I gave birth in my bathroom so why...

[foxytocin]

good one

I had ds1 in hosp and ds2 at home, both fantastic births (I was lucky our hosp is great and I got a 6 hr discharge) I think a lot of people still find idea of hb v scarey, I get loads of 'you were very brave' comments which is ok, I know it doesn't suit everyone, I was very definite that I wanted ds1 in hosp but I think there can be a half way house, why are birthing centres so few and far between? and why can't the hosp enviroment be set up more like home? a comfy sofa for dh to relax on and me to have knelt up against would have been great as it was my best birthing aid when at home - part of birthing at home is being in your own comfortable familiar environment, if high risk women need to be in hosp can we not give them a lovely relaxing birthing room rather than hosp bed??

I've had two homebirths, both very positive experiences, so much so my antinatal group talk about my "dream" labour! Not exactly pain free (!) but it was lovely to be at home and felt very safe. Both times I had 3 midwives attending at the end (student first time, and experienced midwife needing a refresher in home water birth second). For second birth the midwives had 90 years experience between them. I don't think you'd get that in a hospital! Obviously, you have to go wherever you feel safe and confident - for many women it's in a hospital, but for me it was in my own home. And it is bliss afterwards to shower in your own bathroom, and get into your own bed . . .

"we have evolved to be able to give birth naturally and have the means and reserves to do so if we trust our bodies and minds"

No. We have evolved very large brains which do not facilitate the birth of the baby through a pelvic outlet restricted by our upright posture.

Thousands of women in the 3rd world have obstructed labours, die or suffer appalling outcomes such as vesicovaginal fistulae.

Yes, for many people childbirth is a natural process which is facilitated by being in their home environment. For the not-so-small-minority, however this is simply not the case.

(rant over)

Personally (and this is just what I am comfortable with) I am quite happy to deliver in hospital. It doesn't stress me out (I know that this is not most people's feelings), so I don't mind being there. I would also like a birthing centre attached to a hospital.
And oh, if only I could be magicked home about an hour after delivery...

our pelvis has been erm, compromised by bipedalism etc,

however

we have adapted to this restriction by having a malleable skull at childbirth and giving birth to the most underdeveloped of infant primates.

the large frontal lobe does the great majority of its development o/s the womb.

poor outcomes in lesser developed countries are more to do with:

poor/no antenatal care,

poverty related social and nutritional conditions long before pregnancy and

poorly trained hospital techniques in ill equipped hospitals that are trying to mimic the procedures of the more developed world without the same access of a budget, etc .

access to a midwife or traditional birth attendant in the pregnancies and labours that are not straightforward.

and less with:
the shape of the female pelvis

access to one to one care with a midwife as in the UK, or in lesser developed regions of the world, a traditional birth attendant

Agree with you foxy. It's stupid to compare us with women birthing in developing countries who are labouring hours away from poorly equipped hospitals, with untrained birth attendants, women who've had no antenatal care, who have low hb because of parasites, who have malaria, rickets, who've had infibulation, or who are having their baby in early adolescence.

I think people forget that in the 1960's we had a 5% c-section rate in this country and yet we didn't have tens of thousands of women dying from obstructed labour. And that's with the very poor birthing practices they had in those days - routine induction at term, routine supine positions for birth, lack of support in labour etc.

"No. We have evolved very large brains which do not facilitate the birth of the baby through a pelvic outlet restricted by our upright posture."

Doesn't this rather miss the point of Darwinism? If it didn't work, we wouldn't be upright - at least that would be my understanding of evolutionary pressure.

That isn't to say its not a compromise, but as gaby points out the C-section rate has risen hugely without (AFAIK) a resultant decrease in mortality for mother or baby in the last 3 decades. I'm not arguing that we should not intervene or that well-timed C-sections don't save lives in cases where there is obstruction. This does happen naturally but not in as many cases as our c-section rate might have us believe (IMHO of course).

Interestingly an article about obstruction during pregnancy in developing countries concludes that much of it could be avoided by better childhood nutrition, as it is malnourished young girls who's pelvises do not develop fully who are more prone to later problems in childbirth.

bmb.oxfordjournals.org/cgi/content/full/67/1/191

[Incidentally increasing C-sections in developing countries are now being seen as a direct cause in increases in fetal and maternal death according to The Lancet 2006.

Pregnancy & Childbirth | Number of C-Sections in Developing Countries Increasing, Linked To Higher Risk of Death, Health Complications, Study Says
[May 24, 2006]

In the 1960s though we had a very high rate of instrumental births, didn't we? I would imagine that there were therefore a lot of women who were damaged by poorly managed instrumental deliveries. I am very biased as DD1's delivery was an instrumental that was done despite indications that I was not a good candidate and I am still having problems due to it 2 years on. Considering that in those days women were even less likely to complain or even talk about it, it wouldn't surprise me if there are a lot of women who had problems and just put up and shut up.

By the way, re: evolution - giving birth doesn't have to work well - as long as there is an advantage to standing upright, and enough women and babies survive birth to maintain the population, then that is enough.

I was born at home in the mid 1973 I was a second child who arrived quickly in a very rural area.

