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've had two home births, if I have a third baby I'll have another one. The idea of hospital fills me with panic and I would only set foot in it if there was an actual need. First baby was back to back and even that didn't get me in hospital for pain relief!

I look back on both births with fond memories, I don't know more than one person who looks back on their hospital birth fondly and actively enjoys the memories.

@RainMinusBow I live an hour from the nearest hospital ... if something went seriously wrong that hour is precious to my babies chance of survival

Last year I had my first baby I didn’t go to hospital until fully dilated and ready to push and had no pain relief bar a little gas’s and air the birth was test book

But I have no way of guaranteeing the same with my 2nd or any other birth ... I don’t want to gamble with my little ones life

That’s my reason any how

The high rate of still birth is more likely linked to the lack of standard placenta scanning in late pregnancy and the perpetuation of myths such as "babies run out of room", "babies slow down at the end".

I have fond memories of the birth ... my midwife was pretty funny I liked her

I've never really understood why anyone would want a homebirth. I loved being looked after in hospital and getting my breakfast, lunch and dinner handed to me for a few days! Now in fairness I went to a quiet hospital and had a private room so maybe that's different to most people? Either way, I have no interest in giving birth at home!

@ferrier

I always wonder with that statement whether like is compared with like? I'm not being goady, I'm genuinely interested in how the stats are assembled.

As such a small percentage of births are homebirths it must be quite small numbers each year and presumably the vast majority of women birthing at home are low risk with a history of previous straightforward deliveries. Are they compared with similar women who give birth in hospital? Or are all women who give birth at home compared with all women who give birth in hospital? That would obviously skew the stats quite a bit.

It's like the epidural=intervention fact that is always bandied about. Is it genuinely that epidurals cause the interventions to occur or is it that births that are more complicated (back to back, baby poorly positioned etc) are more painful and so more women experiencing those sort of births have epidurals? I anticipate that those sorts of births also generally require more interventions. So perhaps it is more a correlation than causation situation? I genuinely don't know the answers but I find it difficult to rely on headline statistics as without digging down into them it's difficult to know how much value to place on them.

I had a homebirth 8 weeks ago to a 10lb 3 baby. The midwives were fabulous and I got to shower in my own bathroom and go to bed in my own room that night. If you are low risk then why not?

I had a planned home birth with DC3. I have longish labours & find hospitals stressful. I had an epidural leading to a forceps delivery with DC1 & a normal delivery with just gas & air with DC2. As I was low risk my community midwife suggested I would be a perfect candidate for a home birth so after doing a lot of research & with DH on board we went for it. Hospital was only a short distance away should it be needed.

It was one of the best experiences of my life, just so empowering. No complications whatsoever & so much quicker than my previous deliveries. Loads of gas & air. No stitches. And no mess at all.

This was 22 years ago in Bedfordshire. We were luckily enough to have a brilliant community midwifery team locally, who were very supportive & encouraging of home births. I can't remember what the home birth statistics compared to hospital were, but it was very high at the time in relation to other parts of the country. I knew loads of people locally who'd either had one or were planning to but couldn't for some reason.

I had all 3 of mine at home, 2 were in a pool. I didn’t fancy going into hospital and wanted my home comforts (and bed). However, I was classed as low-risk with no obvious complications. It also helped enormously that my DH was supportive too. Plus home births were ‘encouraged’ in our area.

It's like the epidural=intervention fact that is always bandied about. Is it genuinely that epidurals cause the interventions to occur or is it that births that are more complicated that's an interesting point sunshinegirl. I gave birth at 42 weeks after being induced, and having gone through 22 hours of contractions (with no pain relief) that were minutes apart. Baby was completely stuck in a bad position, and I wasn't dilated enough. I literally begged for the epidural at that stage, and it took another 5 hours to get her out (with ventouse and episitomy). I shudder to think what would've happened without any intervention or the utter relief of epidural.

@Sunshinegirl82 absolutely the home birth statistics are low risk mothers. But the point is, if you are OK'ed for a home birth then you have a lower risk of complications than if you had a hospital birth. High risk mothers should always be in hospital.

And yes the epidural causes the intervention (not all of them but lots of them). It's a while since I was on top of the research but I can't imagine the situation has changed.

To clarify... a low risk home birth has fewer complications than a low risk hospital birth.

