The general feeling here seems to be anti-invervention and medical help. Why, when it has saved so many lives?

[greenwithyellowspots]

I am really interested in this question. I think that Mumsnet is really geat, I love it, but one thing I've noticed particularly on the childbirth thread is that on the whole people are anti-intervention or even that doctors etc are the enemy! With induction for example, but also generally, the consensus seems to be about letting women get on with it because 'their bodies know best.'

But in the past, and still today in many countries, it seems clear that women's bodies DON'T always know best - mortality in childbirth used to be/still is horribly high! It often seems as though the medical profession can't win when it comes to childbirth - if they intervene they are accused of being over zealous, but if they get it wrong, they are also to blame.

I'm sitting here pondering the fact that I'm likely to be induced soon-ish and am reasonably willingly putting myself in the hands of the medical profession. Is there not a danger or harking back to a golden age of childbirth that didn't exist? I hope this isn't a really inappropriate question but I'm generally interested in what people have to say about this, as I kind of feel like I'm missing the point somewhere!

What StarlightMcKenzie says I think is right, but from my own pov, I definitely went for a hospital birth because I thought it was the less risky option. The MW had suggested home because we didn't have anyone to look after dd1 and she "couldn't be running around in a hospital" (tho could at home, presumably (she was nearly 3 at the time). Which reasoning struck me as odd.

Surely the best thing is for each mother to be able to make their own rational choice - we don't have to dictate to anyone? And you never know when you might end up with a home birth by accident (or pub, or lay by or wherever you happen to be!) so it's as well to read up on it anyway and have the bootlaces boiling at the ready...

Yes of course, I would believe that she could have seen it as a less risky option and I am in no way suggesting that she would be happy with risking her baby's life! I don't think that for a second. She said that her OB advised very strongly and her community midwives to give birth in hospital - therefore they must have seen it as a safer option. Obviously her independent midwife thought differently and standanddeliver chose to take that option as in her eyes it was safe. It just points out again that there are always two sides to the home birth argument and on MN I only ever hear all the advantages of homebirth and no disadvantages. I've gone off the point of the thread anyway but it was sort of in keeping with the issue that many people on MN are anti-medical help and intervention.

For what it's worth I had an OB who I adore who was very pro-natural and had two home births herself.

Mollyfloss

It seems to me that you ARE against homebirths. That you feel medical intervention of any kind is necessary.

"An obstetrician is medically more qualified than a midwife but yes he hadn't been to a homebirth but he knows what medical intervention is available rapidly at a hospital compared to at home, hence presumably why he advised you so."

"Obstetrics (from the Latin obstare, "to stand by") is the surgical speciality dealing with the care of a woman and her offspring during pregnancy, childbirth and the puerperium (the period shortly after birth). Midwifery is the non-medical equivalent. Most obstetricians are also gynaecologists[citation needed]."(Wikipedia)

Not every woman during pregnancy and childbirth have life threatening complications and need someone surgical to care for them. Thats why we have midwives.

"The main emergencies include:

Ectopic pregnancy is when an embryo implants in the Fallopian tube or (rarely) on the ovary or inside the peritoneal cavity. This may cause massive internal bleeding.
Pre-eclampsia is a disease which is defined by a combination of signs and symptoms that are related to maternal hypertension. The cause is unknown, and markers are being sought to predict its development from the earlist stages of pregnancy.

Some unknown factors cause vascular damage in the endothelium, causing hypertension and proteinuria. If severe, it progresses to fulminant pre-eclampsia, with headaches, epigastric pain and visual disturbances. This is a prelude to eclampsia, where a convulsion occurs, which can be fatal.

Placental abruption where the patient can bleed to death if not managed appropriately.
Shoulder dystocia where one of the fetus' shoulders becomes stuck during vaginal birth, especially in macrosomic babies of diabetic mothers. "

These are the states in which we NEED life saving intervention. We do not need a medical practitioner telling us that we are 'unable' to give birth because theres 'poor maternal effort' and so are practiacally forced to have a C-section or Forceps.

