This IS a thread about a thread

[Mintyy]

but I am doing it because I don't want to upset the op of the other thread, and I don't want to hijack what she has started.

But can we please de-bunk the myth that anyone can have a lovely birth as long as they are PREPARED and have the right mental attitude! It is extremely damaging psychologically for women to feel that they have failed (if they had interventions/caesarian/still birth) because they were not properly tutored or well-read enough in childbirth.

The healthiest, most physically and mentally perfect women can have things go mildly wrong or catstrophically wrong in childbirth. All the birthing classes in the world cannot fix that.

Am v angry!

"Some people are lucky and have wonderful births, some don't. I think it is down to LUCK."

Sometimes.

But if only 46% of low risk first time mums giving birth in obstetric units have normal births as compared to 71% of similar women giving birth in free standing birth centres, then I'd say that how you're looked after is possibly just as or more important than luck.

"Shag, you're kind of suggesting that you do think it is partly down to a woman's attitude. Can I ask if this is what you really believe and, if so, can you explain any more?"

I'm saying nothing what so ever about a mum's attitude.

I'm talking about where she has her baby and how she's looked after (ie - the pattern of care).

"To me, the 46% says that more mums don't have a 'normal' birth than do - ergo it's not actually normal."

You are dead right. In hospital 'normal' births for first time mums are not the norm.

However, outside of obstetric led units (ie in birth centres or at home) normal births are... err. normal!

Shagmund I think you're forgetting that those aren't comparable populations. The outside hospital units only accept low risk women, obstetric units have all high risk women, planned sections, prems & some low risk. If you look at the figures in more detail & compare just the low risk women in obstetric units the results might be an eye-opener for you!

"Shagmund I think you're forgetting that those aren't comparable populations. The outside hospital units only accept low risk women, obstetric units have all high risk women, planned sections, prems & some low risk. "

No SoYo, those figures are from the Place of Birth Study 2011, which only looked at low risk healthy mothers, matched for risk at onset of labour, and assessed according to planned place of birth, rather than actual place of birth. So those mothers who started off in birth centres but ended up in an OU having a forceps delivery or c/s comprise the c/s or forceps statistics for home birth (because you can't do forceps or c/s at home!).

46% of healthy, first time, low risk mothers giving birth in obstetric units had a normal birth.

71% of healthy, first time, low risk mothers giving birth in free standing birth centres had a normal birth.

That tells me that having a normal birth is often a lot more to do with how you're cared for than anything else.

"So those mothers who started off in birth centres but ended up in an OU having a forceps delivery or c/s comprise the c/s or forceps statistics for home birth (because you can't do forceps or c/s at home!)."

Sorry, that should read: So those mothers who started off having home births but ended up in an OU having a forceps delivery or c/s comprise the c/s or forceps statistics for home birth (because you can't do forceps or c/s at home!)."

YY Mintyy, I absolutely agree.

Stats from my antenatal class cohort for anyone interested:

1 v prem delivery at 28wks - parents didn't even get to the first NCT class
1 EMCS at 34wks - preeclampsia
1 planned CS brought forward to at 37 wks due to BP issues
1 EMCS at term - cord prolapse
1 hospital birth (home birth requested but mw declined to attend due to icy weather though apparently it's fine for a labouring woman to go out in such weather to get to the hospital ) - mother did antenatal yoga
1 home birth with 3rd degree tear
1 hospital birth - mother did antenatal yoga but overnight stay req due to BP issues (me!)
1 home water birth
1 home birth with transfer to hosp due to 4th degree tear

We are all alive with healthy babies. That is all that really matters.

"We are all alive with healthy babies. That is all that really matters."

The stats I've quoted suggest that thousands and thousands of new mums are having avoidable surgery every year in the UK. I'm always amazed at how accepting women are of this.

Well shagmundfreud I'm always amazed when people think that the NHS would spend time/resources doing "avoidable" operations given the budget issues they're battling (though that's a whole other thread!).... Funnily enough all midwives and doctors want as outcomes are live mums with live babies

Hypnobirthing can't prevent post-partum haemorrhage. Breathing exercises can't solve a cord prolapse. Antenatal yoga won't stave off preeclampsia.

I still agree wholeheartedly with Mintyy on this one! Yes...There are things you can try to get a good birth BUT some women and some babies will have medical issues which mean intervention is necessary to save the mum or the baby from serious harm or even death. Many mums are on these boards are still alive thanks to interventions during birth!

How are the midwives who do out of hospital births selected?

Are they required to be more experienced?

