I read that appalling Dr Crippen blog last night. And despite being repulsed by his approach and most of the comments, I'm still a little shaken about homebirth.

[verylittlecarrot]

I believe in science. I trust research and well constructed studies. I am compelled by empirical results. And I believed that studies showed homebirth was as safe for low risk pregnancies. I also believe that there are large numbers of unnecessary interventions in hospital which are damaging. But I am also guilty of laziness and shortcuts, so I often (not always, but often) take at face value someone else's reporting and interpretation of studies without actually reading them and evaluating them in full myself. Yes, I've read lots of homebirth.co.uk and similar sites. But if they say "study X showed that outcomes were better for homebirth" I've kinda accepted that without being critical enough.

I tried and failed to homebirth last time. I am booked to attempt another homebirth this time. My primary reason for choosing homebirth is that I believe it is as safe, or safer for me and my baby. My secondary reason is that I believe it will be less painful, less scary, less horrifying, less humiliating than a hospital birth. I have lost trust in some of the NHS hospital staff as a group, as I have experienced their lack of logic, their dogmatic adherence to protocol in place of intelligent assessment of individual circumstances, and their lack of respect for my wishes. I suspect they are also unaware of the actual research on safety and birth outcomes too!

I am not doing this because of a floaty, new age desire to commune with nature or something (although I defend any woman's right to choose the birth she wants based on her own reasons, provided she has been fully informed of risks). If the studies show it is significantly riskier to give birth at home, I won't do it. End of.

Please can we discuss the facts and studies around homebirth vs hospital birth? I don't need convincing on the emotive factors regarding the experience being better. I have no doubts on that. I need help making the right decision and being at peace with it.

I read one study - the real thing. Analysed it, for an exam, as it happens. It was Australian. I genuinely can't remember the details now, but it DID find that HB was less risky for mother and baby than hospital birth. I'm trying to remember what their endpoints / population / timescales were, will try and find it, hang on

Aaargh, my ATHENS account has expired (damn maternity leave). Have located one study which says HB risky (moreso than hospital) if you are already high risk here

Thanks Omnidroid, if you can post the study and help me to understand its conclusions, strengths and weaknesses in construction, I'd be really grateful.

X-post!

Will read the study you've linked...

You didn't 'fail' at HB. It's not a test!

I've no more info than you, sorry, but wish you a lovely birth.

just did a quick Pubmed search but the top few say 'no abstract available'. However, you could look up the titles - think you can read Nursing Times for free on the net (which will presumably link to/give details of the original research).

Or you could try going direct to the Royal Colleges (of Midwives and of Obs and Gynae) and see if they have any articles available online.

From what I understand, it's as safe as a hospital birth unless you have conditions like placenta praevia, pre-eclampsia, are obese or twins. Must check the twins thing actually.

I've found this to be a great, no nonsense very quick read about home birth. I'm planning one too as I'm due in 3 weeks

there's a newish swedish one but i can't remember what it is called and it did decide that homebirth was at least as safe as hospital birth.

interestingly enough i can't seem to find any evidence about the safety of hospital birth vs home birth, always the other way around.

I'm not abandoning the thread - but have to pop out for a MW appointment. I'll return later. Thanks all for your comments so far.

The Aus study:
stand out features for me (based on quick read) -

Good study, comprehensive data collection, well analysed, well thought out. Looked at infant deaths as it's outcome, so doesn't tell us about any other aspects or outcomes of birth, eg disability/pain/mother's health.

Risks are all low. Vast majority of births in all settings go well. Number of deaths over 5 years was 50. And this data was from 15-20+ years ago, what might have changed in terms of practice since?

HB in Australia was found to be higher risk than hospital birth, a serious concern given that most very high risk births happen in hospital, so 'should' be the other way around.

Highest risks found in post term (>42 week) pregnancies, breech and twin deliverys. You're likely to be warned off HB in the UK if you fall into any of these groups.

HB is relatively rare in Aus, tends to use private midwifery services who don't do very many HBs. Over half of the midwives went to fewer than five homebirths a year.

Can we assume that more experience from the MWs means lower risks? Need a Netherlands study too!

The study seems to describe action NOT being taken when it was needed - women with foetal distress, meconium stained waters or stuck babies (shoulder dystocia) weren't transferred to hospital, but carried on at home, with tragic consequences.

We can't, of course, tell what would have happened in any one case was the woman to transfer, but the study looked at a LOT of births, enough to do some decent generalising and tell us that similar situations in hospital ended better.

It seems to me to be telling us a lot about practice in private MWs attending rare HBs, not a lot about any intrinsic risk, eg is HB riskier because attended by less skilled health professionals, not any other reason?

I can tell you that it wouldn't have put me off my own HB, but that I was pretty keen to make sure that my MW was experienced, and that transfer to hospital was expected if anything looked like it was going wrong!

And I've just realised that it must be the same study that I described so confidently in my first post as NOT showing increased risk for HB. THe moral - look at the data, not at my rose-tinted generalisations following my own happy HB!

QT - don't want to worry you but worth checking out whether your private hospital has a special care baby unit, or what would happen if, God forbid, your baby needed extra support - how quickly could they get a newborn to a SCBU? And if it's an NHS SCBU, is it one is regularly full hence babies have to be transferred long distances?

And worth looking back at the Healthcare Commission website (or seeing if the new Care Quality Commission has an archive) to see reports of any inspections/complaints re. this particular hospital.

No reason to think a private hospital will be dangerous but equally there's just as much need to check whether it is up to scratch as there would be with the NHS.

Isn't the gist of Dr Crippen's argument that he doesn't much care what the evidence shows, he knows homebirth is dangerous, it's obvious innit, and anyone who disagrees is mad?

I've never seen much reasoned debate over the actual research on his site, but then I gave up reading it a while back

Right, back from my appt.
MavisG thanks! I understand what you are saying, and I don't beat myself up about transferring, despite the consequences. However the fact remains that I 'failed' to endure my labour to the end at home - I just couldn't hack it. After 24 hours of contractions 2/3/4/5 minutes apart I was 2cm dilated, so not in 'real' labour, yet my waters had gone 36 hours previously so I was under huge pressure to go into hospital, and so I eventually gave up and went. I can't imagine how I could have endured any more at home. Such is life.

QTPie I think the community midwife team worked solely in the community for births and the hospital midwives stayed on the wards. The community midwives who came out to me in labour varied from the wonderfully supportive to the downright hostile. I am booked with the community team again this time, however I am considering an independent midwife this time, simply because the NHS team is such potluck, and the chances of me getting someone I've even MET before are slim, let alone someone supportive. However, I do have reservations about the I.M. route too, which I need to explore further.

Daisymoo, yep, that's a fair summary. I'm annoyed at letting the words of someone heaving such vitriol and bias get to me. But I did find myself wanting to be more critical of both sides before making my judgement.

And omni thanks for your critique of that study. I'm glad to have it, although the results are not reassuring. I don't know how much weight to lend it, as it's 20 years old, set in Australia with its different homebirth criteria and different medical practices concerning homebirth. Are there any other pertinent studies anyone is aware of?

edam thanks. Will check those studies now.

Take a look at this fairly large, very recent study from Canada. Home birth wins on pretty much every count including very serious complications like prolapsed cord, haemorrhage etc.

By the way, I had a failed home birth with my first baby ending in emcs. My third baby was born at home though - with good support, a very active birth and a water birth, I coped with the pain and it was fine.

Carmen - that study is great, thank you!

www.bmj.com/cgi/content/full/330/7505/1416%20

not sure if someone already linked to this one?

Carmen - thank you for the Canadian study link x