Home birth question

[Hikoridikori]

I just have a home birth question...

How can it be that some people opt for a home birth so that they can have a calm/natural birth despite all the risks?

I mean that the baby could be in an undiagnosed breech position, the heart rate may drop and a doctor may be needed, the mum may have blood pressure issues, excessive bleeding can follow after a bad tear that needs transfusion, the baby may need to go straight to NICU because of breathing or other issues etc.

All these mums that go for a home birth how can they not be scared about something not going by the book?

In my mind a medical sterilised environment is less scary than how scary are all the risks I mentioned above.

Please don't get me wrong, I fully respect different opinions. I just want to understand the logic behind this decision.

I’d say it’s the opposite: that women who don’t want intervention are frightened into going into hospital (it is regarded as ‘neglect’ by social services’)
What was the result of the inquiry into the baby deaths?

That women were denied intervention due to over emphasis by midwives on a “natural” birth, without intervention, when that was unsafe. The hospital had quotas for intervention and decisions were not based on medical need. Therefore what women might want, and what midwives told them they should have a natural birth), led to baby deaths. Even when mums pleaded for intervention, they didn’t get it. It’s now the policy of the RCM that the best interests of the mother and baby are the only consideration. Not a “natural” birth doctrine that might be unsafe. They had promoted this for a long time and said they know they have members who won’t move from that position. The RCM says it doesn’t mean women cannot express a choice about what they would like but they shouldn’t be pushed into a “natural” birth due to dogma or quotas. Hence the RCM has changed its position to strengthen their policy of safety above all else. It was all in the newspapers last week.

@Hikoridikori

Very interesting views!

I had a completely opposite experience with my first as I had to be induced for medical reasons and then I was monitored all the time (baby and contractions) and the midwife never left my room.

Despite all this, the emergency button was used and a doctor was needed to deliver the baby safely which was scary… If I were at home, even with a 10min drive with an ambulance it would have been too late. I remember the doctor was saying that had 5min to bring baby out…

Maybe it’s my experience that gives me this scary view about home births.

Now I am expecting DC2 and I can’t even consider a birth center because it’s not at the same town as the hospital, it’s a 15min drive.

I would rather be in a hospital!

For me the more instruments and people I see around, the safer I feel as I haven’t experienced birth as a natural thing but as a medical thing…

Very interesting views though, thanks for sharing!

I had a similar scary birth where the emergency buzzer was used to call the team and dd1 was born via assistance and I had several episiotomies without anaesthesia to get her out in time as she was stuck (shoulder dystocia)

Same dd twenty years later had a home birth and a similar presentation of baby- shoulder dystocia. I was absolutely certain (and petrified) both she and baby would die. Instead- the midwives got her out of the birthing pool and manually manoeuvred baby with their hands (whilst baby was still up there and stuck) and delivered her.
Dd had no pain relief and required no stitches. She was blessed to have two very skilled and experienced midwives present.

What I meant to say was her management in a homebirth situation meant she was an active participant in the process and fully trusted her midwives and her body. In mine the same scenario meant I was seen as a medical emergency requiring intervention-
We had the same result- a breathing and live baby- but I was far more damaged in the process.
Which birth was “safer”?

I had shoulder dystocia with my home birth. I noticed the midwives exchanging glances over the top of my head but nobody panicked and he was out in seconds. It wasn't a problem.

@LowlyTheWorm
Both were safe for the baby. Two midwives at home is wonderful I’m sure. They can also attend to you in hospital and have a doctor present. It still doesn’t alter the fact that “natural” births are not always safe and not all midwives are experts. There are some that are good enough - like most professions. We still have fairly high birthing death rates in this country. So if women are not given the best advice or care, babies die. It’s better to have intervention than death in my view.

You sound very judgy OP. If home is not where you want to give birth then fine. If you're genuinely curious speak to a local home birth midwife, do some research and read some books about home birth.

@lakeswimmer

I had shoulder dystocia with my home birth. I noticed the midwives exchanging glances over the top of my head but nobody panicked and he was out in seconds. It wasn't a problem.

I'm really glad your SD birth went smoothly. Your lucky.

I also had a SD birth. My child wasn't out in seconds and if we'd have been at home she'd likely have died or at least had severe brain damage from lack of oxygen.

It was violent. It took instruments, cutting (thank god I'd already had an epidural and was already in theatre) manoeuvres, and ended with the obstetrician having to reach in, unstick baby by hand and drag her out. I then almost bled to death, no exaggeration, I needed transfusions and lost consciousness from quick and extreme blood loss.