Babies are meant to be born naturally. Women are meant to birth naturally. But...There are sometimes complications if mother or baby is not as healthy as can be.

"During labor itself, the obstetrician/doctor/intern/medical student under supervision may be called on to do a number of things:

• Monitor the progress of labor, by reviewing the nursing chart, performing vaginal examination, and assessing the trace produced by a fetal monitoring device (the cardiotocograph)" all of which are not necessary.

"- accelerate the progress of labor by infusion of the hormone oxytocin" Again not a needed if the mother is in a comfortable setting. Relaxed as can be, prepared for the birth, has a supportive midwife and family if necessary. As well as other factors.

"provide pain relief, either by nitrous oxide (nowadays uncommon, at least in the U.S.), opiates, or by epidural anesthesia done by anaesthestists, an anesthesiologist, or a nurse anesthetist." I dont think Gas and air is uncommon as they say but they are leading to the fact that there are more ways to relieve pain as such, but they dont think about what effects this can have on the baby and mother.

"surgically assisting labor, by forceps or the Ventouse (a suction cap applied to the fetus' head)" Again if the mother is left to get on with it, gets in a postition that she feel comfortable in, has a supportive midwife, family...etc... I know these are unecessary measures as my mother was a midwife and always told me these situations are avoidable. As well as tearing and the need for stitiches.

"Caesarean section, if vaginal delivery is decided against or appears too difficult. Caesarean section can either be elective, that is, arranged before labor, or decided during labor as an alternative to hours of waiting." Again they are stating its not necessary but a request.

"True "emergency" Cesarean sections (where minutes count) include abruptio placenta, and are more common in multigravid patients, or patients attempting a VBAC (Vaginal Birth After Caeserean section). "

So do we all need un-necessary medical intervention. My answer - NO.

Chellesgirl: I do not feel that just any medical intervention is necessary. That would be ridiculous. Most women can give birth naturally - I did. I wouldn't have a homebirth myself but I just said that my OB who I completely trust had them herself so how could I be completely against them? I'm simply wondering if anyone on MN can bring up a disadvantage of homebirths? The constant one sided argument is a bit tiring... thanks for the run down on the emergencies which necessitate someone surgical - who knew? really...

one you listed is true emergency caesareans - highly improbable but what if you needed one and you were at home - again highly unlikely but then that would be a risk take with a homebirth, albeit how small.

A dr friend a NZ dr, and she says that there are a lot of cs by election in NZ, so this would be relevant) finds homebirths tiresome because they can guess about how many hospital births will be happening, but apparently home births which become hospital births (also apparently common in NZ) ruin these calculations and then drs and mws get overstretched. So there's one argument, tho I'm not quite prepared to stand behind it, it being complete hearsay!!

My dd1 needed oxygen and got some straight away in the hospital (we weren't high risk before), but presumably that would have been tricky at home (or perhaps MWs bring some equipment with them?) and perhaps that would have led to dd1 being brain damaged. That's another argument, for me, to go to hospital, but I would never suggest that another woman couldn't have a homebirth and wouldn't think she was taking outlandish risks, just weighing them up differently to me. As would be her right.

Molly - Women choose hospital births because they have been conditioned to see it as the safest place for them to have their baby.

Even when women are presented with facts from organisations like the Royal College of Midwives and the Royal College of Obs and Gynae (who have both released statements saying that homebirth as a safe option for low risk women, and one that offers 'considerable benefits') supporting the belief that hospital is no safer for low risk women, they still 'feel' that it is. Wrongly. Logic and reason influence our decisions surrounding childbirth far less than fear does.

I do agree with you that statistics have their limitations. For example problems in subsequent pregnancies following emergency c-sections in hospital are not factored in when assessing the benefits of homebirth. The stillbirth and infertility rate following c-section are higher than following vaginal birth. As a mother birthing at home is about half as likely to have a c-section as a similar low risk mother booked for a hospital birth I think it would be fair to at least consider this issue when assessing the safety and value of homebirths.

