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?

I have to say I had a problem the other night with a woman who had a needle phobia and I actually wanted to punch her!!!
She had come in with high blood pressure and her waters had broken. Unfortunately she had meconium staining in the waters and I explained why it was a good idea to check her bloods to see if the blood pressure really was a problem. Also, where there is meconium staining we usually cross match blood incase the baby shows signs of distress which might mean a C/S.
She looked a me and shrugged her shoulders saying 'I'll think about it'.
Anyway, she had no contractions so she agreed to a drip to get induced.
So for all my great ideas I was actually pretty annoyed with myself for getting so annoyed with this woman (not that she knwe of course).
I gave her the information and she chose not to comply. She actually delivered OK in the end and that in a way demonstrates what i ultimately think.
Women who are dead cert on a decision regarding delivery are usually right. Those women who absolutely insist on a homebirth are usually absolutely right.

Just as a point of interest, there are varying degrees of placenta praevia. Where the placenta completely covers the os (neck of the womb), the baby would not survive delivery and the mother would have a massive haemorrhage. i don't know any instances of woman insisting on a homebirth in those circumstances.

I wish I had insisted with no 2 but there was tiny chance that I had cholestasis and they were panicking abit not knowing a lot about it, as it was I delivered in 24 minutes, drug free and toddled off home running two hrs later.
Had HB first time round, was 22 my mw was right behind me and it took 37 minutes, was MAGICAL
Next time I'll insist within reason!

I don't think I agree with women being told they are not 'allowed' to have a homebirth - since different medical professionals will have different opinions on what should be allowed and what shouldn't and it ends up being a bit of a lottery.
There's nothing wrong with professionals voicing their opinion and explaining why they think a homebirth might not be suitable, though.
I want a homebirth but if I thought there was a genuine reason why it would be better to have the baby in hospital, then I would go for that. I agree with what you say, mears, about conflict arising from the withdrawal of support.

What is placenta praevia exactly?

Placenta blocking the birth canal -- over the baby exit, you could say! Can be partial, complete, or just very very close to the birth canal.... I'm not an expert, but basically, if the placenta is born first, the baby has to follow very fast or baby dies... and there is a high risk of excess bleeding in the mother (I guess Mears would know why?).

That is a very intersting story, Mears. I find it hard to understand how a woman could risk her child because she has a needle phobia. I'm phobic about hights (very much so). You could have dragged me up the Eifel Tower if my child had needed it.

I suppose that i can't understand how a womans need for a particular type of delivery can be more important to her than having a healty child.

You have it in one Zebra

Thanks, zebra.

I wouldn't have one as I would worry that if anything went wrong and I couldn't get to hospital in time the baby and/or I would be compromised.

BTW Mears I think dh was involved in the cave case, if not then one very similar.

Once also had an experience of a woman who did not want female midwives - so much so that she laboured in a room by herself for a long time as we had no males available. Eventually she consented to assistance but it was a terrible situation. It is amazing the experience women have had in the past that informs their decisions. i felt her situation could have been managed better earlier in her pregnancy but she had to fight the establishment. That is what I think should be avoided at all costs.

Can I also say that I wouldn't have wanted a homebirth but I have every sympathy for women who do.

I felt the same way Countess, and needed sections both times.

Do you feel that women intuitivly know what they need Mears? Or do you think that it was a basic feer of mine that predisposed me to a chain of events that led to a section? (not being in any way argumentative....rather interested in your views)

I have a friend who is very fatalistic about pregnancy etc, and had very easy home births. I suppose it is a bit of a chicken and egg situation.

I'm also 100% happy with both my birth experiences. Very positive, both times.

I think women who 'demand' what they want be it homebirtor C/S know what their 'choice' is. The majority of women dont know and follow a chain of events. It takes a strong woman to insist on an elective C/S fono known medical reason in the same way that women with known medical problems insist on a homebirth.
The rest 'go with the flow' to some extent.

sorry about the typos but you know what I mean.

Great thread this has turned out to be. I love discussion

I must say I am obv in the middle.

I wouldn't make a birth plan on the basis that I would probably be disappointed if it didn't then go to plan, lucky really given what happened. I always thought that situations can change so rapidly and to go in with a flexible approach was probably the best option.

DH was just terrified in general as he sees all the f**k-ups in his job, he was very keen on us following the advice of the Prof.

Mears what would you do if a woman insisted on a home birth with for eg a placenta praevia?

(that's what my mate who's a doctor calls our Toyota Previa btw )

When I was expecting dd I honestly never thought that I would end up having a section. As it happened I did have an emergency, but in an odd sort of was it seemed to be 'the way it was supposed to be'. That makes me sound a bit odd, and I don't believe in predestination

Ds was a planned section for some very good medical reasons.

