Homebirth - should any woman be allowed the choice?

[mears]

Me again looking for mumsnetters opinions. I have been asked to list why women who are condsidered not to have normal pregnancies should be 'allowed' a homebirth if they want it.

I personally think that women should be given all the information they need to make a choice. If the midwife is going to say that they will not be supportive of homebirth, the woman is going to feel they are in a conflict situation.

However, if the midwife is supportive and problems do arise in labour at home, the woman is more likely to trust the midwife and agree to transfer to hospital if necessary.

What do you think? Anyone been told they couldn't have a homebirth and then did?

You really do think about these things don't you Mears?

I think I agree with your third paragraph. And think this would be the best way to proceed unless it was something really obvious like placenta praevia requiring a c-section. But then most women do have that bit of common sense to realise this and accept the (possible) disappointment and get on with it.

I'm hoping for a home birth and when I spoke to the midwife she was quite positive but said that because DS was a big baby that was the only possible issue and I might need a growth scan nearer the time. But since I delivered DS with gas and air and no instruments there is no reason why I shouldn't do it again at home. Seemed like a fairly sensible attitude to me. She wasn't recommending the scan herself but thought the hospital might.

Thanks Bozza. Where are the rest of you?

I think the woman should have to have a consultation with the midwife so that the midwife can ensure she knows all the facts and then once she's satisfied that the woman knows all the risks etc, it should be totally up to her. The midwife should still be supportive, but then obviously couldn't take any responsibility if something went wrong that wouldn't have gone wrong in a hospital.

So basically it should be totally up to the woman because it's her baby, her birth and so her choice.

Sorry what do you mean by "not normal" pregancies? Just not quite sure!

What do you think about first-time mothers having home births?

I ask because I thought I might like one, turns out I probably (almost certainly) would have died if I had as I lost 10 litres of blood and nearly died even being in hospital!

I would never consider having a home birth after that experience, just too worried what would happen if it happened again. So what I suppose I am saying is, is it sensible to have a home birth first time round when you don't know what sort of problems you might face? Do many first time mothers opt for them?

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Wobblyknicks what if the midwife feels that the mother is compromising the safety of herself and the baby? Eg she has some condition (don't know what which is why I asked Mears the Q) oh ok say gestational diabetes where the baby may be big and get stuck (sorry v simplistic probably) and then any delay in having a C-section could result in brain damage.

Sorry to sound dramatic, dh is clinical negligence defence Lawyer and deals mainly with brain-damaged baby claims. Nearly all the brain-damaged baby cases that have gone to litigation (bear in mind that most don't as there is no fault in majority of cases) are as a result of minutes of delay in getting the baby out if it is compromised. How do you do that at home?

CD - it would be more difficult if there was a huge chance of having a big problem than if it was just a higher risk pregnancy but I still think it should be up to the woman, as long as she has all the facts, to decide. The legal side is trickier than the moral side though, because of the society we live in where everyone sues everyone else, regardless of fault.

Oh no I wasn't really thinking of the legal side, just telling you why I am so aware of these things. Obviously if the medical profession are at fault for any delay then you do have a claim for the additional cost of bringing up a special needs child.

Mears, do you know if opting for home-birth against the advice of your doctor/midwife is contributory negligence? (should ask dh this really I suppose)

Have just had a chat with dh about this

He says that if appropriate warnings are given by the midwife/doctor and these are recorded in the notes then there would be no claim.

Of course it is the Mother's choice in the end but like all choices she will have to live with the consequences if there is a problem as a result.

Mears why would someone refuse a transfer to hospital if they knew they were in difficulties?

Mears - I'm slightly in the middle of this kind of thing at the moment. I would dearly love a home birth but I have a complicated medical history which makes my GP suck her teeth every time I suggest I would like a homebirth. I have had two normal very healthy pregnancies, but have been considered high risk each time. I am now in the process of speaking to various specialists about whether they see any reason for not having a home birth - so far they have all said that as long as the preg is fine, then they have no problem with me labouring at home. It is only my GP and hosp m/w's who are nervous. I may well go the independent m/w route (done this once before but still went to hosp as I was a nervous 1st timer) in order to get my home birth. Having said that, I would never jeopardise my or baby's health - if there is a genuine reason for me to be in hospital then I shall be there quite happily.

Not sure about this one, I'd like to say that all mothers, whatever their history should be allowed to have homebirths if they choose but then I worry that is a trace of selfishness in that. If her history of childbirth involves complications would it not be unfair to put future children at pssible risk by not having possible vital equipment on hand?

I wanted a home bith but in the end opted for a birthing centre attached to a hospital, and my reason for that was 'just in case'.

As it turned out I'm glad I wasn't at home. The birth was fine, no intervention or pain relief etc but Lottie was born with Ds which was unexpected and she had to be taken stright off to intensive care. As it happened that turned out to be more ofa precaution and the next day after her heart check came back okay she was transferred to special care where she stayed for the next 4 days.

At the end of the day I'm glad i decided against a home-birth in the end.
However I'm so pleased I had the option of a birth unit as opposed to the main hospital.
I felt as if I had the best of both worlds in a way.