When I had my first, my lovely waterbirth at home plan went out the window due to high blood pressure. I was bitterly disappointed and completely unprepared to deal with hosp staff who ran roughshod over me. The one thing that made me feel better was that a few weeks earlier my ante natal yoga class had been taken by a teacher just back from maternity leave, after excessive pestering from us first timers she reluctantly related her birth story - 24hrs of extremely painful labour at home on so much g&a her nose swelled up followed by transfer to hosp cascade of intervention and eventual section. It can happen to anyone!

Where is this thread of which you speak

Blondie - Drs and midwives do the best they can to keep mothers and babies safe, but there is absolutely no doubt that something is happening to women's labours in hospital that is resulting in many more mothers and babies needing 'rescuing' with medical intervention.

Things like cord prolapse (1 in 500), or baby which is presenting so poorly that it is simply undeliverable can happen to anyone anywhere, but the two most common reasons for emergency c/s are 'failure to progress' and 'foetal distress'. Statistically, even healthy, low risk mothers are more likely to experience both these things if they choose to give birth in an obstetric led unit.

BTW - the reason I'm posting on this thread is because I feel that it's not quite fair to suggest that all mothers everywhere are at equal risk of having a complicated birth. The research shows that some low risk mothers are really quite a lot more likely to have a difficult labour involving lots of interventions than others, and that's healthy mums giving birth in OU's.

Yoga, hypnosis and antenatal preparation don't seem to make a huge difference to mode of birth (though there's been some recent research showing yoga in pregnancy for high risk women is associated with fewer early births, lower rates of pre-eclampsia and better fetal outcomes...). However choice of place of birth IS - strongly!

Midwives who do out of hospital births may be part of a dedicated home birth team, or they may just do them on rotation. Inexperienced midwives may work on home birth teams or in the community. TBH what you want at a home birth is someone who's experienced in normal physiological birth in a non-medical setting. Experienced hospital midwives who are only used to caring for women in high tech settings where the are very high levels of routine interventions may not have the skills needed to manage a safe home birth.

With my DD, I wanted to use the birthing pool, and have a drug-free delivery. To be able to walk around, not to be continuously monitored, and not have to have any needles. To take a healthy baby home.

When I was actually in labour?

I was induced nearly 6 weeks early due to pre-eclampsia, and therefore wasn't allowed to use the birthing pool. 15 years ago, if you were induced you had to stay on the bed and have continuous monitoring.

It fucking hurt, so I begged for pethidine and G&A. I stopped progressing so they started prepping me for a C-Section. I have birth to DD whilst being wheeled down to theatre!

And then DD needed to stay in SCBU for a week.

With my subsequent 3 DC's, the only thing I insisted on was intermittent monitoring and being able to get off the bed and walk around if I wanted.

Births don't always go to plan. I ended up being induced with my first 3 DC's, and even though I went into labour myself with my 4th DC, I still ended up on a syntocinon drip because DS3 got stuck.

Shagmund, please stop saying 'normal birth'. In this day and age there's no such thing, there's a huge spectrum of possible ways to give birth. Separating them into normal and abnormal births is not helpful.

Also, I still think those stats are skewed. I was considered low-risk yet still was made to go to hospital unit, because DS was huge. And yes, I did end up with a CS. You can't assume low-risk means no risk factors whatsoever.

The only way you could compare the two low-risk populations properly is if they were somehow randomly assigned to either hospital or non-hospital. But there are additional considerations guiding where women are sent and these are primarily based on risk (even within low-risk women).

Yes Yes Yes. My birth plan was an intervention free waterbirth, natural delivery of placenta and home after 6 hours. In the event, I was strapped to a bed and continuously monitored for 74 hours, was lucky to avoid forceps and baby was whisked off to NICU. I felt like a failure and as though I'd been cheated of my perfect birth-what I should've felt was that I was blessed to have my baby alive and well (sort of).

Dreaming - 'normal birth' is used in medical circles to mean 'physiological birth'. Like 'normal breathing' means breathing without the need for drugs or a respirator, 'normal walking' means walking without the need for crutches or calipers.

It absolutely IS helpful to have a reminder that although interventions are common, the majority of healthy women ARE able to have a physiologically normal birth, and where this can be achieved and still end up with a well baby this is the most desirable outcome for most women, and ought to be something that health care providers should be striving for.

As for your belief that the stats are 'skewed' based simply on your personal experience, I think you'll appreciate that this isn't a logical or reasonable argument.

And of course 'low risk' doesn't mean 'no risk'. Surely all sensible adults know that?

As for randomising - you know that this is pretty much impossible with research into birth in a country like the UK. The Place od Birth study is well constructed and has been carefully scrutinised by midwives and doctors.

