Fantastic news -new NICE guidelines recommends women are offered full range of birth place options

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The evidence has been there for years - home birth, and birth in midwife led units, is as safe as birth in hospital for many women. In fact, it's never been shown that hospital is safer, despite the recommendations in the 1970s where women were encouraged to birth there.

I do very much hope that this is not interpreted as putting pressure on women to birth out of hospital if that's where they want to be. It's essential that women birth where they feel happiest and that's the point of this - those women who want to birth out of hospital now have the guidance to back them up. Which is fabulous.

I will also point out that it's a woman's human right under EU legislation to birth at home if she wishes to. That hasn't changed. What has changed is that NICE have finally caught up with the evidence.

www.facebook.com/AIMSUK?hc_location=timeline

I was one of the last women to give birth at our local midwife unit which was under threat of closure at the time. It was mainly used as a place to transfer to after giving birth at a big hospital. On the day I was admitted, they were full up with mothers and babies that hadn't been birthed there.

My labour was terrible with nobody attending me for most of the time as they were all busy elsewhere (despite me being the only woman in labour). I only had gas and air (which ran out) and nobody noticed that the baby was spine to spine.

The pain was so bad that I wanted to be transferred to a big hospital for an epidural. This was something that they had promised repeatedly would happen if I needed it. What a load of hog wash. Turned out that you are not considered an emergency for pain relief. The ambulance took over an hour to arrive and they decided that there was a risk of my baby being born on the way and wouldn't let me go. They kept the ambulance there though as my DC tore her way out being spine to spine and they didn't think they could stitch me there.

Then to add insult to injury, I had to walk to another delivery room which had stirrups to stitch me. They couldn't give me enough local anaesthetic because they said I would swell up too much. They then stitched me up on gas and air which wasn't at all effective.

It was a great place to learn how to breast feed in a supportive atmosphere, but not a good place to give birth.

I couldn't face going through it all again, but if I had, it would have been a big hospital.

Do you think that hospital units have become too large to give personal care? In my county three maternity units were closed and we have a one huge consultant unit where nearly 6000 babies are born a year. It is a sausage factory and there is ever enough midwives to give one to one care.

I would like NHS care to move towards the Albany Model or at least look at the advantages. (Ie. increased breastfeeding,

thealbanymodel.com/

The services of the Albany midwives was discontinued because of fears of safety. I find it hard to believe it was possible to do a sensible statistical analysis with such a small number of babies. Weirdly Kings Hospital were quite happy to offer all the Albany Midwives jobs inspite of supposely being unsafe.

There is a lot of politics when it comes to childbirth. Many people want to control women and have a hidden agenda.

I have not researched the evidence so cannot comment on the level of risk of home births compared to hospital births. However, I do know two women who were classed as low risk who gave birth at hospital and whose children have learning difficulties due to unforeseen complications. In both cases outcomes would probably have been far worse without the immediate medical interventions given at the hospitals and this knowledge would personally put me off a home birth. Also I do wonder whether some woman will use these latest guidelines to push for a good birthing experience at home in spite safety issues for the baby and I am not sure how you can offer a choice to someone who either does not really understand the risks involved or is prepared to take the risks to get a home birthing experience. Finally I do wonder if this is simply a means of cutting costs to the NHS and a bit of 'do as I say not as I do' as I know a (low risk) woman in the medical profession who has opted to have an ELC as she felt it was the safest option.

Without knowing the circumstances you can't say that if it went wrong in hospital it would have been worse at home. Some of the problems could have been iatrogenic, or some problems arising might have been missed due to a shortage of staff and lack of continuity of care which might have been spotted earlier at home.

Nor is it a question of pushing for a good birth experience - I was one who felt that a home birth was safer in my circumstances. A good birth experience was a bonus, but was just that.

In a home birth situation you have one to one care for the first stage and two to one care if the second stage from experienced midwives. Problems tend to get picked up quicker in a homebirth because there is better supervision of labour.

" Also I do wonder whether some woman will use these latest guidelines to push for a good birthing experience at home in spite safety issues for the baby and I am not sure how you can offer a choice to someone who either does not really understand the risks involved or is prepared to take the risks to get a home birthing experience"

lol... trust me if you have a home birth health professionals make aware of all the possible risks, plus plenty of risks that don't exist. Safety issues exist however you choose to birth your baby. I also find your remark rather condescending as many women don't understand the risks of a hospital birth.

Why do people who opt for hopsital births not made clear of all the potential risks of choosing a hospital birth. (Ie. infection, not making it to the hospital in time, being unable to get the attention of an over stretched midwife, the cascade of intervention, pressure to give birth in a set period of time.)

Women need good support to make informed choices. Health professionals need to believe that women do have the intelligence to make sensible choices. Pregnant women are not silly little girls who need to be told what to do. People make life changing decisions in lots of areas of medicine. Why does having a bump suddenly make someone to stupid to decide where to give birth?

