Please can you tell me why you are going to have / have had a home birth?

[CranberryMartini]

Because I just don't get it!

DS would most probably have died if I'd have had him at home. His heart rate dropped rapidly and needed a ventouse delivery with a resuscitator (sp) on standby. It was scary but I felt surprisingly calm with all the doctors and midwives around.

Why are you prepared to take any risk with your baby's birth? I can vaguely understand a home birth if it's not your first child and you know what to expect, but your first child?

I've also heard (could be wrong) that it costs the NHS £3000 to fund a midwife to do a home birth.

And doesn't it make a huge amount of mess?

Sorry I really don't want to offend anyone with this post and I would like to hear your reasons for choosing a homebirth. Try to persuade me to have my second at home!

"I've tried really hard to think of reasons why homebirth is better for the baby rather than the mother (and I don't always think the two go hand in glove). "

Let me help:
Mother less likely to have pethidine or epidural - both of which have side effects for babies

Babies statistically less likely to have low apgar score at birth or be admitted to scbu than babies born to low riks mums in hospital

Mother more likely to succeed with breastfeeding - as well all know there are many, many benefits of breastfeeding, including lower rates of hospital admission for breastfed babies.

As for the risks of things suddenly going wrong - well it's true that if things do suddenly go wrong at home you're going to be disadvantaged by not having access to paediatric care. There's no denying it and women who opt for homebirth need to understand this. However - you have to assume that this is balanced out by the lower risk of things going wrong in the first place. It simply must be the case, otherwise logically you'd see higher mortality and morbidity rates for mothers and babies birthing at home, when in fact you don't.

I think it's fair enough to warn women who opt for homebirth of the risks associated with birthing out of hospital. But I think that women who choose to birth IN hospital should be warned that THEY stand nearly double the chance of ending up on an operating table and their baby is more likely to end up in SCBU than if they birth at home.

Sabire & other pro-homebirthers
I am very pro homebirth but I have a question -
are all these statistics this way because the people who are interested in homebirth are generally the ones who would be likely to try to breastfeed anyway (therefore the stats are squiffy) and - the people who opt for a homebirth tend to have children with higher initial apgar scores because the only ones who actually give birth at home are the ones who were pretty much going to have those apgar scores anyway (if you know what I mean)

I am not articulating it very well but I know that there used to be stats about volvos being the safest car and it was as much the case that people who drive safely by volvo's thus perpetuating the "volvo's are safe cars" feeling.

I think the study about the group of midwives who have managed to get 40% of mums to give birth at home it really interesting - I would love to see their breastfeeding rates and stuff (as this would probably disprove my waffle)

What do you think?

JingleyJen - I'm not an expert, but I had a homebirth.

Intuitively I'd guess that to a certain extent you're right - although without knowing where the stats come from it's difficult to say (the National Birthday Trust study tried to get away from that by comparing women birthing at home with women of equivalent risk birthing in hospital and that's where a lot of the stats come from, but they recognised that you can't remove all the bias).

One way I could see to answer it to look at what happens to those low-risk women that want to birth at home but, due to non-medical obsticals put in their path, can't. It'd be very interesting to know the statistics on those - are the AGPAR's and BF rates more similar to those of babies birthed at home or those birthed in hospital (by women that wanted or needed to birth in hospital)?

Jen - I know what you're getting at and it's an interesting point.

However, imo this is what makes the work of practices like Albany, Torbay etc so positive. The demographic of women who give birth with the Albany is quite different from the 'usual' homebirth demographic - there is far less in the way of your white, middle-class, professional bias. They are not that self-selecting group of women who would be 'more likely' to have a homebirth or breastfeed if the service wasn't available. And yet their outcomes are still excellent.

The bedrock of this is continuity of carer, which a practice like the Albany is able to provide - in spades. It is SO important. What does for so many women in the NHS wrt things like breastfeeding is lack of continuous support and badly-fragmented care. Think of the number of threads that MN gets every week saying things like 'well, my HV told me X and my dr told me Y and a mw told me J and then another mw told me Z' - it's crazy! You have your booking appt with one mw, you see another (or perhaps two, or three, or four) for you antenatal appts, you see another for your classes, you get another at delivery (or two, or three or four!) another when you get to the PN ward, another the next day, and then a variety of mws when you get home. What hope do you have if you're struggling? It barely matters then how educated or healthy or well-informed you are - you're knackered and floundering in a system which simply isn't geared up to help you.