Re: 'additional considerations' accounting for the different outcomes for OU's and out of hospital births - I urge you to READ THE RESEARCH before coming to a conclusion about the validity of its findings. It's widely available (full text) online and there has been a lot of discussion of it on this board. All I can re-iterate is that in the Place of Birth study women in all arms of the trial were low risk at the start of labour and were carefully matched, so as to minimise confounding factors.

I appreciate that if you personally were advised to go to hospital because of the size of you baby then it's absolutely understandable that you would follow this recommendation. However I would like to point out that many midwives are happy to OK mothers for home births who are known to be carrying large babies - it's not an absolute or a 'rule' that all mothers believed to be carrying big babies will be 'made' to deliver in hospital. I was 'ok'd' to deliver a baby believed to be over 10lbs at home (he was 11lbs) and made this choice as I felt in my personal circumstances it was best for me and my ds. The point I'm trying to make is that inflexible protocols don't always optimise women's chances of having a happy, healthy and uncomplicated birth, and that women need to know that these things generally make much more of a difference to what happens during their birth than any amount of yoga, reading or hypnotherapy during pregnancy.

Wanted to add something else about whether there is anything mums can do to boost their chance of an uncomplicated birth, because it does seem that the consensus on this thread is that there is NOTHING you can do which will make any difference to your birth outcome.

There was a study into outcomes for mums who were cared for by an independent midwife a few years back, comparing the outcomes to mums delivering in the NHS. 77% ended up with a normal birth, compared to only 54% of similar women cared for by NHS midwives.

What they found was for low risk women, they had exactly the same likelihood of taking home a well baby as healthy women cared for by NHS midwives but all other outcomes were better. See below:

"In the IMA cohort, spontaneous onset of labour was more common in the IMA group (96.6% (1405) v 74.5% (5365); 10.43, 7.74 to 14.0), Prematurity (4.3% (63) v 6.9% (498); 0.49, 0.35 to 0.69), low birth weight (4.0% (60) v 7.1%) (523); 0.93, 0.62 to 1.38), and rate of admission to neonatal intensive care (4.4% (65) v 9.3% (667); 0.43, 0.32 to 0.59) were all higher in the NHS dataset.

I think it's very sad and telling that women who have one to one care from a midwife they know all the way through pregnancy are less likely to be induced, less likely to need a c/s, less likely to have a premature baby, less likely to end up with a baby in special care. And it's not just true of women who are able to pay for midwifery care - these results are replicated in the NHS where women have case-loading care (ie they have one allocated midwife all the way through pregnancy and birth).

In other words - it's WRONG to have this discussion with the underlying assumption that there's nothing anyone can do to influence (not guarantee mind, just 'influence') the chance of a healthy, normal birth. There is!

• try to access case loading care
• consider a birth center or home birth
• consider hiring a doula
• consider mother/midwife ratio and rate of normal births at local hospitals if you live in an area where you have a choice

I'd also add, that if you're keen to avoid complications in labour, if you're offered an induction for 'post-dates' pregnancy where there are no other risk factors, it might be worth getting a second opinion from an experienced and senior midwife.

Well first off, the study itself says that a birth without medical intervention is sometimes referred to as a quote-unquote 'normal birth'. So I don't think it's imperative to use the phrase yourself, especially in a forum where you know women have very strong feelings about their experiences.

I'm not using my own experience as the basis for my argument. You seem to be saying that the planned location of birth is a determining factor of outcomes, but this ignores the fact that planned location is decided in part based on risk factors that will also affect outcomes -- even within the low-risk cohort.

I note the study does not include large baby size as a risk factor, even though this is a potential reason for a woman to have to go to an OU and can contribute to the need for medical intervention. This is the only reason why I mentioned my own experience.

Finally, if you want women to be fully informed, why not mention some of the other study results? Like, "For women having a first baby, a planned home birth increases the risk for the baby", or the fact that around 40 percent of first-time mothers giving birth in midwifery units will have to be transferred to obstetric units anyway.

What I get out of this study is that there's still an awful lot of luck involved. Nearly half of first-time mothers giving birth at home end up going to hospital. So how important is that choice really? It's still 50/50 whether you wiill go to hospital or not.

Actually, Shagmund, according to that study, considering a homebirth if you're a first-time mother will increase the chances of something going wrong:

For women having a first baby, a planned home birth increases the risk for the baby: For nulliparous women, there were 9.3 adverse perinatal outcome events per 1000 planned home births compared with 5.3 per 1000 births for births planned in obstetric units, and this finding was statistically significant.

So you might want to be a bit more careful in your advice there.

Thanks for those further statistics dreamingbohemian - very interesting!