I just can't get my head around someone who would risk their child to get the delivery that they want. I do appreciate that some women are deeply traumatised by birth experiences (natural, cs or whatever). And I am not belittling the depth of their feeling. But the birth is only the start.

To avoid medical care, stating that you see life and death as natural does seem to be an extreme case. And what of the life of the child? (another can of worms, I grant you)

Or a footling breech? (which is what ds was) I've seen wamerican sites where women have delived alone with fb....to my mind an insane risk to take.

I recall that case you mention, Mears, and am appalled that there were at least 12 other similar ones of women having a cs forced upon them. I think choice should always be informed, and then if a women is prepared to take responsibility, so be it.

I suppose most people are reasonable about these things. When I had dd I wanted a physiological third stage. I was prepared to go the other route if necessary, but I had complete faith in the MW that she would do her best to comply with my wishes.

It must come down to professionals really listening to what women want, in the end, and then making those wishes and needs happen, if at all possible. It might cost a bit of money to accomodate everyone but there must be savings to be made on less requirement for PND treatment and other stress-type illnesses that women can suffer from after having an unnecessarily traumatic birth.

I do know someone who has had several 'unattended' births, not because the baby arrived too quickly, but because she feels she and her dh know how to deliver a baby and they don't want any interference. I think that it's actually illegal to give birth without calling for help - Mears will put me right on this issue, I'm sure!

I totally agree with what you originally posted, mears.
I had a hospital birth last time, and I'm planning a home birth this time. My sister decided to have a homebirth with her child, when she was 18. She lives in a very rural area, and her hospital has an awful record of patient care. She was initially adamant that no matter what, she would not go into hospital, at any time. But due mainly to a very understanding, supportive and non judgemental midwife, my sister came to trust that if this lady asked her to be admitted at any point, it would be for a very good reason. If her midwife had at any time made light of my sisters concerns about going to hospital, I feel sure she would have lost that trust, and not complied.
It's ultimately the mothers decision, but information and support has to be provided to achieve the safest outcome, IMO.
(Read that horrific article a while ago )

interesting point, mears, that often women in labour instinctly know what is right for them. I was dead set on a home birth and had very supportive pro home birth midwives. Easy labour up to 10 cms and relaxed, coping well with pain etc. After a lot of pushing, baby was just too big and not coming down birth canal easily at all. Suddenly I just knew I wasn?t going to do it on my own. The mws didn?t hint or say anything, I just knew I had to go in and quickly - I wasn?t pannicked or saying I couldn?t cope with the pain, I just knew that I needed more help. Sure enough, afterwards my mws and the doctors agreed that it was a very good job I had gone in when I had as there could have been major problems if I had stayed at home. The mws knew the ambulance ride at 10 cms and pushing wasn?t such a great idea and were all for trying an extra half hour but I am so glad I called it a day when I did - by the time I was in hospital the baby was in a lot of distress very quickly and it did get rather scary.
Saying that, my mws were fantastic and I have so much respect and gratitude for the work and kindness they showed me. It was just one of those instinctive things.

Have talked to dh and don't think it was that case BUT he was involved in one where the mother had pre-eclampsia, refused treatment and had to be sectioned and given a c-section and sued for assault.

I think in the main it should be the mothers choice, but, at the same time she should listen to what the 'professionals' are saying.

When I had my booking visit with my community midwife for pregnancy number 2 (ds), she asked what type of birth I wanted. I told her that I wanted to give birth in hospital, her response was 'Why don't you want a home birth, you are allowed you know' even though I'd had a difficult birth with dd1. I'm glad I stuck with my decision as ds was born with the cord tight around his neck and had to be revived, his shoulders also got stuck.

In my 3rd pregnancy I wasn't given a choice, my ante-natal care was basically taken out of my hands due to an uncontrolled overactive thyroid. This birth ended up with an emergency cs, apparently I should have been offered one before I went into labour, but wasn't. The Consultant on duty wasn't very happy that it hadn't been discussed with me. When I first arrived on the labour ward, the midwife examined me (she asked first) and told me that I was ONLY 2cm dilated and said that I should go back home. Both dh and I said no way, we'd woken MIL up to come and look after dd1 and ds, and, we both knew that it was real and not a false alarm. She gave in and let us stay, at this point it was about 3am. I didn't sleep at all, contractions etc. By the time the next midwife came in to check on me (thankfully there'd been a shift change) I was 6cm, allowed to have breakfast then transferred to the delivery suite.

I would hope CD that a woman with placenta praevia would not ask for a homebirth because she totally understood the implications. I am not aware of the situation ever arising. Remember, a fetus does not have legal rights so at the end of the day the mothgers choice is hers alone. She may choose to bleed to death in the same way that a Jehova's Witness has the right to refuse a blood transfusion. Very extreme case unlikely to arise. Could be that psychiatric referral would be required and gooness knows the outcome.