Those of you saying you live near to a hospital, how long can you hold your breath for? If something, god forbid, were to go wrong during your labour, chances are you wouldn't get to hospital in time to sort things out in time.
In a crash section, baby should be delivered in less than 6 minutes from decision. That's from the obstetrician saying you need an emergency caesarian section, to transfer to theatre, anaesthetising you and getting your baby out.
Waiting up to 8 minutes for an ambulance, transfer to ambulance, blue lights to hospital, transfer to theatre etc.... it could be an extra 20 minutes minimum on the total time.

I had my third 10 weeks ago- 1st In a hospital 2nd birthing center- I was pushed hard into a home broth for my third, I am beyond glad I went to hospital- the experience was amazing, best out of all of them and I felt safe and looked after, I had gas and air on all 3 but I just felt assured being somewhere where if I needed it, help was on hand straight away- not the half hour to my local hospital. I didn’t think it was worth the risk

@ferrier sure I get that. What I mean is when people say "statistically you have less risk of intervention in a home birth than in hospital" how much of that is due to the location of the birth and how much of it is due to the risk profile of the woman/some other factor?

Are those giving birth at home the women who were unlikely to have any intervention wherever they gave birth? I don't know the answer I'm just wondering how it stacks up.

As my first labour ended up very fast I was advised to consider a homebirth with my second at the booking in appt. I laughed, said there was no way I'd entertain the notion for a second and it was never mentioned again.

They seemed a bit disappointed so I think in my trust as least they do push it if possible.

Just speaking on my own experiences. First birth in hospital - loads of complications both of us nearly died. So second birth I wasn't given the option. Tbf I even went to a different hospital as half the complications wouldn't have happened the first time if they were competent.
I would have loved a home birth though.

I considered it for DC1 but he went footling breech @ 38weeks so ended up in a planned section.

The PP who said no one looks back at their hospital birth positively/ fondly...I honestly do. I was so relaxed that the baby would be here safely in around 20 min that walking to theatre was like walking on air. He cried, DP told me he was a boy, I had no pain (even with recovery really). Postnatal are wasn't the best but the actual birth was splendid. So much so, I want an elective CS for DC2 who is due in June.

What I mean is when people say "statistically you have less risk of intervention in a home birth than in hospital" how much of that is due to the location of the birth and how much of it is due to the risk profile of the woman/some other factor?

The Birthplace study mentioned upthread was a very large and comprehensive study and the researchers did everything possible to control for risk in the way you suggest. It's not possible to do this completely - there's no such thing as a randomised double-blind study for childbirth - but, yes, shockingly, the researchers did spot the issue that you, a random person on the internet, spotted and attempted to minimise it

I had my last two babies at home, first one went without a hitch, second I laboured great (5cm when MW got there) but when my waters broke she had pooed and it was quite bad, they go on the colour apparently, darker the worse it is and it was pretty dark, she asked me not to push but baby was sat there, head could be seen without me pushing, ambulance was called and we were transferred, no panic, all went smoothly and I'd do it all again, but I'm not because I have 5!!!! xx

Sorry.... I did have her at home, we were transferred after!

The PP who said no one looks back at their hospital birth positively/ fondly...I honestly do.

I hadn't seen that comment but I also do. DC2 was a dream. I arrived at 5.05am after having contractions that were totally manageable with TENS. Plenty of laughing about stiffnwith midwives during triage. In own room with gas and air by 6.30. Lovely shift changeover with outgoing MW saying she was sorry to miss this one, incoming MW very jolly saying she was delighted to start this shift seeing me on bed up on all fours and cracking on. More comedy with someone trying to deliver breakfast mid-pushing. DD arrived at 8.20am.

Had a very relaxing shower mid-morning. Nice chats with midwives throughout. All very chilled. Home first thing next morning (Xmas Eve!).

I'd do that all over again plenty of times and not change a thing.

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

Is that not because generally it’s lower risk women who opt to give birth at home and many trusts now will do a scan prior to the home birth to ensure the baby’s position? Also, surely nearly all planned home births are once the baby is term and not overdue so during the least risky time to be born.

There has to be a lower rate or intervention at home because the equipment and surgical team are not there to intervene. Those that need intervention will be taken to hospital.

As for the stillbirth and neonatal death rate being high, I think that is largely to do with the care during pregnancy than anything else.

@LisaSimpsonsbff

Did you mean that to come across as stroppy and rude?

I've been pretty clear in my comments that I don't know the answer and am querying how statements like those mentioned have been arrived at. Do you think everyone should just unquestioningly accept statements but forward as fact? If not, why are you annoyed?