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

[organiccarrotcake]

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.

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when I was giving birth I wanted the facilities of a hospital available if I needed them. However the statistics have shown for years that in certain circumstances home births are as safe as hospital, if not more so. It is taking a long time to convince obstetricians. Home births dont save the NHS money, so they will continue to be difficult to get.

One point women should consider is the issue of transfer to hospital if there is a problem. If you live around the corner from a major hospital that isn't an issue but if you live in a remote rural area you may want to campaign for the revival of a midwife led unit nearby. These are more economical and as the NHS is still withdrawing from small hospitals there are likely to be opportunities to create them.

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 !

I hope she was overstating her case to you, because that would be quite disturbing if she actually thought that - of course there are cases for which ELCS are safer!

From my limited experience, I have had cause to wonder how much training midwives get about the long-term risks and consequences of VB after a first difficult VB. The senior midwife who did my afterthoughts session seemed to think I was a silly little girl making things up, when I told her I was concerned about the long-term risks of incontinence if I had another VB after a very serious tear. "Worst-case scenario you'll get them to tighten you up down there afterwards if you need to", she said

On a different note, I find it interesting that (my own generalization from anecdotal evidence) OBs would much rather give birth in a highly medicalized environment, and midwives would rather have a midwife-led birth. Since one can assume they ALL know what they're talking about, it really goes to show that there is no "right" objective choice, imo.

I think it's because the way labour wards encourage people to give birth, vs midwife-led units, is so different. I've had one of each. In the labour ward the MW told me I had to be on my back, feet in stirrups, because that was 'best'. In the midwife-led unit I had a lovely experienced lady who encouraged me to be in the position my body wanted. My DD was able to wriggle her shoulders free on her way out - no way could DS have done that due to the position I was in.

"I find it interesting that (my own generalization from anecdotal evidence) OBs would much rather give birth in a highly medicalized environment, and midwives would rather have a midwife-led birth. Since one can assume they ALL know what they're talking about, it really goes to show that there is no "right" objective choice, imo."

I absolutely disagree.

Midwives are involved in caring for women from across the risk spectrum, so their experiences are vastly more representative. Doctors focus in entirely on risk and on problematic childbirth - they are simply not involved in normal births in the UK, and in countries where they are involved in delivering babies for low risk mothers, appear to do all they can to make labours as complicated as possible, by interfering at every opportunity.

Um, women give birth surely???? Yes it is about choice NOT fashion. It depends on one's attitude to risk - there is no way of knowing if it will go pear-shaped. As s'one who was blue-lighted to a hospital 30 miles in the middle of the night in second stage from a midwife unit where they had had to call a GP in to decide - we opted to go straight to the big hospital for No2. Frankly we were not particularly interested in the nature of the birth experience (we seem programmed to forget the detail anyway) rather the safety of our babies was our main concern. As far as the experience goes I suspect that having the right supporters on hand is vital - Mum is hors de combat. I had my mother who was a nurse and HV and husband who as a farmer had delivered lambs and foals so I left them to sort it and I was 'away with the fairies'. But everyone is different and we all have a different attitude to risk depending on our characters and experience. I wish the reports were about home birth being a real option now not the 'better' option - or it is only the pendulum swinging again...

Protego - I agree it's about priorities.

My priority was to have a safe birth for my baby AND for myself - which is why I chose a homebirth for my second baby.

There's no way on gods earth I would have chosen to labour in any setting where I was at three times the risk of emergency abdominal surgery with no improvement in the likelihood of a healthy baby, and that's what you get if you are a healthy woman choosing an obstetric setting for birth.

Protego, the evidence is that, in clinical terms, homebirths are associated with better outcomes for healthy women having their second/subsequent baby.

It's important women are aware of this.

My priority was to have a safe birth for my baby AND for myself - which is why I chose a homebirth for my second baby.

Mine too. I had not been very confident with the CLU staff who missed a couple of things ante-natally, and appeared to neither know nor care, and therefore I wasn't confident that they would pick things up quickly with their production line system in the delivery suite. But, I only lived about 7 miles away from the main hospital, on good roads, not rural country lanes. So as far as I was concerned, the back up was as readily available as if I had booked into the CLU, with the added bonus that I had a known midwife attending me.

.......where I was at three times the risk of emergency abdominal surgery with no improvement in the likelihood of a healthy baby,

Yes, I think this is also key. I think that if the outcomes for the baby were significantly better the majority of us would take the hit on our own health. Since they are not, well, we do need to be informed what the position is.

Travelling to hospital by ambulance is never as quick as getting to theatre when you are actually inside the hospital, there's the issue of an ambulance being available for one thing and in an emergency, every minute is critical.

I can't take the pro-homebirth argument seriously when nonsense like this is trotted out. How can travel 7 miles away from a building, when you have to wait to be collected by an ambulance, be as quick as travelling inside a building?

I know what can go wrong in supposedly textbook labours, I've seen babies be unexpectedly flat at delivery and need far more resuscitation then one midwife in the community could provide. However statistically small the is risk of that occurring, it is not one I could ever take and I suspect many women feel the same.

"Travelling to hospital by ambulance is never as quick as getting to theatre when you are actually inside the hospital, there's the issue of an ambulance being available for one thing and in an emergency, every minute is critical. "

There is no point in having the operating theatre in the next door room if if the medical emergency is not picked up instantly. The advantage of having an obstetric theatre on site is ofset by the fact that your midwife is looking after several women at once. As you have said "Every minute is critical" and your midwife can not spot problems unless she is attending to you.