Greenwithyellowspots, I agree with your OP.

I was entirely happy to entrust the welfare of me and my babies to midwives and doctors and I had two very different but both very positive experiences, at a huge maternity unit which seems to get an unfairly bad press. Maybe I was just lucky.

I can't get to grips with the attitude of some that feel that midwives and doctors are ALL completely working against their best interests. Every professional I came into contact with was delightful. OK there was an italian junior doctor who was a bit of a plonker but we had a good chat about fresh v dried pasta.

Interesting debate about statistics. I think most of us go on gut instinct. No way in a zillion years would I have had a home birth! whatever the statistics say.

I think the key is - good communication and an open mind.

No. But I would find it very hard to pinpoint exactly by what or whom I've been influenced.

Isn't it one of life's imponderables....you arrive at decisions in all aspects of life that you feel comfortable with, no rhyme or reason.

"I can't get to grips with the attitude of some that feel that midwives and doctors are ALL completely working against their best interests"

Actually nobody has said that midwives and doctors are 'completely working against their best interests' and I think that this is a very unfair spin to put on the argument. It makes people who argue for undisturbed and natural birth seem unreasonable and stupidly antagonistic.

My view is that doctors and midwives are very focused on wanting to keep women and babies safe, but that the demands of the institutions in which they work sometimes (often) make truly sensitive, individualised care difficult to cachieve, and that this can and does negatively impact on clinical outcomes and on women's emotional experiences of birth.

"Most of us go on gut instinct".

Our decisions surrounding what we do in pregnancy and childbirth are primarily driven by very high levels of fear (which paradoxically has increased as outcomes in childbirth have improved) and by the choices we are presented with. It wouldn't have occurred to me to have had my first baby at home, because I didn't know anyone else who'd done it and because it was presented to me as something extreme, risky and 'odd'. Had I had my first baby in the Netherlands, where around one in three of all births is a homebirth, and where it's considered completely normal for a first time, low risk mum to birth out of hospital, I would have seen the whole issue completely differently.

Starlight: so if I'm low risk in my next pregnancy I would be better off having a home birth as it is less risky - is that right?

My birth went fine, that was until DD popped out and needed oxygen. There was no sign before that. A pediatrician dealt with her immediately and those were the longest few mins of my life. I don't know if any of you know what it's like for your baby not to cry when she's born. I'm not sure what would have happened at home or if a midwife could have dealt with her but I was glad to have the pediatrician there and know that there were other doctors down the corridor to help if needs be. Maybe that's not considered to be a risk to most of you here, but it's enough to make me not want a home birth next time.

I don't think I am influenced by the media etc. Many members of my extended family were born at home (and were fine) and I have a couple f friends who have recently had home birth (and were fine) but my experience tells me I was definitely better off in hospital and noone could have foreseen that.

"My birth went fine, that was until DD popped out and needed oxygen. There was no sign before that. A pediatrician dealt with her immediately and those were the longest few mins of my life. I don't know if any of you know what it's like for your baby not to cry when she's born. I'm not sure what would have happened at home or if a midwife could have dealt with her"

My ds was born 'flat' at home because of a shoulder dystocia. The two midwives calmly and efficiently resucitated him on the bed in front of me and he was fine. If I'd had him in hospital the midwife would have pulled the emergency cord as soon as she realised that there was a problem, and the room would have filled with doctors and other midwives, all rushing and full of adrenaline. I would have been given a large episiotomy (standard practice in hospital) and my baby would have been pulled out and taken outside into the corridor to a resuscitaire (the ones in my hospital are outside the rooms in the birth centre). I would have been left in the room wondering if my baby was dead or alive. I would have been terrified and traumatised. I probably would have said afterwards 'thank god I was in hospital, if that had happened at home it would have been a total disaster'. But it did happen at home and it was fine. I'm the only person I know who's had a shoulder dystocia with an 11lb baby who hasn't ended up with a shredded perineum and a major degree of birth trauma.

