesn't mean it's all they do. You sound very uneducated when you make statements like that.

"I'd love us all to have ALL the choices we want. All of them."

Really? What a farce! You'd love for people to have the choices that you think are valid. You are the same person who said epidurals are a waste of resources, that tokophobic women should not be given c sections and now you are saying that women have no right to choose who provides their ante natal care. And yet you expect me to believe that you want everyone to have the choices they want? Don't kid yourself. You don't stand for womens' choices- you only stand for your own.

"Midwives job is to spot when a pregnancy or a labour deviates from the norm and make sure the mother gets appropriate treatment. And actually they're pretty good at this, hence the good clinical outcomes associated with midwife led care. I have never met one who believed that 'pain relief is to be avoided at all costs'. Have you?"

Yes, I have. Several actually. Even though I am under private care, the midwife in my doctor's practice has often shamed me for requesting a c section. The NHS midwife who looked after my SIL refused to get her an epidural saying "You need to bear this pain. Don't be a baby!". While my colleague was suffering from a uterine rupture and screaming in pain, the midwife who failed to diagnose the condition accused her of being a "drama queen". In fact, the leader of the Royal College of Midwives, Cathy Warwick has often been quoted saying how she is against epidurals and c sections on maternal request and that low risk women should be forced (not advised) to give birth in free standing midwife led units.

It's all very well to say that a midwife's job is to spot when things are going wrong and refer the woman to the right person. But are they as qualified as obstetricians to always be able to spot complications on time? I am not convinced they are.

"But insisting that every pregnant woman has to be seen by a consultant does seem like insisting that every mole has to be seen by an oncologist, just to make the woman feel safer."

I am not insisting that every pregnant woman should be seen by a consultant(although that does happen in most other countries, incidentally).

I am simply saying that women should have the choice to request ante natal appointments with consultants and they should also have the right to request that a consultant be present for the birth. Why does that bother you people so much?

shagmunfeud

I am aware of what happens at ante natal appointments. It isn't about what happens during the appointment, it is about trusting the competency of the person conducting the appointment and about interacting with someone who is more likely to support your choices. It is about being comfortable with the background of the person taking care of you and your unborn child.

You still haven't answered my question- how would you feel if given your greater faith in midwives and their approach to birthing, you were forced to undergo ante natal appointments with an obstetrician?
Look at it this way- we know that high risk women are better looked after by obstetricians. Does that mean they should be forced to go to consultants? What if they prefer the care of a midwife despite being high risk? Should they be denied their preference?

Get your facts straight. Dr Amy is a Harvard educated doctor who gave up the practice of medicine to raise her four children. Her registration did not lapse. You clearly dislike her, but there is no need to make up nonsense in a desperate attempt to discredit her.

I was following the links from Benedicts latest post, where a journalist had checked her registration. Yep, she may be wrong, you can't always trust what journalists say.

But I would agree with the person up thread who said that there were much better sources of information than her - including our own RCOG.

Carrie I am not sure why you are going FFS
Or do you just choose to interpret them as suits your own argument? The RCOG takes a different view to you, why shouldn't this be pointed out to others? It's not as though they are not qualified to speak on the matter.

I think the crux of it is Whatthehell is that you just don't think a midwife is up to the job and a consultant is superior in all areas.

There is a very strong risk adverse culture in places like America because of fear of law suites.
At one point (this may still be true) there was a shortage of OBs because of the incredible cost of insurance.

So seeing a consultant at every appt is possibly not because it is what is best for the health of mother and baby.

It may be because it is what is best for the health of the Practice.

In most other countries? Really? Surely for only those with the money to insist?

WhattheHell high risk women are forced to go to consultants. Sure they can not attend the appointments if that is their wish (just as a low risk woman could theoretically shun an OB and freebirth), but we always, always refer to consultant-led care where appropriate.

Given that you think all women should have free choice of maternity provider, presumably you also think you should be able to choose to go to an opthalmologist for your routine eye test (which I always did in Canada, and looking back I think it was ridiculous), and you think you should have the choice of a paediatrician instead of a GP for your children's medical care? (As in the US.) It's the same principle.

cuddler

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

How patronising and misogynistic.

If a woman has formed an opinion that childbirth is inherently risky (which a lot of people would agree with btw), you want to "educate" her and tell her it's not true? If a woman prefers to give birth in a hospital under the care of a doctor and within easy access to specialists, she needs to be "educated"?
Are you insane?

Why not just let every woman form her own opinion based on the available information and then leave her the fuck alone?

Sorry - where have I said that 'epidurals are a waste of resources'?

Where have I said women with tokophobia should be denied c/s?

