Why is the home birth rate so low?

[RainMinusBow]

It's just 3% in my area and I think that's about typical, if not higher than the average?

I know for first-time mums home birth slightly increases the risk of problems but this is my third, low-risk pregnancy.

Having done lots of research, I'm very much hoping for a home birth this time around after two not great previous hospital births. My midwife has been great about discussing this with me.

My fiancé (his first baby) just assumed from the get-go I'd be going to hospital to deliver but he's supportive of my wishes (unlike my ex-husband was!!)

I have had home births. It wasn’t about the experience. It was about safety for me and my babies. I didn’t have a birth pool or music, nor a mess to tidy up. I just called a midwife, gave birth and then they left. That’s all. Correct choice for me.

Because I wanted more options for pain relief.

Because we wanted to be in a hospital where if anything was to happen to me or baby we would be there already. That comes from us both being health professionals and slightly paranoid about things going wrong.

Because it turns out I’m really good at haemorrhaging after birth and would have needed putting in an ambulance rather quickly.

@IvinghoeBeacon Do you mean about it being safer in hospital? Lots of people I have spoken to about my plans (fiancé included) feel that hospital birth is always safer than at home.

A lot of it is personal preference. I can see the attractions of home birth but I didn’t want the risk of having to transfer to hospital by ambulance in the late stages of labour if things weren’t progressing. I also liked the reassurance of having emergency help nearby if needed.

You can have a hospital birth and still decline interventions. I was in the midwife led unit pool with only gas and air for most of my labour and they gave me plenty of time to try and push my baby out before intervening. I only moved next door to labour ward and had epidural/forceps when it became clear he wasn’t budging.

I would consider a home birth for my second but I loved the pool in the midwife led unit so much I’d probably opt for that again.

I had an unplanned homebirth (precipitate labour) for my first baby and would 100% do it again. We were extremely relaxed labouring at home, the only point we panicked was when we realised I was giving birth before the midwife could get there. I had to be transferred to hospital after for a PPH but would definitely do it again if we have more DC.
My trust is very encouraging of homebirth for low risk women, and the Birth Place study shows that homebirth is statistically safer and results in less injuries for both mother and baby (not in FTM).
I think people are put off for the following reasons:

1. What if? The worry of something going wrong and not getting to hospital on time
2. Pain relief - women who would like an epidural/stronger pain medications.
3. The mess (although the midwives clean this up)
4. People's perception - just look at the thread on 'positive birth' and the way homebirth is described as being hippy dippy, woo etc. People can be extremely judgemental when told of homebirth plans.

Personal choice. I have a low pain threshold, I was under no illusions I’d need a fair whack of pain relief to cope & sure enough I did. I also felt safer at a hospital. I don’t think labour is over medicalised, it’s now incredibly safe because we of medical advances literally saving lives. My baby got completely stuck as she had her arm over her head & I had a big bleed, without the hospital & letting things ‘be natural’ we may have both died.

But equally, many labours are fine & if that’s what you want then go for it! It’s a bit like anything, it’s a weighed up risk!

For me there was zero advantage in a homebirth. I like hospitals, they make me feel safe. My first was an induced bit of a blur experience with pethidine. Not the ideal but fine.

Having seen how much mess there is involved I went from about a 1% inclination to homebirth DC2 to 0%. For me people saying how wonderful it was to get in their own shower and bed right after makes no sense. I'm much happier knowing I can leave all that blood and everything somewhere else!

I find the whole process of booking in and seeing triage and seeing what examinations they want to do at each stage.quite interesting too and wouldn't have wanted to miss it. I do realise that is quite weird!

It depends where you live. I am in a very rural area. Had an easy birth and asked my GP with the second if I could have a home birth.

His advice was, 'You can if you push for it. And in 99/100 cases everything will be fine. We are 40 miles from a hospital - so if things go wrong you are likely to be waiting 15/20 mins for an ambulance and then an hour drive there. It will be no consolation to you if you are the 1 in a 100'.

I opted for a hospital birth with that and all subsequent babies.

@IvinghoeBeacon Do you have any evidence for this?

I think a lot of townies live in a real bubble and don't realise that many CLUs have been centralised to large hospitals and as a result a lot of people do not live near to one so if anything goes wrong with a homebirth the risk is increased.

I am planning a home birth for this (my second) pregnancy. Statistically its safer and I had a very short labour last so I'm concerned about not making it on time.

There is a lot in the media and anecdotally about things that can go wrong with birth so many people are very anxious about it.
Many people on here have anecdotes which say "If I had a home birth I/my baby would have died/been ill because XYZ"
However they dont know how different the birth may have been if they had a home birth. Or how many home birth babies may have had issues if they had chosen a hospital birth. If its statistically safer to have a home birth it must be the case that for every birth which is safer in hospital, there is one which is safer at home and you'll never know which yours is.

I had a hospital birth with my first and home with my second. I'm lucky in that I seem to have quick, easy labours. In fact, the speed of my first was one of the reasons for staying at home for the second - we'd moved out of the city and it would be a longer drive to get to the hospital.