All homebirth midwives are trained in resucitation techniques. They are drilled and prepared for emergencies so that they are less likely to flap and panic. I've heard plenty of stories of midwives in hospital flapping and fannying around when a baby's born flat or when there is a significant shoulder dystocia. Maybe you worry less about the drills when you know there's someone there to pass the buck to.....

I do also think it's worth pointing out that babies born at home are actually less likely to be born with low apgar scores or in need of resucitation in the first place.

StandandDeliver, I am in favour of natural and undisturbed birth. I'm also in favour of medical intervention where necessary. I've had one highly medicalised birth and one completely natural, no pain relief, so I have no particular axe to grind. Actually I do think some people are unreasonable and antagonistic in their views. (not necessarily on mumsnet, just in general).

No doubt fear is a factor. I would have been a lot more scared at home I can tell you. But if someone is frightened, can you really reverse that through giving her the statistics? I don't think so.

I was extremely well-informed (to the extent that I was asked several times if I was a midwife) but I still chose hospital birth and I would do so again.

Did you know that many babies are born not breathing. My dd didnt cry straight away, and guess what the hospital didnt give her any oxygen. I know If i was at home like planned the midwife would have been able to focus on my baby and realise she could not breathe properly. They did give her oxygen when I ran to get the baby doctor nearly 10 hrs after she was born cause she went blue. This could have been avoided and so could her Stay in NICU if the midwifes wernt rushing in and out of the room to deal with other women in labour.

I know for certain my next birth will be a planned homebirth again.Because I know that in my heart and gut that both me and my baby will be safer and better cared for.

And molly midwives carry oxygen with them to resuscitate a baby. And I would have far better a midwife do it at home that 10hrs later when my baby could have died without my mum noticing her lips turning blue.

disadvantages of homebirth

This is an NHS leaflet. I typed in Disadvantages of homebirth in google and this is what I got.

Please read as it is sooo interesting!

molly you wanted disadvantages -
I have found some for you. Please if you like, read all of it.

Advantages of home birth...

-Statistics show that home birth is as safe or safer than hospital birth for low-risk women with adequate prenatal care and a qualified attendant.
-At home a woman can labor and birth in the privacy and comfort of the familiar surroundings of her own home, surrounded by loved-ones. in whatever positions and attire she finds most comfortable.
-The laboring woman maintains control over everything impacting her labor and birth.
-Meeting her needs is the only focus of all those present. Nothing is done to her without her consent.
-Labor is allowed to progress normally, without interference and unnecessary interventions.
-Studies show that the risk of infection is reduced for both the mother and the baby.
-During labor the woman is encouraged to eat, drink, walk, change positions, make noise, shower, bathe, etc.
-Care-givers are invited guests in the birthing woman's home. She can have anyone she desires present: family, friends, children, etc. Her medical team (midwife and birth assisiant) do not go home because their shift has ended or because it was supposed to be their day off or because it is a holiday or because they planned something else.
-She doesn't have to worry about when to go to the hospital since her care-providers come to her.
-Continuous one-on-one care is given by the midwife, providing ongoing assessment of the baby's and mother's condition throughout the birth process and postpartum period. Her care provider knows her well and she knows her care provider. They have established a trust relationship.
-Women are supported through the hard work of labor, and encouraged to realize the insights, and experience the personal growth as a human being to be derived from such a powerful, life-changing event.
-Bonding is enhanced and includes everyone who has contact with the baby including neighbors and relatives. Breast feeding is facilitated by the baby remaining with the mother.
-Cesarean Section and forceps deliveries are unavailable - transportation to the hospital is necessary if these interventions are required. However, rates of both, as well as episiotomy, are very low.
-The cost of a home birth may be less than a hospital birth, and is often covered by insurance if a CNM is utilized.
-Pregnancy and birth are viewed as normal, natural body functions and not as an illness or disease.

Disadvantages of home birth...