Shoulder dystocia is an obstetric emergency situation and not 'not a big deal' in a home birth scenario. It can literally be life and death/serious serious injury. It's certainly not something I'd want to be dealing with outside of a hospital environment. It's also unpredictable- I had zero risk factors for SD and was on paper an ideal candidate for HB.

knew I'd get more focussed attention from a midwife at home

I read this quite a lot on these threads and I don’t quite understand it; I had two at a time for the entirety of my labour. They stayed with me literally the whole time, held my hand, even after their shift ended and coming in the next day straight over to see me in post natal ward.

How would that experience have been better at home from a midwife perspective? I appreciate I only have experience of one hospital on two occasions that’s why I’m asking I suppose.. what’s it like elsewhere? Is it not like I described?

@Londondreams1

Local maternity clinic by me puts electronic tags on the babies... that’ll be a firm no from me. Can’t imagine being in such a “prison” type environment. Yes I understand there’s the odd risk of... babies getting snatched I suppose, but on the ball staff and the layout of the department should surely be able to deal with that (a door with a code , given to the mothers should suffice, surely?!!)

Sounds like the hospital I trained at many years ago!! Thing is, the layout of the ward was absolutely ridiculous- staff couldn't actually effectively monitor comings and going's. Definitely designed by people with no clinical experience. Like, the nurses desk was aaaall the way at the end of the ward as far away from the door as it's possible to be, with no line of sight. And we were running around like blue arsed flies the whole time. With the best will in the world we weren't able to be particularly "on the ball" with who was entering/exiting b

You can’t do the same birth twice.

Some births will benefit from being in hospital. Some births will benefit from being at home. You cannot prove which was which, and you cannot know in advance.

That’s why the large place of birth studies are so useful.

We all know and acknowledge that there are some obstetric emergencies that have a higher chance of bad outcome if not dealt with immediately either in a hospital or by experienced staff and extensive equipment on hand. Even on this thread of only three pages we seemingly have several mother and child pairings who would have died if they were at home, but this frequency thankfully is not borne out by data.

In order to mitigate the extra risks of being at home or further from direct surgical intervention, the hospital environment must come with risks of its own. Risks that are not inherent to childbirth, but purely risks that come from the hospital environment itself and the way that it manages women in labour. We do not and can not know if a complication was caused or exacerbated by the fundamental place of birth. We cannot measure the impact of taking a labouring woman out of a familiar place, strapping her into a car which does not allow her to move, taking her out in a public place, brightly lit, and asking her to lie down and submit to intimate examinations of a sensitive area by a stranger. Even if a woman has no other interventions past that point, even if all is well and smooth, leaving the home is the first intervention, and it is reasonable, given what we know of mammal behaviour, to assume it has an impact. This is one example, just one, there are many more, of a different set of risks. Different. Not better. Not worse. Just different.

Women should be where they feel safe. But you also cannot compare a naturally progressing labour to one that has been subjected to deeply unnatural scrutiny, as with the cats behind the bath. The labour is unlikely to go as well if you drag her out from behind the bath, even if you do nothing more.

I chose a homebirth for my 3rd because I had two totally case book births in a midwife led unit. Also my labour's stopped when I arrived a the hospital with my second and i didn't want to have to worry about childcare.

DS was 10lb 4... he got stuck, also SD.. but the midwives took control it was all OK thankfully. I know it could have gone a very different direction and I think if I were to have a 4th I would have to be absolutely postive there wasn't another giant child in there before having another homebirth.

OP there are risks with anything in life. The NHS' own data show that home births (and even just planning a home birth even with a transfer) have better outcomes for low risk women. This is why the NHS:

1. support women who want to home birth and
2. have spent huge sums of money building home from home mw led units absolutely everywhere.

In my mind a medical sterilised environment is less scary than how scary are all the risks I mentioned above.

On this point, hospitals are NOT sterile environments. They are not risk free environments. There are big problems with hospital acquired infections - have you heard of MRSA and cdif? You're unlikely to catch them at home, they are nosocomial ie hospital acquired. Did you know that in the first wave 60% covid cases were caught in hospital? Did you hear of the inquest into the maternal deaths of women who caught herpes virus from their surgeon at c section?

There are many many reasons why a woman might choose to home birth. A quick independent look into the subject will provide these answers.

MN seems to have a huge problem with home birth posts. It seems whenever anyone asks about home births immediately lots of ill informed posters jump on to be as judgemental and scaremongery as possible. This does NOT happen with conservations on the subject IRL or other forums. I suggest genuinely interested people go and seek information elsewhere but MN does not seem to be the place for it. Pregnant women, all women should be treated with care and respect when it comes to their choices - this doesn't seem to be happening here. Are women who choose elective c sections immediately jumped on and criticised for their choices on here? I hope not and I suspect not.