ReallyTired I did not mean to be condescending or try to imply that pregnant women are stupid ( I have DCs myself). I am only voicing my concern that not every woman's choice will be based on the best for her baby as not every person understands information equally well (this is the case with all things in life) or wish to miss out on a home birthing experience even in cases where it would be better to do so.

littlemonkeyface
Hospital trusts have a clear set of criteria for a home birth. Its very simple to see if some meets the criteria to be deemed suitable for a home birth.

This is the leaflet for my local hospital trust. Its interesting the the criteria is more relaxed than when I gave birth to dd.

www.westhertshospitals.nhs.uk/ourservices/womens_services/maternity/documents/Choosing_a_place_of_birth_FINAL_retd_16_12_13.pdf

I think it outlines the advantages and "considerations" (aka disadvantages) or various options. I feel that reading such a leaflet is enough to give an "informed choice."

It has been the case for years that women can be idiots and make inappriopiate birth choices (ie. unassisted birth). It has been the case for years that a woman can choose a home birth regardless of circumstances. Ofcourse a midwife cannot be forced to attend a homebirth.

I had series of interventions in my hospital birth that wouldn't have happened if i was at home. Pitocin for not progressing quickly enough for their liking despite baby showing no signs of distress and me being a first time mum, epidural (which was failed anyway) because i "won't be able to handle" the contractions intensified by the pitocin.. And when i got to the pushing stage, strapped to the bed on my back in the most uncomfortable position i was told that because of these interventions i would be left to push for 1 hour before them using ventouse or forceps and 2 hours max before a c-section.

Would my baby have had a better outcome at home? I don't think so, i did manage to push her out quickly enough for her to be born with no intervention but i dread to think what would have happened if i didn't feel the full force of my contractions, had the epidural worked.

No one can deny that for certain people having a hospital birth has far less risk factors than a home birth however i think the guidelines were in desperate need of a change and homebirth doesn't have to be seen as a "hippie" and "taboo" thing to do. We need more women to be supported in her choices and not have to fight so damn hard for their right to birth at home if that is what they feel is best for them and their child.

My daughter has recently qualified as a midwife . Currently working on the post- natal ward of a big regional maternity hospital . The work load and stress are horrendous. Please God the recent experience of that poor young woman in Bristol leads to some genuine review of the ratio of midwife to labouring/ newly delivered woman . As other posters have said,that is what really matters-someone well trained , (British Midwives are-they are in demand world wide apparently- and are treated as 'sole practitioners' , like doctors) who can properly monitor the progress of labour and knows when intervention is needed, but can support the labouring woman to avoid unnecessary interventions .
My daughter says her own preference would be to give birth in a Midwife led unit attached to a hospital, so transfer is quick and easy if need be (she also says water births are brilliant-harder to organise at home).I had mild complications in both my deliveries-cord round neck of one, second got stuck by the shoulder . In both cases it was the attending midwives who sorted it . I had more faith in them than the very young Dr's who stitched me up . As an elderly prima gravida (I was 35) a home birth was frowned on . I think home births would have been fine in both cases .

PS said daughter says in no circumstances would she have an Elective Caesarean, and the fact that some people think its the easy /less risky option astonishes her !

sigh

Your daughter needs retraining then, if she really feels like that and is going around saying things like that. Its potentially going to mean she isn't going to give the right/appropriate care to some women.

She might not want an ELCS herself, but she should understand why some women might want an ELCS so she's not quite so 'astonished'. She should understand that people assess risk in different ways and women have different preferences and concerns and they are equally valid even if it isn't something she would personally do. She understand these reasons, even if she doesn't agree with them for herself.

Being astonished isn't going to help women be listened to and their preferences being respected. Given this is a thread about promoting choice, it kind of reinforces the feeling that midwives are very set in their beliefs and are not particularly open to women making choices.

I'm guessing attitudes vary by region too.

I had my first birth at the age of 36 and mentioned very early on to the MW that I was considering a home birth.

Fabulous, she said, and booked me in straight away. Bit too quick really!

Again with this pregnancy at 40, the midwife didn't bat an eyelid about the prospect of a homebirth.

I don't know if there are stats anywhere to show regional/hospital variations on place of birth.

redtoothbrush I don't think that postchildren meant that her daughter is going around telling her patients that! I think she may have meant in a private conversation.

bringon, I don't think it matters whether its said privately or to patients. The point is that she is still unaware of why and 'astonished' by women who choose it. Its the gap in knowledge that bothers me.

It's all well and nice once baby comes out safely into the world with no complications . But how can anyone 100% guarantee that? Giving birth is unpredictable unfortunately. Best is to give birth in MLU attached to CLU . If it's straight forward you will leave in less than 24 hrs.

I don't want to be in an ambulance being shipped to a hospital in case of an emergency . I personally feel more comfortable at a hospital while others feel happy to give birth at home. As long as there's a choice I'm happy.

How can you guarantee a 100% safe hospital delivery? You can't.
Best is to weigh up your options and do what you consider is best for you and your baby.

