interesting website - GP talking about home births, experience of midwives and breastfeedng etc

[mogwai]

Stumbled across this and I think it's very interesting.

It's basically a blog written by an NHS GP.

If you scroll down his pages, there are some very interesting discussions about homebirths and breastfeeding. The arguments stirred up are worth reading, but be prepared to get addicted!

nhsblogdoc.blogspot.com

MisChief: DH likes the idea that I will be supported by professionals and he won't be left feeling clueless and lonely as my only support. He did a fantastic job last time but thoroughly hated it.

Enid: I'm convinced you're right, that homebirths are fantastic and much better in all outcomes, except what appears to be a slightly increased risk of infant mortality (not maternal, interestingly). And of course if you are the 1 in a 1000 with a dead baby then all the other positive benefits of homebirth are completely wiped out. The trouble is, although the studies give this as an overall picture, they are not helpful for determining the risk for individual groups: I may well be in a group where the risks are the same between homebirth and hospital but I just can't tell. Grrrrr.

It doesn't help that ll the GPs in \link{http://nhsblogdoc.blogspot.com/2006/05/home-delivery-lunacy.html\this conversation} have a picture of normal birth as a risky activity, a picture I don't agree with. They are characterising the decision to homebirth as a decision to put the infant at higher risk in order to achieve some nebulous 'better experience'. Actually, that's a polite precis of what they actually say about women who homebirth.

Hmmm. I don't want to hijack this thread too much - maybe I should start another.

hijack alert..gizmo, how the devil are you?? was thinking about you the other day

Heeeeelllloooo, SC.

Ehhh, fair to middlin', thanks for asking. Doing lots of work avoidance, as you can see How's Wales?

not too bad ta, how are things with you? everything going ok?

Nice, straightforward pregnancy so far: nothing to fret about except homebirth and what some completely irrelevant doctors think about it . Possibly I might be over-thinking this a little....

lol
how many weeks are you?

Motherinferior, that's the other thing: even the obs and other GPs can't agree among themselves.

Which makes me mad actually: it's all very well for doctors to say this should be a women's (informed) choice, but if the evidence is so contradictory that even experts in the field hold violently opposing views about it, what chance does a lay woman have of reaching a sensible conclusion?

Anyway, I'm a pretty risk tolerant individual and I think in a low risk group, so the most likely outcome is that I'll go ahead a homebirth. If the outcome is dreadful, well I'll just have to bear the burden.

Gah.

Just coming up to 25 weeks and have large bump to prove it. Blessing my office air-conditioning with every summer day that passes....

25 weeks already!!! last time i saw you, you were 8!!!.
im glad everything i9s going well for you, havent read all the posts but are you coming up against some hurdles, re, a home birth?

Oh no, no hurdles except in my pesky head. In fact Addenbrookes is so overbooked for September (must have been a busy New Year ) that I have heard local midwives are suggesting homebirths to first timers.

Since homebirths require two midwives per woman and, as we all know to our costs, hospitals seem to be able to make do with one midwife between four, I'm not sure how that helps, but I guess they have their reasons!

well did you last birth go ok?
also im not a fan of the roaie anyway, i had a bad experience there with ds2 and vowed never to go there again, went to hinchingbrooke after that, the thing is, if anything happened(which is rare), you are close enough to the hospital to get there in a hurry, and it would be much nicer to be in the comfort of your own home, rosie is always overbooked! and they keep the heating on full blast!

Hi Gizmo (and others)

I picked up this thread from NHS BLOG DOCTOR. Gizmo you said:

"It doesn't help that ll the GPs in this conversation have a picture of normal birth as a risky activity, a picture I don't agree with. They are characterising the decision to homebirth as a decision to put the infant at higher risk in order to achieve some nebulous 'better experience'. Actually, that's a polite precis of what they actually say about women who homebirth."

That is an emotional statement; a "wish" statement if you like. Childbirth is the most dangerous physical thing a woman goes through until she reaches old age and serious illness intervenes.

I wish that was not the case, but it is.

Go back a hundred years and look at literature. Why were there so many "wicked" stepmothers? Because, sadly, so many women died in or shortly after childbirth.

I wish that home deliveries in the UK were safe. But they are not. You cannot predict with certainty who is going to have problems. Even the so called "lowest risk" mother can have an unexpected PPH or a cord prolapse.

If you have not already done so, read the tragic story of the midwife who STILL favours home births notwithstanding the avoidable death of her son due to unexpected complications of a home birth.

nhsblogdoc.blogspot.com/2006/05/home-birth-tragedy.html

That child would probably be alive and well today if the birth had taken place in hospital.

I speak not just as a doctor, but as the father of four children. All born in hospital. And pretty unpleasant some of it was too. I wish we could have had the babies at home. It is much more pleasant.