IPityThePontipines Out of interest what is your job? How many normal births have you attended?

Anyway the new NICE guidence isn't forcing homebirth on anyone. It recommends that women are offered the full range of birth options.

How can it be as quick, IPity? Because if they have left you unattended, which happens, they might not realise there is a problem. Or the theatre(s) may already be in use, in which case you will wait anyway.

I get fed up with hearing about this ideal consultant unit where there is one known midwife to each woman, where the operating theatres have infinite capacity, the obstetricians are just waiting around and don't have to be called in in the middle of the night, the anaesthetist ins't already attending to another woman etc.

There is a balance of risks - your choice obviously wasn't mine, but it doesn't make another woman's opinion nonsense, and I am glad that NICE is now beginning to realise this. I also note that the chair of the committee which made the recommendations is a professor of complex obstetrics, so must have seen the problems you talk about. Is her opinion nonsense too, because it doesn't agree with yours?

Yes, if your baby needs an emergency crash team, you need them in less time than it takes to travel 7 miles.

But the 'team medics' vs ' team midwives' thing is so rubbish, what a position to put any pregnant woman in, especially someone who has never given birth before and only has the biased opinions of others (and chance) to trust in.

I think women shouldn't be railroaded by the natural birthers into demonising pain relief - it has its place and should be available on demand to anyone that needs it, which isn't the case with home births (and in practice isn't with the average hospital birth either).

But equally they shouldn't be subjected to the brutality of the last-minute admission hospital system with overstretched midwife care, which creates massive stress and increases the likelihood of messing up the body's birthing hormones so that interventions are more likely.

I had a crash team attend immediately on delivery (induced hospital birth) - and it really was immediate.

It's difficult to draw any conclusions about what would have happened if I had had the home birth that I was encouraged to have. The care in early labour on the ward was appalling and the stress might have contributed to the difficulties, the care during the birth was patchy due to being overstretched, but generally very good.

Have those of you who don't like the NICE recommendations bothered to read them? Have you read the Place of Birth Study? Please show me where it says that 'home births must be made compulsory' for low risk women.

Please also tell me how many emergency crash teams are waiting by the side of the road, to deal with the woman who gets turned away because the hospital is heaving and she is deemed not to be in established labour. Or convince me that women never get turned away.

HouseOfBamboo - as an induced hospital birth these recommendations would not cover you because you would no longer be classed as low-risk.

LaVolcan - fwiw I was classed as low risk until going 14 days overdue, no pregnancy complications at all and the midwives I saw during pregnancy were all keen for me to go for a home birth.

And I completely agree re lack of any kind of medical care, let alone a crash team, for the unfortunate women left labouring outside the hospitals who refuse to admit them in early labour, it's shocking.

HouseOfBamboo - for the purposes of the Place of Birth study and the NICE recommendations they would still have excluded your data - because the induction took you out of the low risk category before your labour started, regardless of what sort of pregnancy you had had.

LaVolcan - well, if low-risk mothers never need an immediate crash team then that's fine, obviously.

On the other hand, hospitals are not the ideal place to get your birth hormones functioning correctly, I've always thought it's a bit like trying to have a poo on stage. It's a shame that the system apparently finds it so difficult to provide a calm relaxing start to a birth with pain relief and medical provision also available.

If a low risk woman went into labour spontaneously and then needed a crash team she would then show up as a home birth ending in CS. You would hope that with one to one midwifery it would be picked up before it became a crisis, but I am sure that this doesn't always happen.

By the same token, some high risk women need crash sections - this happened to a friend and sadly having the top consultant's name on her notes didn't save that baby when she had a placental abruption at home.

I see these recommendations as a welcome move to acknowledging that one size doesn't fit all.

Providing one to one care in hospital and domino midwifery would go along way to making hospitals better places. If staff were not over stretched in hospitals then mothers and babies would have better outcomes. There would be less need for crash teams or instrumental deliveries.

However it all costs money.

However it all costs money.

AAAAArrrgggghhhh this never ending fallacy.

Its costing us MORE now because we don't fund the basis in the right area so we end up with the higher costs of clearing up the mess left from poor investment in prevention.

There is the money to do all these things in maternity. There is not the political will to.

Too many people who are protecting their own arses rather than admit the failings they have presided over for years.

Ipity - in the birthplace study 2011 (which forms the main plank of evidence for the new NICE guidance) the best outcomes for low risk mothers and babies (including first timers) was for freestanding MLU's. These have no obstetric staff or facilities. In the study the average transfer distance for these units was 17 miles.

Of course there are sometimes dangers with giving birth way from an obstetric service - some babies will be lost because it. But the overall results are comparative because there are also significant dangers to both mothers and babies that are the result of subjecting mothers to an obstetric model of care.

Can I add, that it's hard when the evidence doesn't support your sincerely held views or your experience, but that's not a good reason to simply disregard it.

Re: humanising obstetric services to make hospital birth less obstructive to the hormonal physiology of labour, yes this must happen. But I think this will be very difficult.

But the overall results are comparative because there are also significant dangers to both mothers and babies that are the result of subjecting mothers to an obstetric model of care.

This is what I think some are having difficulty with - it's hard to get across that a problem arising in an obstetric unit is not necessarily 'just one of those things, and would have happened anyway', however hard people try to argue that it is.

It puts me in mind of the audits which took place into childrens' cardiac care - some hospitals were not up to scratch, and oh boy, (from what I remember), they didn't like to be told that.