Completely agree, Mintyy (and glad that you and your baby were ok).

I did prepare, I did hypnobirthing, I had Ideas about how I would like things to go - but the Most Important bit of my preparation, IMO, was knowing that it could all change at any point and the chance of things going according to my preconceived ideas was next to none. THAT was the most important thing to know.

Yes, the hypnobirthing helped. Yes, I think the raspberryleaf tea helped with stage 2. But aside of that, I was lucky that I had a good birth with DS1.

I would have liked to have had as good a birth with DS2 but it wasn't to be - he was oblique transverse/unstable lie, I had polyhydramnios, and I needed interventions that I hadn't needed before. I railed against them, told the doc I Wasn't Having That but had it anyway because the alternative was CS. At any point, it could have gone wrong and I knew that - I was soooooo lucky to get away with delivering DS2 "normally" - I was just about to be prepped to go to theatre when they turned me onto my back and he dropped clear of the anterior lip and shot out of me in 2 quick pushes.

I'm never doing it again, for several reasons, but one of which is I think I've had my share of the luck. I'm not pushing it.

"Well first off, the study itself says that a birth without medical intervention is sometimes referred to as a quote-unquote 'normal birth'. So I don't think it's imperative to use the phrase yourself, especially in a forum where you know women have very strong feelings about their experiences."

No - it's not imperative. But it's a standard medical term. The Royal College of Midwives even have a website called 'Campaign for Normal Birth' with information for midwives on midwifery practices that increase the likelihood of mothers having births without complications.

That said - I'm happy to substitute a different term to describe birth without complications. What would you suggest? Are you unhappy with the term 'normal' used in relation to any other aspect of having a baby? Do you object to the term 'normal conception' to indicate a conception which takes place without medical intervention?

" You seem to be saying that the planned location of birth is a determining factor of outcomes, but this ignores the fact that planned location is decided in part based on risk factors that will also affect outcomes -- even within the low-risk cohort."

With respect - it's not just me who is saying that planned location of birth appears to determine outcomes. The Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists are saying it too:

"Maternal intervention rates were much higher in births planned for OUs with lower ?normal births? and spontaneous vertex deliveries." (comment by the president of the RCOG in response to the findings of the Birthplace study)

"Women who planned birth in a midwifery unit (AMU or FMU) had significantly fewer interventions, including substantially fewer intrapartum caesarean sections, and more ?normal births? than women who planned birth in an obstetric unit." (statement by the RCM in response to the Birthplace study).

"I note the study does not include large baby size as a risk factor"

Only low risk women were included in the study. A woman who was identified as carrying a large baby would not be classified at 'low risk' as macrosomia is an identified risk factor for a range of complications in birth. That's not to say that some women in ALL arms of the trial wouldn't end up delivering very large babies.

"Finally, if you want women to be fully informed, why not mention some of the other study results? Like, "For women having a first baby, a planned home birth increases the risk for the baby", or the fact that around 40 percent of first-time mothers giving birth in midwifery units will have to be transferred to obstetric units anyway. "

Yes - transfer is an issue. And yes - homebirth seems to increase the risks to the baby for first time mothers. However, birth outside of hospital (ie in a free standing midwifery led unit, with no access to doctor care without transfer) is not associated with poorer outcomes for babies. To me that suggests it's not birth away from a medical setting which puts the babies of first time mothers at increased risk, but issues surrounding the way care for women birthing at home is managed.

"What I get out of this study is that there's still an awful lot of luck involved. Nearly half of first-time mothers giving birth at home end up going to hospital. So how important is that choice really? It's still 50/50 whether you wiill go to hospital or not."

But even though half the first time mums in the study were transferred as a group they STILL had a MUCH lower rate of emergency surgery than women who'd opted to go to hospital in the first place, and I think this is very important!

"So you might want to be a bit more careful in your advice there."

If the RCM and the NHS are happy to recommend home birth as a 'safe' option for first time mums (they are - birth at home is still considered very safe as over all poor outcomes were rare), then I don't see what's wrong with encouraging those women who are keen to avoid an emergency c/s to 'consider' it? Obviously 'considering' it means taking all important factors into account.

I think the bottom line is this. First time mum who is low risk, healthy and has a choice of birth setting?

46% of first time mums who give birth in an OU have a normal birth.

71% of first time mums who give birth in free standing midwife led units (with no immediate access to medical care) have a normal birth.

The outcomes for the babies of first time mums in both these groups are the same.

That is a MASSIVE difference.

IMO you can't have any sort of sensible discussion about realistic expectations of birth without acknowledging the impact of setting on birth outcomes.