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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I pushed for a home birth, so to speak... and the midwife didn't believe me when I said my dd was coming as it was my first time. In fact, she arrived 10 minutes before the birth, with the second midwife joining her (with the gas and air...) half an hour after dd was born. Luckily I had a doula with me to keep an eye out for any red flags, and a calm husband. All went very smoothly and relatively quickly.

All the doctors I met beforehand who found out we were planing a home water birth thought we were absolutely crazy, but it felt like the right choice for us. It's incredibly frustrating that a normal birth is generally not perceived as the norm, but as a dangerous whim, and as pp have said the huge impact of hospital environment & hasty interventions just isn't fully recognised.

Obviously choice is always a good thing, and there needs to be a lot more information given automatically about the real implications of the choices available.

"some babies will be lost because of it".

Oh, so that's alright then.

The issue is this. It's fairly straightforward to point at home births that have ended in tragedy and consider that this may not have been the case had the baby been delivered in hospital.

It is considerably less straightforward to claim that of babies born in hospital, without getting into victim blaming guff about mothers being too anxious or daring to want an epidural.

It is one thing to lose a child when everything that could be done, was done. It is another to lose a child in a situation where they did not have quick enough access to all possible resuscitation equipment. However a small a chance there may be of that occurring, it is still something that many women would not chose to face.

As for me ignoring evidence, you've also ignored my point about ambulance times and the OP's ludicrous claims about women having unassisted births.

It's not alright.

But babies die in hospital from infections picked up in hospital and from difficult births MADE DIFFICULT BY BEING IN HOSPITAL.

Which is why there aren't an excess of deaths in babies born to women labouring in out of hospital settings.

Do you get it?

First time mums giving birth in freestanding MLU's (no obstetric facilities, average transfer distance 17 miles) lose no more babies than first time mums giving birth in hospital. Second time mums lose no more babies than mums giving birth in hospital.

I don't think you seem able to accept that there is no evidence of an excess of deaths in the groups I mentioned above? Why?

And incidentally, none of this factors in the higher rate of stillbirth in pregnancies following c/s - a c/s which is MORE THAN TWICE AS LIKELY if you choose hospital for your birth setting.

Do these statistics include any babies that were born at home and needed help ASAP but ended up disabled because they couldn't get the specialised help in a home birth? Every second counts

Yes they do.

It is disheartening how people refuse to accept the evidence in relation to this issue.

The research shows that the chances of a baby dying or being born disabled is about the same for low risk second time mothers for women who planned a home or a hospital birth. Why is this?

Unplanned non hospital births do happen. My community midwife told me that they were as common as home births in my area. Certainly I would never have reached the hospital with dd.

"some babies will be lost because of it".

Oh, so that's alright then. hmm

So some babies will be lost because of hospital births going wrong, are some of you saying that this is all right? A significant number of women will suffer greater morbidity because of a hospital birth going wrong? That's OK too? That's what you seem to be implying.

I don't know which OP you are referring to when you talk about 'ridiculous claims about unassisted births', but if it was me, I certainly don't think it's ridiculous to talk about women being turned away and then giving birth unassisted in the car park, or parked by the side of the road. That makes me very angry, and makes a mockery of the idea that you must be in hospital because its safer, if they are too busy to let you in.

One serious concern I have about current obstetric practice is that a lot of it is way less evidence based than you might think.

I was amazed by the difference between how the risks were presented to her and the actual percentages.

Its not that current obstetric practice is less evidence based. Its that understanding of the statistics of risk is poor with relative and absolute risk being completely alien concepts to the vast majority of people including doctors.

Doctors have been asked to see if they could explain the risk to see what patients were being told. What's apparent is significantly doctors can't do it accurately than can. BBC article on the problem of understanding statistics in health I know that the NHS were in the process of a massive review into how statistics are presented to patients, but I'm not sure how far along that now is. Its very overdue because its massively affecting care. The worse offender of this being screening programmes which have targets so the emphasis ends up being on deliberately persuading patients.

Even then though, it does come down to a personal preference. There is much evidence to suggest that doctors will recommend one course of treatment which 'is less risky' but then choose a different one for themselves. The difference being that whilst one option is less risky in that it carries less chance of dying, its has poorer quality of life outcomes which the doctors would be unwilling to live with.

I think its hard to understate the idea of having to live with the consequences in the context of childbirth, yet it rarely seems to be mentioned.

I know my decisions were ultimately the right ones for me, because going into it I was at peace with the fact that if anything did go wrong, I was more comfortable with the possible outcomes than if I took an alternate plan and didn't feel like I would be left with a sense of 'if only' should the worst happen.

I think the key thing is to have a choice. And to be award of the risks, so that you have a plan B. I chose a home birth for DD1 but had a backup plan. She was 31 days late so not what would usually be considered low risk. We transferred to hospital after 24 h labour (she was in an awkward position, and we weren't sure she would get out unaided). No drama, we went there by car, the hospital were expecting us, a consultant anaesthetist had been called and was on standby. As it turned out, DD1 made it out without help, shortly after we arrived. Remaining DCs were born at home.

I just think its good that mums have more choice. although when i have said i want a home birth my midwifes have not been very encouraging. its like they dont want to be put out..

i had 3 of my children in hospital, it felt stressful midwifes at my local hospital seem to have a chip on their shoulder theres no empathy, dont talk in a very nice way. its like a chore. just not nice at all. although im sure some people have found them very good. but with all 3 of mine i did not find it very nice at all and ruined whats meant to be special.