I had low risk pregnancies, knew that an ambulance would be with me quickly if needed (10mins ish) and that, statistically, I would be safer at home. It also meant I could be home for my elder child straight away, instead of waiting to be discharged. Plus I got to sleep in my own bed!

It worked for me. But I think that there is a very strong link between birth & hospital that is the cultural norm now. A lot of people thought I was weird or taking huge risks with my baby's health.

It’s up to you but in your case with your history, I wouldn’t risk it

Personally speaking...

I was induced with my first son as I got to 42 weeks. I felt very pressured, was never offered the option of additional scans etc.

I would say I have a high pain threshold but the intensity of even the first contractions was indescribable. I went into labour late on the Weds evening after the pessary but son wasn't born until the Friday morning. Had Meptid and eventually an epidural as it just became unbearable. Ended up with forceps and a very bad tear. Baby was not large or anything like that.

Second son I went into natural labour but student mw broke my waters (basically because labour ward were so busy and they needed the room). Baby went into shock but I'll spare all of the details here as it wasn't good.

Delivered at 4.30, was asked to take my newborn into the TV room at 8.30 and wait to be collected by my husband as birthing room needed. Baby did not have final checks.

Same day GP came out and told us to get to hospital with baby ASAP as baby had jaundice.

Rushed in and jaundice was classed as serious, baby had intensive light therapy for a week. ABO incompatibility with possible cause being related to birth trauma.

All of these reasons are why I'm so keen for a home birth this time around.

I can see both sides. I am risk averse and so for me being in hospital felt safest. In the end I had complicated pregnancies so wouldn't have been supported to give birth at home in any event.

6 months before DC1 was born a friend of mine had her baby at the MLU attached to the hospital. She was merrily labouring in the pool with only gas and air and no intervention when she abrupted. She had a category 1 section under general anaesthetic and baby was delivered in 8 minutes. Fortunately they were both ok following quite a lengthy hospital stay.

Statistically at a population level that story is insignificant but when I was considering my options I did feel that if I'd been in a similar situation myself at home and had a negative outcome I would never have been able to forgive myself. I think a lot of people know someone who had a similar delivery or hear of someone who had a significant complication and so they feel happier in hospital just in case. Everyone has to assess the risk for themselves.

@Practicalmagico Not sure what history you mean?

Most women will plan for their birth to be as low risk as possible, and statistically, that means giving birth where their are medical staff as close by as possible to intervene quickly if necessary.
Home birth is statistically equally safe for a second or subsequent low risk.
www.npeu.ox.ac.uk/birthplace

Strangely people seem to be a lot more relaxed about birth in a midwife led unit, which doesnt have any more medical facilities than a home (cant have a c section, epidural, emergency surgery, NICU etc.)

I had a home birth with my third. In Hampshire, they are very supportive of home birth.
I had two previous relatively unproblematic births in hospital. The second labor had only been an hour and a half long, and we had since moved further away from the hospital, so there was a good chance I would be having the baby in the back of the car somewhere if I was planning to go to hospital.
My husband is a GP so I had some obstetric back up. He was supportive of home birth given the likelihood of a quite healthy short labour birth.
The midwives arrived just as my son had crowned even though I rang them as soon as I felt labour was beginning. I had had a paracetamol at the start of labour, there was no time for gas and air but it was fine. I was kind of into the hypnobirthing thing which works better if you are calm and comfortable anyway.
We had put a shower curtain down and dark towels. You know, to save the carpet! It was good, we just chucked the shower curtain away after.
They cleaned up any mess, took away the placenta etc and stayed two hours. This is protocol, to check you don't need help with blood clotting or have problems afterwards.
The local GP was notified and he popped in as one of his house calls the next day to do the relevant checks.
It was a positive experience.

@BeanBag7 that depends on the MLU. At the hospital I delivered at the MLU is part of the hospital. You can be transferred to the labour ward in minutes if necessary. It still has the pools, en suites, big beds though. Personally I think that's a great option, sort of the best of both!

The UK has an unnecessarily high stillbirth and neonatal death rate so some women feel safer in hospital whereas perhaps others went the option to have the pain relief available to them at hospital. Personally, I think women should be able to birth where they feel comfortable that is also safe.

Risk of complications occurring in a home birth is statistically lower than in a hospital birth. There is a lower rate of interventions too.

@Sunshinegirl82
We have one attached to our hospital too, that's where I gave birth the first time. However it didnt have big beds or en suites, no birthing pools were available when I was there. So I guess it varies. Apart from being midwife led I dont know how mine varied from the labour ward.

The "proper" MLU with all the nice facilities is a 20 minute drive from the hospital- further than my home

My friend had 3 homebirths. The first one there was complications, but ambulance is always on stand-by. She was rushed into hospital (30mins) just when she was ready to start pushing, which wasn't ideal. However, she still thought the entire experience up to that point was well worth it, and opted for the same again for the next two (no intervention was required for either)

I never went into labour so was induced post 42 weeks.

My hospital doesn't support home-birth post 42 weeks.

Also although I was booked in it's still down to whether they have enough staff at the time.

I should imagine staff shortages are a huge issue tbh.

The UK has an unnecessarily high stillbirth and neonatal death rate so some women feel safer in hospital

Could there be a link between this statistic, and the high number of hospital births with interventions?