Have you read comments I've made on other threads, done your normal thing of distorting them, and are now feeding them back here in an attempt to discredit me? Please don't. Its so unhelpful to having an adult debate. Stick to what I've actually said, not what you think I feel or believe, particularly if the conclusions you're coming to can't be supported by anything in my posts.

Anyhoos - Are you are suggesting we completely bypass our system of allocating women to consultant care on the basis of clinical need and change to a system of self-referral? And you actually think this would work in the NHS? What are your thoughts on where the money and the doctors would come from to fund this extension of obstetric services and on what grounds would it be justified in a formal sense? (because I think arguing that some women just prefer doctors and don't like midwives wouldn't cut it in political terms).

I'm sorry you've had a bad experience with your midwifery care. I've had midwives I've not been happy with. However, having had two complicated pregnancies and births I've seen many doctors too, and I can categorically tell you that having a medical degree doesn't guarantee that you will be sensitive to womens feelings or needs, and it doesn't guarantee that you will be an effective practitioner. There are fantastic people and arseholes working in both professions.

MrsDeVere

"^There is a very strong risk adverse culture in places like America because of fear of law suites.
At one point (this may still be true) there was a shortage of OBs because of the incredible cost of insurance.

So seeing a consultant at every appt is possibly not because it is what is best for the health of mother and baby.

It may be because it is what is best for the health of the Practice.^"

Whats wrong with being risk adverse, may I ask? Especially when it is regarding your own health and that of your unborn child? Should we "embrace" risk now, just like we are supposed to "embrace" the pain of childbirth?
It isn't simply a question of "how is this better"? It may not be to you, but different women have different priorities and preferences. Just because they don't match yours doesn't mean they are wrong or invalid.

"In most other countries? Really? Surely for only those with the money to insist?"

Yes, in most other countries,even those with Universal Health care. In Canada and France for example, you get a choice regarding who will provide your ante natal care- an obstetrician or midwife. Even in developing countries like India and China, women are given this choice.

Whatthehell, I heartly recommend you read the 'Patient Paradox:Why Sexed Up Medicine is Bad for You Health' by Margaret McCartney

It covers the idea of good versus bad evidence (Bad science) and the idea that well people are being made into patients. The principle is that we are taught to believe doctors are infalible and rather god like but actually we should be doing rather more questioning than we are.

I think that both obstetrician and midwives are needed to work together and along side each other, to cater for the enormous range of different needs out there. Everyone from the most pro-homebirth to the most pro-ELCS and everything in between, without inflicting their preferences on other people.

Shag, the one thing I will say, is that someone who acts in the way Whatthehell has, probably has a few issues to deal with and probably does need to be given the relevant care. I certainly do not think that cost should come into it, in her case...

WhatTheHellJustHappened, for the record, I probably have tokophobia. I have talked about it on here before quite a lot. I don't always agree with Shag, but I do get where she is coming from with a lot of what she says.

I would also like to point out that after listening to what I said, that she said to me that yes I probably should have an ELCS given my circumstances.

"Are you are suggesting we completely bypass our system of allocating women to consultant care on the basis of clinical need and change to a system of self-referral? And you actually think this would work in the NHS? What are your thoughts on where the money and the doctors would come from to fund this extension of obstetric services and on what grounds would it be justified in a formal sense? (because I think arguing that some women just prefer doctors and don't like midwives wouldn't cut it in political terms). "

What exactly would be so scandalous about a system of self referral when so many other countries with government funded healthcare are able to give women this choice?
As for the justification, you think a woman's preference means nothing? It isn't reason enough to consider a request? She has to prove she really needs it to get it? I don't understand what your problem is.

HmmThinkingAboutIt

"It covers the idea of good versus bad evidence (Bad science) and the idea that well people are being made into patients. The principle is that we are taught to believe doctors are infalible and rather god like but actually we should be doing rather more questioning than we are. "

It amuses me that you think I believe doctors are infallible. Nobody is more suspicious of the capabilities of the average healthcare professional than I am. I am one of those nightmare patients who don't take anything at face value and need serious convincing to accept the form of treatment being suggested.

"I think that both obstetrician and midwives are needed to work together and along side each other, to cater for the enormous range of different needs out there. Everyone from the most pro-homebirth to the most pro-ELCS and everything in between, without inflicting their preferences on other people. "

Ideally, yes this should happen. But it isn't an ideal world.

Shag, the one thing I will say, is that someone who acts in the way Whatthehell has, probably has a few issues to deal with and probably does need to be given the relevant care. I certainly do not think that cost should come into it, in her case...

Someone who acts in the way I have? And what way is that?

So my suggestion that women be given complete freedom in terms of healthcare choices is apparently so insane that I have "issues" and need "relevant care"? Wow.