I gave birth to my 4th child at home. i was not meant to as it was classed as a risk as i had Anemia. but it all happend to fast. i had no one here with me no midwife or anyone it was the best birth ever. im pregnant with my 5th now and im going for another home birth although hopefully i wont be totally alone this time. But i just felt much more happy and relaxed there were no bad vibes like there were in hospital. just felt very happy in myself it was ace.

I wonder if the trusts would have the human ressources to deal with an increase in demand for home births? There is already a shortage of midwives where I am, so how would they cope? Would they prioritize the requests for home births over the women in hospital, or the other way round? Maybe they would have to... train more midwives?! (gasp!)

Weirdly I always had two midwives with me when I gave birth, was never left alone for one second - but it was never the same two for long, I had 4 different sets in the 20 hours I was in labour. Probably not related to anything, but it just reminded me, lol.

Training midwives isn't the problem - the midwifery schools are full, with no shortage of applicants. For the powers that be, bothering themselves to find the political will to see that these applicants get jobs when they finish is a problem.

Retention is also a problem - some of which is almost certainly caused by staffing ratios cut to the bone and midwives being under too much stress and burning out.

Well at the moment not many places seem to prioritise home births, - it's usually the home birth service which gets suspended first if there is a staffing crisis, and the MLUs which get closed when a round of cuts come. I am too cynical to hold my breathe that this will change quickly.

I have to say, I really think that women choice, or lack of. has been more to do with political will than the recommendations for a long time.

Even when NICE say that ELCS are cost effective and cost should not be used as a reason to refuse one, hospitals are saying they are too expensive. And likewise hospitals repeatedly argue that homebirths are more expensive than hospital birth despite all the evidence to the contrary. And the trouble is the public largely accept this rubbish because of conditioned prejudices against anything that's not a VB in a hospital.

So much depends on where you live. I found it very easy to arrange a homebirth in my area. The year that dd was born my area had a 6% homebirth rate. This website shows a huge variation in the standards and outcomes of care across the UK

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It is interesting ask why homebirth is more common in Hertfordshire than Mersey. Are Liverpool women really at greater risk of complications?

LaVolcan, that's not surprising I guess, and it comes down to the same thing - having more midwives costs money...

so many of issues would be solved if we had more midwives - in terms of birth choices, in terms of how women are treated in hospital during labour, in terms of post-natal care... I get that the NHS is short on money, but surely, surely childbirth should be a priority.

Where i am, the midwives who attend Home births are community midwives (same ones that run clinics at the docs surgery etc)

The delivery suite midwives are a completely different team of people that you don't really ever see unless you go to the delivery suite.

My community midwife (the one who's at my surgery) shares her time between the surgery and the hospital, so maybe different trusts have different policies? (or maybe she does something different at the hospital, I never thought to check!)

The community midwives here run an antenatal clinic at the hospital too so it could well be that! The delivery suite midwives are literally just within the delivery suite (security sealed unit within our hospital)

it says

"Birth in the Delivery Suite - You will be supported by our team of Community Midwives throughout your pregnancy and by our Hospital Midwives for the birth of your child."

There are some great evidence based posts here focusing on the safety side of things and the complications cascade. Which is all well and good.

But there is a factor that isn't much discussed here.

The convenience of home birth.

We had all three at home, and especially for 2 & 3 not having to rush to an overheated, not very comfortable and all rather public hospital is really nice. You are in your own space. And can take your own time.

I think that having ownership of the space makes a great difference with a homebirth. At a homebirth midwives are your guests and they follow your rules. In the hospital the delivery room is the midwives and doctors territory and they are in complete control. I liked having my own food, using my own bathroom, sleeping in my own bed and the privacy of a homebirth.

I don't think even the most anti homebirth person can argue that a homebirth can be a nice enviroment. They just think we homebirthers are all reckless and have a total disregard for the wellbeing of our baby.

I'm a first-time low-risk mother, currently 17 weeks, and I don't want to give birth at home or in a midwife led unit purely because I want to know I'll have easy access to an epidural.

I had several MCs previously, one of which was at nearly 12 weeks and which led to me being admitted via A and E for shock and blood loss. The embryo was stuck in my tightly-closed cervix and I was contracting to push it out. The pain was the worst thing I've ever experienced. I was traumatised, terrified and the only place I felt safe was in hospital, where they could give me hefty drugs and tell me what the hell was going on.

Because of that I will not feel relaxed and safe unless I know I have access to anaesthetic. And I can't have that in a midwife-led unit, or at home. I'm not generally pro or anti home birth or hospital birth, I'm making a personal decision that this time I want to be in hospital. If I have a second child, I may well choose to have a homebirth then. It will depend on the experience of having this one.

I don't think I'll face a fight asking for hospital, but I worry that the new guidelines mean women like me will be judged more. I will basically be choosing to do something that is 'less safe' for my baby.

But womens' experiences of birth matter too. You shouldn't feel you have to try and do without an epidural because opting for a hospital birth where you can have one is selfish. And a lot of this thread reads, to someone like me, like I'm being told that having a hospital birth means I'll be selfishly endangering my baby for a bit of pain relief.

It's up to individual women. Give us all the relevant evidence and we can make our own minds up. After all, once we've all got the information it's no-one's business but our own, right? It's depressing seeing the level of 'us v them' judging in general on MN about women who have epidurals, women who have homebirths, women who have elective caesarians, etc, etc. I couldn't give a fig what anybody chooses, provided they have all the info and it's right for them, and it'd be nice if the feeling was mutual.