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!!)

Had a textbook vaginal birth with first baby. Second baby was 9cm dilated one birthing pool at hospital when had a very acute placental abruption , massive and sudden blood loss , babies heart rate petering out. Team of people came in, ran along corridor with me on stretcher (still hemorrhaging) , baby born by cat 1 section. Was in pool at 2144 and babies time of birth was 2147. She was thankfully fine but I lost over 2L blood and took hours to stop the bleeding. Baby would have died if I’d had a home birth, possibly me too. I had zero risk factors for this, just “one of those things”. I do think hospital is the safest place to be. Sometimes a transfer by ambulance would take too long and it’s just not worth it. You can have a very relaxing time in a hospital birthing pool.

To clarify... a low risk home birth has fewer complications than a low risk hospital birth.
This was what the research told me years ago when I opted for home births after DC1 was born in hospital. I loathe hospitals and the local one was built to pretty much the same design as the one my DM had died in not so long before. The midwife showing us round actually said to me, 'Oh, my love, no need to look like that, it's not THAT bad here.' She ended up delivering me at home a few years later with a subsequent baby.

People always say that they'd blame themselves if they had a home birth and something went wrong, but they never say this about delivering in hospital, because hospital is the default option. But things can go terribly wrong in hospital which might not have gone wrong at home, where a labouring mother isn't left alone or given drugs to 'speed things up' or whatever. Catastrophes happen during both home and hospital deliveries, but somehow the feeling is that the hospital ones were unavoidable - when at least some of them weren't.

Possibly I am biased because the childbirth catastrophe story I knew the best would have been unlikely to have happened if the mother had been labouring at home: she would have been transferred for a section by a watchful, experienced midwife, not left in the hands of an inexperienced locum.

To be honest I do find it a bit annoying when people assume that they know better off the top of their heads than people who design and conduct research for a living - and people do it all the time on MN

Because the hospital was too far away to get to quick enough if anything went wrong.

I was booked for home birth. All ready, house ready etc and when I went into labour the home birth team were under staffed so I had to go into hospital. I fell apart! I was booked in due to having massive anxiety surrounding our local delivery ward. Was under mental health Midwife because of it. Fortunately all was ok and I went home 3 hours post birth. My sister and mum both had home births though.

I haven't assumed anything. Have you read all of my posts? Or have you read one, got annoyed and fired off a shitty post?

It may well be the case that there are large studies that have compensated for the various things that could impact on outcomes, level of intervention etc I don't know (as I said several times).

The post wasn't, for example, "this really great study you can read here demonstrates that it's safer to give birth at home". It was a simple, unreferenced statement. That's fine (and I'm not criticising that poster) but I think it's fair to query how robust the evidence behind that statement is.

I was led to believe that I couldn’t have one with my first because of the risks (I’d had a DVT) but will be next time!

My reasons:

• I spent 4 months as an obstetric SHO, and I saw how quickly the rare, unpredictable complications have to be dealt with. Like cord prolapse. General anaesthetic, minimal scrub, baby out in minutes and still usually needs resuscitation. It can happen to a completely healthy mum with a low risk pregnancy without warning. Massive abruptions. Massive PPH. Shoulder dystocia. All unlikely but not a risk I’m willing to take.

• Pain. With my first baby I laboured in a midwife led unit, bathtub then birth pool, low lights, aromatherapy oils, supportive partner, gas and air, lovely and experienced midwife, no pressure. I had a precipitate labour and it was the most terrifyingly painful thing that has ever happened to me, I felt like I was going to die and it took months to recover from the trauma. Next time I’ll either be induced with epidural in place, or have a planned section.

• Distance. I live 40 minutes from the nearest hospital and 3 hours from the nearest labour ward. Not counting the time for an ambulance to arrive. I’ve done the 40 minute trip in the back of an ambulance at high speed when I wasn’t the patient, and the idea of doing it in labour or having just delivered is not appealing!

• Comfort. I work in hospitals, they don’t frighten me and the monitoring etc actually makes me feel more relaxed. At home I’d be worrying about making a mess!

The threshold for transfer with home birth is much lower too. You're likely to get a more experienced midwife, who is with you 121 and will transfer you early. Risk is managed very differently. I'd rather that than someone coming in and out every 30 mins while attending to 2 other births.

Yes, things can and do go wrong. But they go wrong in hospital too, and sometimes because of hospital. Birth is a risky business wherever you do it.

(Full disclaimer - totally crap hospital birth followed by brilliant home birth).

@ArgyllFTM my first Labour was precipitate too-awful-that made me more determined to go for home second time so I had more agency in managing it and could slow it down with the pool. Which is why it's so great we have the choice, because we all approach it differently.

I saw how quickly the rare, unpredictable complications have to be dealt with. Like cord prolapse. General anaesthetic, minimal scrub, baby out in minutes and still usually needs resuscitation. It can happen to a completely healthy mum with a low risk pregnancy without warning

Exactly what happened to me.

Personally I couldn’t think of anything worse than having a home birth. I was high risk both pregnancies for different reasons but even if I wasn’t I would have declined. I also would have declined midwife lead units if I had been given the option.