"I would also like to point out that after listening to what I said, that she said to me that yes I probably should have an ELCS given my circumstances."

How very magnanimous of her.

I don't see it like that at all. Shag annoys me at times, but she is no way the monster you are trying to make her out to be. More than she understands that the reasons women become tocophobic in the first place.

If a lot of issues in maternity care were sorted out, then less women would develop secondary tocophobia in the first place.

Primary tocophobia is perhaps a different beast. She wasn't being magnanimous at all. She just respected what I said and listened to me, despite her strong preference for VBs. Because I do believe she quite rightly recognises it as a medical condition.

More that*

Thanks hmmm

what - I think what you're suggesting is dismantling the entire system on which the NHS operates currently and restructuring the way healthcare is provided. Are you a Tory mp by any chance?

I honestly think that's a separate argument. Personally I am primarily interested in the way things are right now and how to get the safest and most acceptable care for the largest number of women, with the resourcess the gov is willing to allocate at present.

I agree that the system can be inflexible and that's hard if your needs can't be accommodated. I was in the same position and ended up having to pay for the services of a private midwife with my second and third children. You would hope though that the system would at least be able to accommodate the needs of those with mental health problems relating to birth.

Hi all

This is an interesting discussion and of course an emotive one. We don't want to have to delete the whole thread, so please do stick to our Talk Guidelines and refrain from the personal attacks, please.

See this is what I am talking about

'Whats wrong with being risk adverse, may I ask? Especially when it is regarding your own health and that of your unborn child? Should we "embrace" risk now, just like we are supposed to "embrace" the pain of childbirth?
It isn't simply a question of "how is this better"? It may not be to you, but different women have different priorities and preferences. Just because they don't match yours doesn't mean they are wrong or invalid.'

Are you confusing me with someone else? Why the overt hostilty and the accusations that I think other people's preferences are invalid. WTF did you get that notion from. Seriously, calm down. I have already stated I dont CARE what other women do. If you want to see a consultant every five minutes, go ahead.

Why are you talking to me as if I was somebody who has told you to embrace pain and dont go to hospital? Why are you being so rude? Why are you accusing me of wanting women to do what I want them to do?

What is this shit based on exactly? Which of my posts has made you believe that I am anti pain relief, anti hospital births, anti whatever you think I am.

See my earlier post about people writing replies to posts that dont exist.

My point, which was clear, was that the fact women saw consultants had nothing to do with it being a good idea, rather that is was to stop people sueing.

"Which of my posts has made you believe that I am anti pain relief, anti hospital births, anti whatever you think I am."

Maybe she thought you were me.

Except I didn't say those things either.

*Carrie - you are biased. You have admitted as such.

You are also ignorant about the evidence on the subject - purposefully so I reckon, because it completely undermines your view that hospital is the only safe and appropriate setting for birth.*

Not what I said, Shagmund. I am merely playing Devil's advocate, and presenting the facts (yes, facts) about what can happen in any delivery, Homebirth or otherwise.

Biased ... I quote you ... pots and kettles.

"I am one of those nightmare patients who don't take anything at face value and need serious convincing to accept the form of treatment being suggested."

Do you think it would help to look at the evidence on this issue?

You say you need to be convinced and don't take anything at face value so I'm assuming you'd appreciate and evidence based approach.

Does it reassure you that the Royal College of Obstetricians say that midwife led and out of hospital care is safe for babies and is less likely to result in damaged mothers?

"So my suggestion that women be given complete freedom in terms of healthcare choices is apparently so insane that I have "issues" and need "relevant care"? Wow."

It's more the point that you think our entire health system should be restructured in order to provide a pattern of care which you like the sound of, but which appears to have no clinical benefits.

It's a bit.... overkill, to be honest.

I wanted a homebirth despite being categorised as 'high risk' and turned down by the homebirth team. I was gutted at the time but recognised that it would be unreasonable to try to make a case that they should change all their protocols to accommodate my particular wishes, and accepted that if I wanted that type of care (a homebirth with a caseloading midwife) I was going to have to pay for it myself. So I did.

WhatThe I don't think anyone on this thread thinks that women should be lowest priority in the allocation of NHS funds, but it is a fact that we have limited resources. So, like shagmund said, we need to try and optimise maternal care for all women within the limits of the resources available (and perhaps campaign for more resources to be made available).

Given these points, it doesn't seem like consultant antenatal care for low risk women is a good idea. I'd like to choose to have a massage at antenatal appointments - it would help me feel more relaxed and positive about things. It doesn't mean I should get it! I know that's a slightly silly example, but given that many hospitals are already providing piss poor care in labour and postnatally, should we really divert funds to something so nonessential?