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! :)

"and presenting the facts (yes, facts) about what can happen in any delivery, Homebirth or otherwise."

Oh ffs Carrie - it's obvious that bleeds/abruptions/prolapsed cords/shoulder dystocia can happen in any birth setting, and if they happen when you are at home or in a free standing MLU then there will likely be a delay in your baby and you getting essential treatment, which is likely to lead to a worse outcome than had you been in hospital.

People know this. And if they don't know it they're told it by their midwives when they discuss booking a homebirth.

But what they generally DON'T know is that this hasn't ACTUALLY resulted in higher numbers of deaths and adverse outcomes for mothers overall when compared to outcomes for similar women labouring in CLU's. (except for first time mums and even here it's not necessarily about instant access to doctor input, otherwise you'd expect to see similar results for free standing MLU's, and you don't). And it's REALLY important they understand BOTH these things.

The problem is with your stance is you acknowledge the first - the risk of a rare and severe obstetric crisis necessitating doctor input - but you utterly ignore the second - that it doesn't overall make a difference to outcomes at a population level.

And that's probably because you don't want to acknowledge that SOME women and babies are coming to harm in hospital which they might have avoided in other birth settings - which is the most obvious explanation for the parity of outcomes between home and hospital birth.

"and presenting the facts (yes, facts) about what can happen in any delivery, Homebirth or otherwise."

I was thinking about this sort of comment. The Place of Birth Study has been made available on line by the BMJ and is open to response. I notice that some commentators say 'We were surprised... have you considered ....' and similar, followed by details and backed up by references.

OK, this thread isn't the BMJ, but it is one where lots of informed people care passionately about what is on offer at present and are seeking ways to improve matters, so yes, I think it is valid to ask for some decent evidence.

I wonder how far responders who strongly disagree with births outside CLUs would get if they wrote to the BMJ to say '...I don't agree FFS, get real, what don't you understand, read Amy Tuteur etc. etc. ......' I don't see the BMJ bothering to publish such a response, so how about giving us some proper evidence too?

You're right LaVolcan - the mud slinging isn't good.

Sorry for being rude and sweary!

I really dislike the way these debates, which are so interesting, get polarised and personal. There's a massive problem on mns with debates surrounding any of the contentious issues (birth, breastfeeding, Gina Ford!) of people extrapolating wildly. Lots of straw man arguments. Really wish it didn't happen so often - it's very unhelpful.

there are a few ways in which the Birthlace study may be biased in favour of CLU too -

1)BBAs (of all kinds) disincluded - though i appreciate this is for good methodological reasons, some areas have more BBAs than planned HBs..

2)heavy post-correction of results e.g the actual incidence of serious adverse outcome for first timers 4.9 vs 4.8 HB - (for good reasons again, but this has to be done correctly - a complex matter given the interdependence and range of the variables - finding the right correction for, say, socio-economic status wrt e.g. braxus-plexus injury = not easy. couldn't find comment on how this was done).

3. re-sampling of CLU data - though the study did find really good solutions to incomplete data sampling (looking for complete months to make a min 85% complete year, say) 5 CLUs were re-sampled -and obv the busiest (and likely worst) month is the most likely not to be sampled. if you were a HB transfer into a CLU during such a crap month, most likely you would still be included OTOH.

i would welcome a sub-study to determine causes of negative outcomes and how they might be avoided, as it strikes me that would help HCPs in all locations. the information was collected, so it is a shame there is no comment i could find on e.g. how many of the SAO's in the HB/ MLU groups were from transfers, how long after transfer, how transfer is managed....etc etc.

OP- best of luck with whatever you decide! I do hope whether hospital or home you have a better birth than last time. Also pregnant with DC2 and decide to go for home. Had amazing (and admittedly straight forward) water birth at St Thomas's Home from Home, no pain relief and as I was getting out of the pool they said " You should go for a home birth"! I am actually in the Kings catchment area and as mentioned on MN they take a refreshing attitude to Home Birth and subsequently have one of the highest rates in the country.
Cathy Warwick, now head of the Royal College of Midwives, was head of midwives here. They looked at the evidence regarding the benefits for women and babies and the cost savings and put the systems in place to make it happen. I think that they have a lot of births per year and this part of SE London probably has its share of high risk women so it probably worth saving the beds for women that really need them.

At my booking in, before I had even mentioned it, they had suggested it. I'm really excited. There is a regular monthly talk too for people considering. I know lots of people here have a real battle to get the HB they want but I always think it's worth celebrating the NHS when it gets it right.