I feel safety in the comfort of hospital, knowing if needed there is a consultant on hand in case of complications.

I don’t find baths calming, and when in pain I don’t find my home calming. I got to 7cms at home with both births but that was enough for me.

A few of my friends have had home births and loved them, but not my cuppa tea

I didn't do it because I didn't know that I wouldn't have a story like @RoseHippy1. The risk of something happening that results in death or serious injury without treatment only available in hospital is low but not one I'd take.

People always say that they'd blame themselves if they had a home birth and something went wrong, but they never say this about delivering in hospital, because hospital is the default option
Perhaps that's because things could "go wrong" at home and end in death, whilst if the same thing happened at hospital mother and baby would both survive? I'm not saying hospitals are perfect or never make mistakes but there are cases outlined here where people would be dead if they hadn't had hospital births.

I very nearly had a home birth with my second ... but the “what if” thoughts stopped me. Every day I count my lucky stars that my baby and I are here and healthy, that I opted for a hospital birth and that she was able to be born by section so incredibly quickly. I had PTSD for a few months after her birth and still shudder when i think what could have happened.

I didn't say nobody looks back on it fondly, I said I know one person who has been to hospital who looks back on it fondly. It's great that you do, but apart from that one person, everyone has hated the food, lack of privacy, midwives, lack of being listened to, not being kept informed and dignity not maintained. Even while I was pregnant nobody told me any positive stories about childbirth, nobody seemed happy which is very sad when you consider what an eventful day it is.

Because I was a low risk pregnancy but we ran into horrific problems minutes before my child was born and they needed resuscitation and taking straight to PICU. I also needed immediate intervention.
I’m so pleased I was in hospital under consultant care

My first was 45 minutes my second was 15 minutes start to finish I'm due my 3rd soon and I've been asked a few times if I want a home birth.
I have thought about it but I just don't want to risk it going wrong but then again the way my labours come on out the blue with no warning signs who knows where this baby will be born

With my son I had period pain for about 10 minutes then three huge contractions and then he was born instantly I had no tears no stitches needed nothing and it was actually lovely I'm hoping it's like that again luckily I was already in the hospital as they was going to induce me anyway

Because it’s not as safe of something goes wrong. There are a lot of women who simply aren’t allowed to plan to birth at home regardless. Of the ones who are many don’t want to risk it. I only know two people who successfully home birthed. Of the people I know who didn’t even try it most suffered one kind of complication or another (I didn’t labour quickly enough for example although hospital did fuck all to help, another woman I know was doing great until she fractured her tailbone, quite a few who ended up with an emergency ventouse, forceps, Caesarean, some who gave birth without issue to a baby who need immediate intervention and so on). Human being aren’t well designed for giving birth, we’re pretty shit at it actually. Modern medicine is the solution.

@Sunshinegirl82 the main study is called the birthplace study and participants were matched on things like risk factors. Low risk home births were compared with low risk hospital births and so on. So the idea that hospital interventions are higher because they are more likely to be high risk pregnancies is not correct.

Had a low risk pregnancy, toyed with the idea of a home birth (had a v supportive community midwife), but for me the possibility of having to be taken in during labour due to complications sounded more traumatic than just being in the hospital in the first place. Our hospital has a MLU right next to the central delivery suite.

In the end she was delivered by emergency section after a 40 hour labour. Had to be resuscitated & was in NICU. Both of us were septic & she had group b strep. They saved both our lives.

Despite all that, I felt safe, well cared for and respected, and still feel it was a positive experience. Have to have an ELCS for any future birth (had an odd incision) which I am so relieved about.

@GrumpyMiddleAgedWoman things generally go wrong in hospital births due under intervention. I say this as someone who had to suffer through reading medical negligence cases. I’ve never read of or heard of something going more wrong than it would have if left to nature as a result of medical intervention. For instance I was given drugs to ‘speed things along’ but the dose was slightly to high. My baby was distressed and we needed to deliver by ventouse. But if they hadn’t intervened the baby’s risk of infection would have been significantly higher (I had a subsequent similar delivery where they refused to intervene and my baby ended up with an infection for comparison) and there was also a risk that I would face a caesarean due to complete exhaustion (I hadn’t slept for about 24 hours at that point). I ended up with a healthy baby and an episiotomy when I could have ended up with an infected baby and major surgery.

Sorry OP can you clarify what you are asking me for evidence for?

I always think that the question is -

If there are risks to home birth which are not present in hospital birth (which there are)...

But the most comprehensive study for years (controlling for planned place of birth) suggests an equal or better risk profile for second time mothers plus...

What are the hospitals doing which cause not only a balancing of the risk of distance but in some cases tip the safety in favour of the birthing woman staying at home?

I think that’s a reasonable question.

@ChanklyBore I agree with you.

As others have said upthread if something goes wrong with a home birth the parents (and others) blame themselves. Whereas if something goes badly with a hospital birth it's just "one of those things, thank goodness medical help was nearby". Hospitals should be held accountable.