Out of the small percentage of women who get transferred to the hospital from a home birth the vast majority do so due to failure to progress or because the mum has decided to get more pain relief. And i think you will also find most even use their personal cars...

I'm not saying emergencies don't happen but emergencies happen in hospital too. I personally feel safer at home where i have 2 to 1 care and any potential problems can be spotted well in advance rather than in hospital where there is one midwife caring for several people.

I'm finding the public debate on this issue incredibly frustrating - people seem to entirely disregard the evidence.

People INSIST that opting for a homebirth is more risky, and no matter how often you point out that research suggests that it's simply not (except perhaps some additional risks for the babies of first time mothers), it makes little impact on the debate.

mythical I agree, I think the risks attached to interventions (epidural, induction etc) are too little publicised.

I also agree that this publication is a distraction from where the real focus should be: that the ratio of midwives to labouring women is far too low.

This is the main reason I have considered a home birth to be honest - because I've heard horror stories about apparently low risk women being left to their own devices in hospital, with bad results, and at least with a home birth I have a guarantee that the midwife will not leave my side. That's a really bad reason for considering a home birth but that is what it's come to.

Rootandbranch Agreed, but this goes right back to my first posting. You spend 45 years screaming that home birth isn't safe, so to now say, "well actually, we got it wrong", will take some time for the message to get across.

I wasn't given a choice with my first, and I didn't know my options. As it was I started at a midwife led unit, then got blues and twos transferred to hospital, where I went on to deliver naturally, but with a lot of unwanted drugs.

my second, I again wasn't given a choice, and initially chose the midwife led unit again. But then I read up on it, and decided on a homebirth. I obviously had to tell the authorities that be, and they ummed and ahhed, but in the end, I was having a homebirth whether they agreed or not. I had a successful homebirth, that ruined my living room rug ;-)

More women should be made aware that homebirth is an option. We are so conditioned to hospital birth that many women don't even consider it.

"my second, I again wasn't given a choice, and initially chose the midwife led unit again. But then I read up on it, and decided on a homebirth. I obviously had to tell the authorities that be, and they ummed and ahhed, but in the end, I was having a homebirth whether they agreed or not. I had a successful homebirth, that ruined my living room rug ;-)"

I am surpised your rug got ruined. Most midwives are very good at avoiding mess. My old house where dd was born had a cream carpet and the only evidence of a birth was dd!

minipie "OP - the stats you quote which compare "like for like" on risk factors: do they exclude women who have an epidural? As an epidural is known to increase the risk of CS. If not, then I would assume the increased chance of a CS in a labour ward vs home birth/MLU, for equally "risky" mothers, is down to the increased use of epidurals."

No, because the probability of choosing to having an epidural in a planned hospital birth (121/1000 in multips) is significantly higher than with a planned home birth (28/1000) and the CS rates simply follow. To take out the epidural rates would skew the figures in fact. It's important to understand the relationship between epidural and in-labour CS (aka EMCS).

reallytired "It has been the case for years that women can be idiots and make inappriopiate birth choices (ie. unassisted birth). It has been the case for years that a woman can choose a home birth regardless of circumstances. Ofcourse a midwife cannot be forced to attend a homebirth."

The women that I have known who have had an unassisted birth are the most non-idiotic women I know. They know their stuff and know the pros and cons of the choice they make. It may not be your choice, but it's as valid as any other and to call them idiots is to just not know where women come from when making this choice. One might say that a woman choosing an ELCS for birth fear is idiotic. But one wouldn't be doing themselves or the women they are referring to any favours.

A midwife's code of conduct requires her to attend a birth if she is asked.

As you say, a woman has the absolute right in law to have a home birth. An assistant cannot be prosecuted unless they attempt to pass themselves off as a midwife. So for instance, the woman's partner is perfectly within his or her legal rights to be the birthing woman's only support provided that the birthing woman is not led to believe that that partner is a registered midwife if they are not.

Useful info on your birth rights: aims.org.uk/?faq.htm

LaVolcan You are ABSOLUTELY right and thank you for raising such a vital point.

Midwife led units are awesome and desperately need fighting for. Their statistics are phenomenal. What I would like to see is more women "allowed" to birth there - it drives me mad that arbitrary rules are in place, however in my own local MLU I find that I can often support a woman to persuade them to take her. Always worth trying.

Postchildrenpregranny - just an aside, but for many women a waterbirth is very easy to organise at home. In fact, often easier than on wards where there are limited facilities.

I have had one hospital and two home births. I just wish women were encouraged and supported in their choices. Whether that choice is home, MLU, CLU, ELCS, whatever.

I agree entirely, Penguins. Ironically, guidance on the support of women wanting an ELCS came out a long time before guidance on supporting women wanting a home birth or MLU birth. I advocate for birth choices, not home birth or natural birth or whatever birth, but a positive birth, whatever that looks like for the individual woman. It's immensely exciting to have this new guidance, just as it was to have the CS guidance.