The only night I have EVER spent in hospital was the night after I gave birth to dd, I don't plan to repeat the 'experience' especially the bit where DH was sent home an hour after dd arrived as I didn't give birth during visiting hours and the midwife put her first nappy on backwards! love the attention to detail!

Sausage on a sausage machine was the overriding experience.

Agree with MrsTittlemouse -as long as there is an overall advantage to being upright with a big brain, then this will more than compensate for difficulties in childbirth.

I agree there are lots of other factors in the 3rd world. I was just trying to disagree with the idea that our bodies are designed to deliver babies, if we just have confidence in our ability to do so.

I don't think hospitals are nice, or safer for the majority of people. But some mothers and particularly some babies need them. And it isn't possible to know beforehand who will (although some people are clearly higher risk than others).
So you have to make your own choice, depending on the things like your feelings about being in the home environment etc.

and agree completely re: c-section rate being unnecessarily high - this is particularly true in some 2nd world countries, where it is increasing for reasons related more to health economics than appropriate medical care.

"But some mothers and particularly some babies need them. And it isn't possible to know beforehand who will (although some people are clearly higher risk than others)."

It is true that some low risk women will have life-threatening experiences in childbirth needing hospital care that couldn't have been anticipated, However, logic dicatates that this must be compensated for by the decreased incidence of infection and the decreased levels of unnecessary intervention in hospitals that put babies at increased risk. If this wasn't the case then you'd expect to see significantly higher rates of maternal and infant mortality associated with planned homebirth in the West. As it is the rates are comparable when you compare hospital and home birth.

What midwives can say to mums is that statistically - being at home does not put you at greater risk of losing your baby, but it does put you at a much lower risk of ending up in an operating theatre.

childbirth will never be without risk, regardless of where the birth takes place

but on balance, IMO, if a woman is healthy, well nourished, has had good ante natal care, is low risk, that her birth should be straightforward

not every situation can be anticipated of course, but often there is some warning that things are not going well.

catastrophic outcomes can and do happen in hospital.

for many women, labouring in hospital leads to a less preferable outcome, you are at the mercy of hospital policies, whihc are hard to fight in labour, there is the well known 'cascade of intervention' that can lead to more medicalised and complicated births. simply lying on a bed can make your labour take a different course to being upright or mobile.

I thought that if a woman had planned a homebirth and had a skilled midwife with her giving 1:1 care, statistically the outcome was actually supposed to be better than a hospital birth?

I will dig around and see if there is any hard data to support this.

If you count all home births this isn't very helpful scientifically - you need to strip out the emergency-by-accident-no-midwife-for-miles ones to get accurate figures.

I haven't found raw data but there seem to be two fairly recent key documents that support home birth. Perinatal mortality rates appear to be similar but is less risk of intervention to achieve this.

---

Source: British Medical Journal 2005; 330: 1416-22

The largest prospective study of planned home births to date evaluates the safety of such births supported by direct entry midwives.

Among low-risk women, home births assisted by certified midwives achieve similar rates of intrapartum and neonatal mortality as hospital births, with lower rates of medical intervention, reveal Canadian researchers.

"Despite a wealth of evidence supporting planned home birth as a safe option for women with low risk pregnancies, the setting remains controversial in most high resource settings," note Kenneth Johnson (Public Health Agency of Canada) and Betty-Anne Daviss (International Federation of Gynecology and Obstetrics, Ottawa).

To examine its safety further, the team compared perinatal outcomes for all planned home births (n = 5418) supported by the North American Registry of Midwives in 2000, with those previously reported for low-risk hospital births in the USA.

Overall, 12.1 percent of women were transferred to hospital for delivery. The incidence of neonatal mortality among those who remained at home was similar to that documented for low-risk hospital births, with no maternal deaths. Medical intervention, however, was substantially less common among home, versus hospital, births, with epidural, episiotomy, forceps, vacuum extraction, and cesarean section rates of 4.7 percent, 2.1 percent, 1.9 percent, 0.6 percent, and 3.7 percent, respectively.

"Our study of certified professional midwives suggests that they achieve good outcomes among low-risk women without routine use of expensive hospital interventions," conclude Johnson and Daviss.

---

Here's an excerpt from the British Joint statement No. 2, April, 2007 on Home Births. I found it cited on the internet but haven't cross-checked it. I have no reason to believe it's untrue, however.

"The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman's likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby."

---

If the assessment process for suitability for home birth is any good, you would hope that all interventions are uncommon - this is a selected group of low risk mothers who should have good outcomes.
There is some evidence that if an urgent need to transfer does (clearly rarely) arise then baby outcomes are worse.

Home birth is clearly much better than hospital if you don't need hospital.

Mothers should be given all the information, including the RCM/RCOG statement, (the full document is entirely supportive of home birth), and then they can make choices that are right for them.

it is, I think, personal. My own personal assessment of the risks and benefits of home and hospital births isn't going to be the same as someone who dislikes hospitals and feels uncomfortable as soon as they enter one because those feelings will affect their labour adversely.