But it is not safe.

And it is not fair on the baby to put his/her life at risk so that you can have a touchy-feely home birth experience with the midwife.

I am sorry, but midwives who advocate home births in the UK are a dangerous liability.

Best wishes

Dr John Crippen

NHS BLOG DOCTOR (nhsblogdoc.blogspot.com/)

lol, it obviously was a busy new year, dont think there was much on the telly!

Last birth adequate (certainly nothing to moan about compared to some) but pretty unsupported until things started to go a bit pear shaped. Postnatal care was utterly shite.

So I'm not really interested in doing the Rosie again unless my pregnancy suddenly becomes high risk when I'm sure I'll be grateful to have it!

yes my post natal care was diabolical there and im sure contribited towards my post natal depression

Dr Crippen

I am pleasantly surprised we have come up on your radar. Thank you for entering the discussion.

As you will have gathered (and I'm afraid you may find this is a slightly underpopulated thread) you have certainly given me pause for thought. I am going to read the literature that is available on the risks of homebirth and try to analyse it in the light of my case. As I have already observed, this is not an easy task for a laywoman, but in order that I make an informed choice I think it is important that I do so.

In the meantime, on the subject of informed choice, how do you suggest I deal with the fact that my GP, and a number of prominent obstetricians, seem to have no difficulty with the idea that homebirth is an appropriate choice for people like me? Presumably they have access to the same data as you yet they are drawing different conclusions?

This seems to me to be the difficulty in using mass studies to assist patient choice. They are not designed to do that, of course, they are there to guide policy, and the result is that no GP, or OB, is ever actually in a position to give tailored advice to real patients.

I take your point that childbirth is a dangerous activity for many women, but when it boils down to it, that again is a statement only true for the mass population. For me that statement may not be true - I may be a climber, an event rider, or any one of a number of high risk individuals for whom childbirth is not the most dangerous activity they will undertake.

For my child, however, this will be the most high risk activity it has undertaken in its short life. So the ethical question becomes whether I am justified to put the baby's life in greater danger by birthing at home. I could write reams about the judgement involved there (involving, as it does, balancing the interests of my other child and dependents against this risk) but I'm not going to right now, as I think this debate would be more interesting if some others have a chance for input

that was an excellent post gizmo

Thanks.

I doubt Dr C will agree. You should read his blog, it really is excellent and an eye-opener for those of us on the other side of the waiting room. My doctor mates rate him highly.

Which is why it gives me such pause for thought that he is so adamantly opposed to homebirthing: he is plainly humane and worried.

gizmo-i read his blog, i can certainly see where he is coming from, however, i think its a case of six of one and half a dozen of the other, i can see every ones point of view, i dont however agree with him when he said that women wanted touchy feely homebirths, i think women choose to have a home birth because they want to be in control of something that is at the end of the day, a completely natural process, when it goes to plan, however i accept that there are many cases where it doesnt and complicvations ensue, which could have been prevented or dealt with in a hospital enviroment.
medical blunders meant i suffered a traumatic delivery with my daughter which nearly resulted in her death(dd1), however had i been at home, she would def had died.
its a difficult decision to make, however succesful home births dont make headlines, tragic ones do.

he has a professional opinion, but it still is an opinion.

Personally, I disagree that home-birth is sought by women because it's "touchy-feely". I instinctively wanted to birth at home, felt I could do so safely as I was low risk and did this with the full support of my mw team and my GP. I did have a PPH too (not a huge one, but pph nonetheless) but this was dealt with at home by the mws. It's obviously never risk-free but I could never somehow see it as more risky for me to birth at home than in hosp that's why I was able to go ahead with it.

I think there should be more encouragement for those at risk of unplanned home births to have planned ones

I agree about the 'touchy-feely' thing, Mischief - I have absolutely no interest in getting 'touchy-feely' with my midwife, thank you very much!

Basically, if I decide to homebirth, I'm trading off a higher probability of a number of low impact events in going to hospital (studies show higher rates of interventions, episiostomies, lower apgars and lower rates of breastfeeding from hospital birth, all of which concern me) against a low probability of a very high impact event (ie death of my baby).

I'm sure there is some inherent bias in these studies (ie the population likely to chose homebirth is at lower risk of some of these events in the first place) but I don't think that's sufficient to explain the marked difference in the probability of these events between home and hospital. And they represent a significant enough issue for me to give me major reservations about having my baby in hospital.

I am sooooo not going to get involved with this thread!

Ahhhh, go on Rhubarb, you know you want to!

If you really want to kill some time, you should try reading the responses section to the original Dr Crippen article.

Nothing like a nice lively debate when you should be working, eh?

No no no no no no no no no no!
I need to chill out! My throbbing temple might explode if I don't!