@Londondreams1

Local maternity clinic by me puts electronic tags on the babies... that’ll be a firm no from me. Can’t imagine being in such a “prison” type environment. Yes I understand there’s the odd risk of... babies getting snatched I suppose, but on the ball staff and the layout of the department should surely be able to deal with that (a door with a code , given to the mothers should suffice, surely?!!)

A definite plus - no one will be able to steal your baby if it's born at home. 😬

@TizerorFizz

Can the NHS really afford midwives delivering babies at home now? Choice is expensive. As usual lots of sneering at Caesarian’s and other interventions. Home births can be risky. You cannot always have what you want. I felt truly lucky to have an epidural. Not available at home I think. Home births are only available to the “natural” birth converts. I wasn’t one.

Firstly home births are cheapest for the NHS, not that I've ever met a mw or dr (I know lots professionally through work) who has ever been concerned about a women's birth choice costing the NHS too much money.... tbh it's a bit of a weird argument to being up. Did anyone criticise you for having a costly epidural? I think not. We should all capitulate to the cheapest option now should we? 🤯

Secondly epidurals come with absolutely loads of risks including convulsion and death
www.nhs.uk/conditions/epidural/side-effects/ these risks will have been explained to you and you've consented to them. That's fine, you wanted an epidural and were given one.

I interpret risk differently. I look at this and think I would like to avoid an epidural if possible to reduce my risk of complications.

Your choice is valid and should be respected and so should mine. Your assessment of home birth risk is not based on evidence. It's based on your bias. I suspect you will not allow yourself to hear information on the birth risks that doesn't conform to or reinforce your view, which is a shame, but very common on MN.

Theoretically I could have had a home birth but I never would. I don't understand women who say they're more relaxed at home. I'd be an anxious mess if I was giving birth at home. Knowing me I'd also stress myself out if there were any chores which needed doing!

OP, many women feel that birth is a primordial thing that women can do best in an environment that makes them feel most in control. Instinctively I felt that I could work with my body with most calm and relaxation in my own home, in a pool. I felt that a hospital environment would make me feel interfered with and disempowered.

I wasn’t daft: attended all midwife appointments, made sure that there were no symptoms of any risks, and also we live close to a great hospital.

The logic is that women DO Labour best when relaxed and confident. And some people find that that is at home, others in hospital.

I am baffled by the number of women on OBEM who deliver lying on their backs. Every home birther I know was upright, leaning on the back of the sofa or headboard, leaning on the side of the pool or whatever, or on all fours. That’s anecdotal obviously, but it seems to me to signal a difference.

My first two were born in a MLU attached to the hospital. I have birth both times leaning over the headboard of the bed, and I used that position for my homebirth too.

Gave birth, not have birth, bah.

@coffeeiwish
So you have immediately said my choice was not sensible. You have data to back up what you think. You clearly think I made the wrong decision based on your data.

This is the whole problem. Women, and the RCM, have constantly said have a “natural” birth because if you don’t, you are risking too much. It’s browbeating and most women are absolutely fine. And yes, you and the NCT criticised me for wanting/having an epidural. Because my weighing up of risks and keeping calm lead me to a different conclusion. It’s clear from their new policy, the RCM itself did not support choice. It supported the choice of “natural” birth and intervention was not explained fairly by midwives. Instead they criticised their choices. It’s continued propaganda and doesn’t take all circumstances into account. The RCM is seeking to change and everyone else should change too.

Home births are self selecting. Of course they prefer it. I was already second class by being not allowed to have a home birth. Instead, it would be better to make a hospital delivery as good as possible. I had absolutely no complaints but how many midwives are needed to deliver huge numbers of vs use at home? Economies of scale must play a part in this.

No @TizerorFizz what I said was we have interpreted risk differently and all women should be supported in their birth choices without judgement (especially from random internet folk).

Your supposition about the costs of home birth are based on an entirely false premise. But again you think NHS money is absolutely fine when it's funding your birth choices but not mine?

I was very lucky to get what I asked for. I was also a bit old. So whatever happened I would not be cheap. I would advise anyone to pay privately if they can.

@PiesNotGuys

Your point about going to hospital being an intervention in itself is a good one. I had both my babies at home, and even then, in a totally comfortable, private, low-light etc environment with very discreet, low-key midwifery, my labours stopped completely once the midwives arrived and only started again once I got comfortable with their presence in my house and also went off to hide by myself until the contractions kicked in again, at which point I was ok going back into a room where they were. I strongly suspect that a hospital birth for me would involve failure to progress leading to emergency interventions for a distressed baby, rather than the very straightforward homebirths I had.