Right, am waffling and ranting now and I really need to get to work. I probably haven't answered your question at all! Breastfeeding rates for the Albany are on that page if you scroll down a bit - they're a bit out-of-date now but from what I know from colleagues who work with them they're still relevant.

This might be a good point to just flag up One Mother One Midwife...

Women who birth at home use far less pain relief than women birthing in hospital - and I reckon it's that more than anything else that impacts on breastfeeding rates. I also think that not having HCA and overworked, underskilled agency midwives around hurling bottles of formula at you if your baby hasn't breastfed within a few hours of birth might have some bearing on it!

Re: apgar scores - I think this is related to the fact that women who birth at home have real freedom of movement during labour and this has GOT to be better for babies. At our local hospital they're still sometimes using EFM on low risk mums having normal labours (it's not protocol but it's still happening) and the majority of women give birth sitting on their ares or lying flat on thier backs. I was at an MSLC meeting recently when a midwife did a presentation on the experiences of mothers birthing in the CLU. Of the 100 women she questioned the over 50% had given birth in a supported sitting position. 15% gave birth lying flat on their backs and 19% gave birth in the lithotomy position even though the assisted delivery rate at this hospital is only 10%* Go figure!

How can that be good for babies or good for mothers?!

so let me in on the jargon sabire

Whoops -
HCA: health care assistant
MSLC: maternity services liaison committee
CLU: consultant led unit
EFM: electronic fetal monitoring (should have said CEFM - continuous electronic fetal monitoring)
lithotomy: legs in stirrups.

what!!!
19% gave birth with legs in stirrups!! that is appauling!

the birthing classes that Dh & I had were through an organisation called birthlight and they were brilliant - not judgemental about the rights or wrongs just clear explanation of the cascade of intervention and stuff.

The one phrase our teacher wanted us to have the courage to use was "what are the consequences of us NOT doing that "

so faced with - you need continuous monitoring or lying flat on a bed - or being induced etc to use that phrase - it is non confrontational and allows the person to say - your baby is in real troub;e you have to listen to us - but also allows you to make a judgement call if the situation is not about the immediate health of your baby (or yourself)

thanks for decoding!

Surely the reason why a homebirth can be better for the baby is that it can lead to a more uncomplicated, quicker and calmer delivery? This is surely a great positive for the baby as the baby will not get as stressed and tired as it can during a long labour that is traumatic for the mother. What's traumatic for the mum is traumatic for the baby, both at the time and afterwards when the baby could be bonding with its mother and enjoying/exploring its first few minutes of life instead of being taken away to be checked over or helped.

What I can't understand is why women with a history of quick births brave the traffic trying to get to hospital and risk having the baby in the layby or the lift in the hospital.

What a fascinating thread. I've read it with great interest, especially as I'm due today, an have a hb planned for no3. I had dd in hospital, and although the experience was ok, it certainly wasn't great. the mw who delivered my dd was nice, but I didn't see her again after the birth, I felt pushed into having pethadine (although had a bath, and by the time I came out was told "too late" ) and ended up delivering on my back thanks to monitoring (un-necessary?). Plus having to go to and from hosp when in labour and living half an hour away wasn't exactly great!!

DS was born in a pool at home, under the care of a lovely independent mw. DD went next door while i delivered (she was 20 months at the time) and I had mum, dad, and DH there. the whole experience was much more relaxed, and I felt much happier throughout. Mw (bless her) told me afterwards that she'd had G&A in her car had i really needed it!!!!

Now awaiting the arrival of no3, booked for a home birth. Live in different area of country now, but so far have had nothing but positives from the mws who all seem very pro hb. I thank my lucky stars nothing has gone wrong for me (or baby) either time so far. For me hb was a much more positive experience than hosp, and although it doesn't suit everyone, for me it was the right choice, and I hope will be this time round too.

All women should have the choice as to whether or not they have a hb. It's very sad that not all women do.