I think the information should be given freely and any mother who wishes to have a home birth should be supported in this. First time round I suggested it as a possibility early on in my pg and was told in no uncertian terms that neither the Dr or midwives could support this for a first time mother. As it was I had a prem baby and spent ages in Hospital!! 2nd time around I would not have suggested it due to my history, however if I had already had one with no complications I would have insisted on it 2nd time around. I really wanted waterbirths and ended up with 2 c-sections

Everything else being OK I think that women should have the right to choose a home delivery. And with that comes the responsibility to make a rational decision based on the facts of a case.

If the mother has, as others have said, placenta previa, then I would think that the midwife has the 'right' not to help with a home delivery in those cases. I don't think that a mothers right to choose should override the mw's prefesional duty of care IYSWIM.

ds was a section because he was a footling breach (also dd had been a section and I had pre-eclampsia.) I was very happy to have a section! However, should I have had the right to demand a home birth? Even if that went agains a MWs professional assessment? Would I have had the right to effectivly coerce the MW into going along with something that she felt was dangerous to me and the baby? I don't think that I did. What do you think Mears?

I think it does depend on what the (potential) problems are, and also how practical it is to get to the hospital if the worst happens. A home-birth wasn't something that really appealed to me but from reading MN posts I can see how important it is to a lot of women to be able to have the choice.

It turned out that I was right to have a hospital birth. Both my boys were large babies and got their shoulders stuck. It was also suspected that ds2 might somehow have turned himself round into a breech position as the heartbeat could only be heard at the top of my bump. Luckily he was the right way round but bizarrely his heart could only be heard through his bum!

I think the majority of women would make a reasonable decision if informed of all the facts. However, I think it must be a tough decision for a MW to make about whether to assist in a home-birth when he/she knows it would be a high-risk birth.

CD - I should have been clearer saying normal pregnancy - meant pregnancy where mother is deemed to be 'low risk' ie has no known obstetric or medical problems.

Women are often told that they are 'not allowed' to have a homebirth eg if they are a previous C/S or have have previous retained placenta - there are loads of reasons actually.

However, a woman has the right to choose and a midwife cannot refuse to give care (a GP can).

In reality then, a woman can refuse to go to hospital to give birth. For women who request homebirth, I think it is giving them the informed choice and making sure they understand any risks involved. If they still want a homebirth, then I think it is better for the midwife to build up a relationship of trust and try and support the woman. That way, if anything does start to go wrong, the woman will co-operate regarding transfer.

Often women are persuaded not to have homebirth 'incase' something goes wrong, however the riskiest place to have a baby is hospital statistically (read Safer Childbirth? by Marjory Tew). That is because there is still a lot of intervention, especially induction of labour.

Women who want to deliver at home will relax better and labour better there. A natural labour is by far the best option.
It is unlikely that a woman with placenta praevia would ask for a homebirth - that would mean certain death for her baby and possibly for her.
However, there are women who do not want to give birth in hospital but are bullied into doing so. My argument is that these women should not be put into a conflict situation with the midwife telling her that she is not 'allowed' to give birth at home. Better that she gains support from the midwife who she will hopefully become to trust. That way. 'if' complicatios do arise, she will be more likely to agree to transfer in.

A woman who has been informed of all the fact cannot then sue the midwife if all does not turn out well. She is taking the reponsibility of her own decision.

Ah but Mears is it not possibly the case that as usual these statistics are skewed. As you say women with serious potential problems would not choose a home birth, these are the ones who usually run into difficulties and therefore hospital is a more dangerous place!

If half of all women regardless of probs were to give birth at home I bet the statistics would have a different outcome!

Sorry got to go and see dd now but will come back to this later....

CD - the very interesting thing about these statistics is that they were skewed to show that hospital births were safer and drove the radical change of predominatly births at home to birth in hospital. Marjorie Tew is a statisician who looked at archived stats from the 50's and discovered that they were skewed in favour of hospital confinement for women. It is a really interesing book. She has no connection with obstetrics at all and was amazed by the information she gleaned.

Anyway, a bit off topic now but this is an interesting famous case here

Fascinating mears - what an extraordinary story.

I suppose I support any woman's "right" to homebirth precisely because the alternative is a mechanism that can force the manner of birth, such as the C-section case Mears linked to.

I hate women being told they are not 'allowed' X Y or Z as seems to happen all the time. I think sections are pretty great, but do think women should have the right to a homebirth, except possibly in extreme cases, eg placenta preevia like me. Don't know what you'd do with a complete loon who refused to go to hospital with PP though.

interviewed Sheila Kitzinger once, amazing woman

Why did she want to go to Wales to give birth in a cave??? I come from there, and there are lots of houses she could have gone to???

The cave bit makes her sound a bit loopy, tbh. And I do support a womans choice, that bit just sounded a bit crazy.

I refer the learned ladies to the Mumsnet e-mail on things I learend about giving birth, specificaly Motherinferior's comment. That was one of Shiela's wasn't it?

I stumbled across a placenta previa board the other day... I always thought it was fatal to baby, probably to mum, too, to attempt vaginal birth when you have full PP. But there were several people saying that they themselves had been undiagnosed placenta previa babies but still born vaginally, or granny had had a few, etc., usually baby died but it wasn't the automatic death sentence for both I thought it would be.

Some people have immense hospital phobia, that's one reason they know they'd be better off taking a bit more risk at home rather than needing serious tranquilisers to cope with being in hospital. I have needle phobia, and don't think I could be relaxed through birth hooked up to an IV or similar.