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.

www.facebook.com/AIMSUK?hc_location=timeline

I don't think anyone is getting angry, LaVolcan.

There are three issues: women should have a choice (we all agree), that choice should be based on accurate information( all agreed), finally what that accurate information is (different views on this)

Now for first time mums, they are being told that it is as safe to give birth in an MLU as a consultant unit. They aren't being told about a doubling of adverse outcomes and a trend towards increase in perinatal mortality. They are just being told it is as save.

I just think that is morally and ethically unacceptable.

Sorry I said MLU nor freestanding MLUs. Alongside MLUs don't seem to have the same risk.

From what I remember the freestanding MLUs came out as the safest options for first time low risk mothers. Alongside MLUs were not quite as safe as them. For a substantial number of women it's an irrelevance anyway, because there isn't one nearby.

How many women are given a true evaluation of the risks of a CLU? Conversations seem to revolve around how wonderful they would be if some problem arose, and not that the basic care might actually be quite poor.

Yes, I agree that basic care in CLUs is sometimes awful, LaVolcan, but surely the right thing to do is improve it because that is where a lot of women want to give birth.

Freestanding MLUs look to be the least safe option for first time mums after home birth - but there again, the risks aren't huge so women should be perfectly entitled to choose them if they wish - providing they know the risk. What is morally wrong is telling first time mums that Free standing MLUs are as safe as CLU - the evidence points the other way. For subsequent babies there didn't seem to be any difference amongst low risk women though - it is only first time mums.

Isn't it just as morally wrong to paint a rosy picture of CLUs though? Isn't it as wrong to pretend that iatrogenic problems never arise?

I would agree if that were the case, LaVolcan, but I think NICE is making it very clear that CLUs have higher instrumental and emergency c/s.

I don't think anyone would paint a rosy picture of many CLUs - there are too few midwives and they are overstretched, but that is partly because very many women choose to give birth in a CLU even when they have other place of birth options.

So yes, iatrogenic problems possibly do exist in CLUs but isn't the logical answer to change practice in CLUs so that women who choose CLU do not have to put up with substandard treatment?

To your last sentence - absolutely.

As for choice - this very much depends where you live: we don't all live in London.

I think that many women believe that a birth in a consultant led unit will be more comfortable as there is access to an epidural or petidene.

I find it terrible that women are fobbed off from having an epidural.

You can have pethidine at home or an MLU, unless the rules have been changed, and not everyone wants an epidural. But I agree, women who do should not be fobbed off - realistic information should be given as to how long you are likely to have to wait.

One of the problems there, IMO, is because you are highly unlikely to have met the person who will attend you. So, the woman whose birth plan says 'epidural' needs to have a midwife who is of the belief that there are no prizes for saying no to pain relief. The woman who wants to see how far she can get on her own, needs a midwife who is of the same persuasion. The mismatch suits no one. Then of course, there need to be sufficient anaesthetists.

In my area you are not allowed petidene at a home birth as the risks to the baby are far too high. i have no idea if petidene is allowed in MLU.

There is a risk of a baby being born flat (ie needing resuscitation) with petidene. I think the petidene should not be allowed in a home birth situation.

full range offered full range would surely include right to ELC?

It was the best birth I had, the most relaxing for me, as far as both ways go and it was a brilliant way to have a baby.

with most costs of maternity wards going to pay outs for damaged babies and mothers from CB. offering more ELC would help ease those costs...

I find it terrible that women are fobbed off from having an epidural.

Fobbed off from all pain relief that will help, including an ELC...

We are supposed to want and idolise this spreading of legs, humming by stone henge and easing baby out with chanting and candles.

Nice already supports elective c-section on maternal request. Unfortunately many trusts ignore this.

I feel it's important support people in choices which personally I would not make.

There are a lot of hidden costs with vaginal birth. The cost of a c-section is not that much extra.

www.nice.org.uk/guidance/cg132/resources/nice-publishes-updated-guidelines-on-caesarean-section

I suppose that having too seek "mental health support" is a bit of nuisance for a woman who simply wants an elective c section for no clear medical reason. Extreme fear of childbirth is quite rational and not just a phobia for some women. Being very scared can be mentally healthy in some circumstances.

Make what you like of my post as I am a homebirth advocate for low risk women.

What this to me highlights is the need to listen to the woman; to ask her what she feels most reassured by.

I am not convinced that C sections are hard to come by though. The CS rate is between 25%-33%, with probably about half of these being elective. The home birth rate is something like 2.5% with one or two areas as high as 10%. MLU's - something like 10%, I believe, but many areas don't have one.

I have no idea whether these reflect the woman's true wish about the place of birth (or style of birth e.g. assurance that waterbirth will be available), or whether they are a reflection of what is on offer.