obstetrician who had a homebirth

[ClarityMa]

Has any one read that new book The Heart in the Womb written by Dr Amali the obstetrician that had a homebirth? Its really inspirational. I didn't know what to expect but it is a real women-power book.

I agree that some risks would be less in hospital if women in hospital had the attention of their caregivers. I'm sure that by the time women with pphs get to straighttalker, they are safer than they would be in her absence. But I'm not alone in having a story about being ignored and scolded on a post-natal ward when I was developing a life-threatening complication. When I developed the same complication at home, I had a midwife who was watching me closely and reacted immediately and appropriately. That's why I'd have another hb knowing that I've had two very similar births immediately followed by major pphs requiring emergency intervention.

I read this thread with interest. I had a homebirth with DS in 2010 and it was a great choice for me, DS and DH. I waited until the very close to the end of my pregnancy to tell my Dad who is a retired obstetrician. He went absolutely spare at me, saying it was completely P, dangerous and unnecessary. So it was contrary to my own preference but I completely understood his reaction which was based on love and concern for me. If a birth goes well, the ob does a bit of paperwork and the MW do it all. It's only when things go wrong that the ob gets involved and my Dad had a lot of EMCS and very sad times to deal with. I completely understand straighttalker's attitude and it's important that we get choice on how we give birth - the hospital is a most reassuring atmosphere for the majority of women.

Pregnant with DC2 - Dad hasn't asked me about my birth plan yet :)

I think we've got seperate issues here.

Straighttalker is right - women with PPH are safer in hospital than at home. However that doesn't mean home birth is dangerous.
Equally women are safer with a close focus from their HCP - but that doesn't mean hospital birth is dangerous.

You may improve your chances of one to one care with a home birth. You may also reduce your chances of surviving a pph. Neither of these are definate though and we should resist the temptation to talk about birth in such absolutes.

I'm not sure they are separate issues. Many 'low-risk' women in hospital receive very little attention from HCPs, and are ignored when they ask for attention. These same women would receive more attention at home. Mostly, the difference is between a miserable and a happy birth experience, because the women in question are at low risk of complication in either setting, but sometimes - as in my case - a close focus from the HCP affects the chances of survival.

Though I agree that absolute terms aren't helpful in relation to birth risk - we're juggling too many variables.

My very lovely Uncle who is an anaesthetist at a big children's hospital gave me a dressing down after the 2nd of my very easy, positive, safe, home birth's along the lines of straighttalker's point ie 'you took a risk you got away with it, lucky you- lots of kids I see end up eating through a tube for the rest of their life.' What I pointed out to him was that by asking for a home birth I had guareenteed a midwife was with me at the pointy end of labour for the entire time, and in fact at the end of my labour that 2 midwives were focussed on just me, for the entire time. Having had friends give birth in the 2 hospitals that would have been relevent for my births and had an awful time it was a pragmatic decision as much as an emotional one. I didnt get left on my own, I didnt get MRSA, both of which happened to friends.

Having said all this I recognise that the first home birth decision was driven more by an emotional need to be somewhere I was relaxed and comfortable- and he probably had more of a point. The second birth I felt I could make more informed decisions; I knew I would get better more consistant care at home and I was prepared to move quickly to hospital if it all started to go wrong.

I can see where Straightalker is coming from. My former boss is a consultant paediatrician in paedicatric intensive care. she was very very very anti home births based on the poor outcomes she had had to deal with.

I had a hospital delivery for my first child and am due to give birth in January again. I think I will have a home birth this time. I have no real complaints about the care I had in hospital, I was lucky to have a midwife with me pretty much all of the time...though there were problems with the epidural and getting that sorted etc...I ended up with ventouse and episiotomy.

for me I feel that I laboured well and quickly at home and it all went a bit wrong when I got to hospital. Just little things like the birthing pool was cold (by my standards) and half full so I was freezing, puking and contracting all at the same time...and I just kept being polite to everyone all the time when I probably should have been a lot more
focussed. I think at home I'll be able to be myself more and hopefully deal with it all a bit better.

having said that I may change my mind, it isn't fixed yet. it could be down to the weather mind you, I hear we are in for a shocking winter!

The other way of looking at this is that midwives seem to be far more pro home births mainly because they know how many births are straightforward, surely? I had a homebirth with DD2 after much persuasion from midwife - was convinced when friend who'd had similar labour time to me with first delivered second in hospital car park....

My situation was a bit different though as I was due to give birth in local midwife-led unit - which has no back up facilities and would require transfer to a larger hospital in the event of any emergencies or even just wanting an epidural. My house is nearer the other hospital than the midwife unit - given that many places seem to think it's acceptable to deliver in a midwife led unit without full back up, I can't say I felt it was particularly irresponsible to opt for a homebirth.

Happy to say it all went well - I was lucky enough to have 2 midwives present for first birth (midwife led unit in different area, so full back up available), as one was recently qualified and awaiting her registration so couldn't practise alone - and two for the homebirth. Made a massive difference to me.

I'd kind of hope that when it comes to childbirth, ALL health professionals would temper the views they've arrived at through personal experience, with some regard for research evidence.

History is littered with examples of doctors recommending harmful treatments and protocols (routine episiotomy, routine use of forceps in the US in the 1930's, scopolamine births.... ugh) - particularly when it came to pregnancy and childbirth - with the utter conviction that they were benefiting women and babies through their use. That's why I think the movement towards evidence based practice is one of the great things about modern medicine. The evidence isn't always water tight, but it's a damn sight better than what we had in the past.

Extract from 'The Business of Being Born'

If you read the book.......all the statistics about safety for mum and babe suggest that in straightforward pregnancies (not problematic pregnancies/ill mothers) the risk of death and damage to the baby is the same as hospital birth and the risk of death and damage to the mother is much less at home than in hospital.

If you read the other blogs around....you can see that homebirth can be a political issue for organisations such as the American College of Obstetricians, who hate homebirth and published a much lambasted and clearly flawed research paper last year to support their view....but when their figures were looked at by independent people all the figures did not add up correctly.

Forgot to mention that The Heart in the Womb has 200 references for those who want the facts about hospital birth versus homebirth.

The book is a great combination of the point of view of a mother, doctor and the wise woman brought up in both eastern and western traditions. Amali has written in easy to read language which is very refreshing.