-Client's must assume a greater level of responsibility for their own health: physical, mental and spiritual. This requires active ongoing participation in decision making in all aspects of their care, and a willingness to accept the consequences of those choices and decisions.
-Since the hospital is the currently socially acceptable location for birth, choosing otherwise may result in negative judgments and lack of support.
-Cesarean Sections, forceps deliveries and a nconaialogist arc not available at home, transport is necessary for these and other medical interventions.
-Personal arrangements must be made for postpartum care, such as meals,(I think I'd rather eat homecooked foods!) housekeeping, child care etc.(Youd still need childcare if in hospital so this aint true.
-The cost of a home birth may not be covered by the client's insurance.
-Analgesics are not readily available with a home birth.

Advantages of a hospital birth...

-Many mothers feel safest laboring a hospital.
-It is the safest environment for the mother at risk for medical complications during labor.
-Emergency personnel and equipment is available if the mother develops complications or needs medical attention.
-It avoids the rush of a last-minute transfer to the hospital (from home or a birth center) if medical problems arise.
-It is the only option available in the event a cesarean section is necessary.
-Immediate pediatric attention is available should the newborn need medical care. Baby does not need to be taken off site to be routinely examined by a pediatrician.
-It has round-the-clock help for the mother and baby (food, diaper changes, medical assistance and information.)

Disadvantages of a hospital birth...

-The parents are not on "home ground" and do not have the same control they would at home.
-Hospitals are primarily associated with illness.
-Hospitals can seem impersonal and intimidating.
-As a large institution, the hospital has rules, policies and red tape; they are rarely altered to accommodate an individual.
-Less privacy is available.
-The father is often less actively involved in a hospital setting, and may fell like an "outsider".
-The mother's birth is usually managed by experts trained in pathology, not normal births.
-The risk of iatrogenic complications and infection to the mother and baby is greater among mothers who deliver in hospitals, than among those who give birth at home or in a birthing center.
-The mother is at a significantly higher risk of having an unnecessary cesarean section.
-Some routine separation of the mother and baby is almost unavoidable.
-Most hospitals do not allow the mother much rest.

Like I said 'I don't know if the midwife could have dealt with it'. You all seem to be saying that she would have. I'm still feeling more comfortable with a pediatrician doing it because if the oxygen doesn't work (which in most cases it does) then the next steps to be taken are by a pediatrician.

Chellesgirl: How do you really know If you were at home the midwife would have been able to focus on my baby and realise she could not breathe properly? What makes you so sure? What happened in the hospital sounds pretty much like malpractice in any case. Luckily, my baby was thoroughly checked over and I felt this was done as there was someone specifically there to focus on her.

I am personally in favour of a natural birth and letting women who want to just get on with it but I personally like to know that there is expert help nearby in case (for the baby, not so much for me).

'Standanddeliver pointed out that some medical organisations have released statements saying that homebirth is as a safe option for low risk women, and one 'considerable benefits' supporting the belief that hospital is no safer for low risk women, they still 'feel' that it is'. Even medical people who base everything on studying and reason still rely on their gut somewhat and in the case of homebirths they still feel it is safer to go to hospital despite the stats. In fact presumably most of these midwives and obstetricians' who have given birth themselves have done so in a hospital despite the apparent 'considerable benefits' of homebirths. Obviously the research is not convincing them as much as they say. You know that someone is really convinced of something when they act upon their words. You could argue that they too act on illogical fear but being people who essentially work with science and reason, this just doesn't make sense...

Perhaps instead of trying to convince people that homebirth is the solution to the surplus of intervention in hospitals, the problem in the hospitals should be dealt with directly. This would probably make a lot of people happier.

Oh yes of which I have tried to get done in my hospital and guess what not in a million years would they consider to change. All they can say is they were sorry. Whats sorry I wanted change so mums and dads could get the right births that they wanted. The government just dont want to admit that in many areas the NHS is failing.

I just dont see why women would wanna put a horrid scar across or down thier tummy just because they wanna opt out of having a VB? Whats in it for them. They have to recover for longer. I am talking about the ones that have elective c-sections not the women who need them.