I have had one hospital birth and two home births - both in the bathroom. Also thought it would be in softly lit bedroom - it was all ready but sat in bath for home birth number 1 and couldn't go anywhere else when I was hauled out so gave birth standing up hanging onto towel rail. Home birth 2 was quick and waters broke neatly into the loo and I realised DD2's head was crowning - so she arrived two minutes after the midwives did - I was on all fours. Loved my home births - but who knows how I'd have felt if something had gone wrong? Still - I would have a fourth at home if possible - and if we have a fourth at all!

But the report says that interventions are indeed less common, surely suggesting a better outcome in the majority of cases, and interestingly enough, implying that efficient transfer systems are in place. There is no evidence that outcomes are necessarily worse if there is a transfer.

However you are right about it being a personal choice. That's very important.

Funnily enough, I actually liked going to hospital to give birth. I felt that I was going into a safe place, not in statistical terms of birth outcome, but in the sense that I was sheltered from the outside world.

• The only purpose of the place was to give birth
• I was away from all my other responsibilites - most importantly I was away from DD1 as I switched into Mum-mode whenever she was around and my contractions stopped!
• no-one was allowed into the room without my consent, it was very secure - rather than friends or family dropping by or phoning up

I know that I would have felt differently if I had been in a regular labour ward, but I loved the midwife led birthing centre.

"If the assessment process for suitability for home birth is any good, you would hope that all interventions are uncommon - this is a selected group of low risk mothers who should have good outcomes"

But the operative/instrumental rates are much lower for homebirth mums EVEN WHEN YOU COMPARE THEM TO SIMILAR LOW RISK MOTHERS IN HOSPITAL.

"There is no evidence that outcomes are necessarily worse if there is a transfer"

Actually there was some recent research (widely reported) suggesting worse outcomes for babies transferred from homebirths. Unfortunately the study didn't differentiate between those who'd laboured at home and those who'd transferred long before labour started, so was a bit pointless!

There's a big difference between an elective homebirth and an emergency one, and I think we need to see proper studies that compare like with like before jumping to conclusions either way.

I had a relatively quick and easy hospital birth with my first dd and the midwife at the time said to me that I would be a good candidate for a home birth and to be careful I didn't give birth in the hospital car park next time.

I did find my contractions slowed considerably while we drove to the hospital and got settled. So much so that they wanted to send me home, when I knew that at home I had been having contractions that were almost completely continuous. Sitting in the half dark, clutching my dh's leg, dragging off gas and air - I felt almost depressed. I wished I could be at home in the warmth watching my favourite movie.

So yes, I would love a home birth and yes, I am probably a great candidate. What frightens me is these things:

1. I only lost 100ml's during my 'easy' intervention-free hospital birth and the hospital asked me to stay in overnight - they said that sometimes when you lose such little blood, it can come on later dangerously fast and if this happened I may need an emergency blood transfusion.
2. My husband's ex starting bleeding profusely after she gave birth to my dh's son and she needed emergency transfusion - she learnt later that had it been a few minutes more she may have died.
3. I've heard of stories where ceasarians are carried out in minutes because emergencies such as babies umbilical cords is wrapped tightly around it's throat or it's heart rate starts plummeting. Situations where even a hospital 8 minutes drive away (add two minutes to get out of house into car and 2-3 minutes to get to theatre at the other end) and that is 15minutes - just isn't close enough.
4. I am getting over the hills, and this will definitely be my last pregnancy.

This is what stops me considering a home birth.

I really welcome your thoughts on the subject as would love to be able to feel comfortable with the thought of a home birth.

Many thanks.

I think the risk of haemorrhage etc is worth serious consideration in relation to home births, but the midwives are prepared for that, as it is one of their main concerns too.

However hospital is no guarantee against disaster either. Concerns about home birth need to be counterbalanced with things like hospital acquired infections, lack of staff at hospital and faulty equipment.

One of my friends lost a perfectly healthy full term baby in a top teaching hospital because a monitor was faulty and when they did realise there was a problem, they were not able to resuscitate the baby when it was born because the oxygen cannister was empty and hadn't been replaced. Imagine how she felt, after going into hospital for the 'safer' option, when an old fashioned ear trumpet and a constantly attending midwife could have made all the difference??

In short, there are no guarantees when you have a baby and there is always an element of hoping for the best.

I had a homebirth with my first in September - I chose to have my DS at home because I believed absolutely that giving birth is what my body is designed to do and there was therefore no need to be in a hospital which is for people who are sick.

All went well, but during the birth I realised that although I did believe my body should be able to give birth, I also did not really truely believe that it could. It just seemed so bizarre and impossible.

I think this deep seated mistrust of my body has come about through deeply ingrained cultural attitudes towards birth in the West - the belief that women's bodies are not good enough and flawed and that childbirth is unbearably painful. The doctor's comment on the article typifies this and in my opinion is incredibly mysoginistic.

It's got to be a personal choice but I would always wholeheartedly support anyone choosing homebirth... daisy5 you don't say how old you are, I'm 37, and I'd like to have a few more at home even though I'll be an 'old mum'!!

Boffinmum - all large scale research into outcomes related to place of birth in the UK in the past 20 years has excluded unplanned homebirth.