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 think it's up the the mid-wives to if they feel comfortable assiting the home birth. I know mid-wives who won't do home-births at all because they know everything which can happen and how quickly.
I personally think it's a bit of a gamble to let firt-time mums have home-births. You have no idea what your birth will be like. A lot of women write the most wonderful optimistic birth-plans and don't even think of the possibility that something might not go according to plan. I think second-time mums with easy first-births are the best candidates for home births.

I've been thinking about this. (I had a lousy first birth and a very straightforward second birth, at home. The pressure on me was from DP and his mum (who kept saying I was far, far, far too old and that look what happened last time); none whatsoever from the professionals who totally supported me in my choice.)

I think this links up with the thread on which women are discussing hospital care. A lot of us opt for a home birth because hospital is so very horrible to be in. It is also the right place to be in for many women - but what I'm saying is that our choices get skewed by the awfulness of hospital.

Not being very coherent, am I

OK so we are talking about minor pregnancy complications here

I'm still not too clear what these might be, your original post said

"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"

What exactly do you mean by "not to have normal pregnancies"?

It sounds to me like Levanna's midwife got it spot on, which I think is what you are referring to mears, giving support so that the woman will go into hospital if things do become serious.

I also think that ultimately it should be the woman's choice. Nobody of sound mental health should be forced into hospital, and I'd guess that someone who has placenta previa and refuses to have a cs in hospital would probably end up being sectioned under the mental health act.
I have been advised by various people against home births for both of mine. For my first home birth I went the independent mw route, second time round I had a great community midwife who was completely supportive (but then I did have a panic attack during an antenatal just thinking about going into hospital ). One of the other community mws on the team was very unsupportive though and miffed that I refused to go and see my consultant for 'permission' . She also made me sign a waiver (personally, I think women should be informed of the risks of giving birth in hospital). I wasn't bothered about her opinion to be honest - she had no experience of home births and had worked in hospital until recently, whereas my cmw was very experienced.
I just read the article on SK's site - I must say I found the woman's stance of death being the inevitable end result of certain conditions somewhat freaky (and not indicative of her being in good mental health). Would she refuse antibiotic treatment for herself or her child should she/he have pneumonia, for instance?

"under2, I must say that you have summed up exaclty how I felt in that article. All that stuff about going to a cave....crazy. And counter productive to the 'immage' of hb as a rational decision, made by woment who are quite sane and 'normal'...IYSWIM.

Death is inevetable, but that doesnt mean that we have to ruch to meet it halfway

Here are a few reasons why a woman asking for a homebirth might be told she is not allowed.

first baby
Blood pressure diastolic over 90
haemoglobin under 10
previous C/S
had had 3 babies before
retained placenta previously
previous forceps delivery
breech

the list could go on.

I like the suggestion that the risks of hospital births should be discussed!

Here are a few reasons why a woman asking for a homebirth might be told she is not allowed.

first baby
Blood pressure diastolic over 90
haemoglobin under 10
previous C/S
had had 3 babies before
retained placenta previously
previous forceps delivery
breech

the list could go on.

I like the suggestion that the risks of hospital births should be discussed!

Even if you've had three babies at home before (I'd have thought you'd be pretty used to it by then, wouldn't you?)?

I think there are 3 types of women who go for homebirth:
Camp A) Just think it would be nicer than hospital. Safer too, probably.
Camp B) Had previous bad experience in hospital and don't want to go near the place again.
Camp C) Have deep-seated strong feelings not based on previous experience, but have strong anti-establishment feelings, surgery phobia, etc.

The media focus on extreme cases of C, the Camp B crowd can be me most strident, but I'm pretty sure most would-be homebirthers are in Camp A). Willing to work hard for a homebirth, but not absolutely set on it. The thing is, I think most of us make parenting choices that at least one other person thinks is crazy and all-wrong, maybe it's like that with homebirth. Whether it be smacking, leaving child alone in the car for 5 minutes, working full time when you don't need to or homebirth in a situation that someone else might label as WAY too risky. I try not to judge.

message withdrawn

wahey, excellent discussion

Mears, there was an editorial headline in the BMJ 2 weeks ago, 'Denying patients choices is patient abuse' (from memory, probably not exact).

This is exactly how I feel. ANY patient should always be given choices and allowed to come to a decision that suits them. Of course, there is always a cohort of patients who cannot make decisions or prefer their physician/midwife to make the decision for them.

Pregnant women are tremendously vulnerable and when you couple that with an increasingly litiginous society and an NHS that practices defensive, rather than sensible, medicine.....well, you get the picture. For women who want to take responsibility for their pregnancy/birth etc, then they should be allowed to, as long their is a full and frank discussion of the worst-case scenario and how the women would feel afterwards eg no point in sueing the NHS if a homebirth went wrong, it was the woman's decision.

I personally feel really strongly about this and very, very angry in my case. I have MVP and was told that I cannot be under the care of a midwife at my healthcentre. I was also told that I would have to have continual monitoring during the birth. I would have 'no choice, that's the rules'. Get this........ this was even though I told her that, as a cardiologist, my husband stated that there was absolutely no risk to my health during pregnancy. Midwife was unwavering, so I stated that I would rather have a section than be pinned to a bed giving birth in an uncomfortable position with the risk of tearing. 'Oh no, there's no need for that' she said.
Jeez........

You highlight my point beautifully highlander. You are able to make your own decisions in life yet you are being told what you will or will not be allowed to do regarding your own pregnancy and delivery. You should be able to make an informed decision about your own care. No health professional has the right to dictate to you. Far better to have a trusting collaborative relationship with your doctor/midwife than to start a relationship shadowed by conflict.
If you want to have an intervention free labour, you have that right. You cannot be made to labour strapped to a bed and monitor. Good luck

I am so shocked that hospitals still get away with telling women what to do when actually they have no right to do this. Of course drs and midwives can advise, but no more. Pregnant women do seem to be regarded as either a/nothing more than vessels for their babies or b/giant overgrown children themselves.