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 loved being looked after in hospital and getting my breakfast, lunch and dinner handed to me for a few days!

I hated being in hospital. I didnt feel "looked after" at all and I could have done without the tiny lukewarm meals. I would prefer to be looked after in my own home by my husband who can cook and deliver meals to me, in a comfortable bed with my own bathroom which doesnt require me to wheel my baby down a long corridor in my pyjamas.

@DrinkSangriaInThePark breakfast lunch and dinner for a few days?! You were lucky!

When I had my first I was in for all of 6 hours before they pointedly told us we could go home now! I had 2 bits of toast and a cup of tea, had to get myself dressed and go out in the rain to go home. It was one of the factors when I chose a home birth with my third - no having to get dressed and walk miles through hospital corridors to find the car hours after giving birth.

Definitely reasonable questions. And the attraction to me of a home birth was being able to reduce the likelihood of having to spend time on a postnatal ward, which no one I know has good things to say about, which should not be the case.

As it turned out first time round, my own risk factors meant that the safety of a home birth was outweighed by the safety of the MLU, and my house at the time wasn’t really suitable, though I did fully consider all the options. And I was lucky enough to labour mostly at home and have a very straightforward birth in a pool where the MWs barely touched me - so really the kind of birth people talk about having at home, but... not actually in my own home.

My straightforward labour history means that actually I could well be a good candidate for a home birth second time round, but my risk factors are still there...

I loved being looked after in hospital and getting my breakfast, lunch and dinner handed to me for a few days!

Where was this? Every single one of those pits of Hell that are post-natal wards all involve women fetching their own meals - and if they don't know this, they go without. Have yet to hear of one where the women were actually looked after by the staff.

(I was able to stay overnight on the MLU in a private room as they were quiet (again, risk factors meant it was better for me and baby to stay in for one night) - I doubt I would be this lucky a second time!)

Hello OP. I researched and chose a home birth for my second child. First DC was a planned hospital birth with a cascade of interventions and a traumatic experience. For my second child I planned a home birth. The home birth was amazing, quick and easy and tucked up in my own bed eating a bacon sandwich an hour after DD was born. I'm sure you'll do the research, I've yet to meet a woman who had a home birth who didn't consider it very carefully. If you want a bit of light relief amid the facts then Abigail Cairns book "Home Birth, Stories to Inspire and Inform" is simply wonderful. Best wishes for whatever you decide is best for you and your baby.

Where was this? Every single one of those pits of Hell that are post-natal wards all involve women fetching their own meals - and if they don't know this, they go without

King's College Hospital in 2016 and 2017. Had all meals brought to me. Morning after DC2 was born I had someone come round to take my lunch order. I said no thank you as we were about to be discharged. She smiled and said she'd bring it anyway. She definitely knew better as it took hours and I enjoyed my lunch choice!

@ChanklyBore I agree.

I think what is challenging for me personally (and I suspect, based on the comments here, that others struggle with similar) is that everyone will have heard a story of someone who suffered a significant complication during birth which, on the face of it, would have had negative (possible fatal) consequences if it had occurred outside of a hospital setting. That's pretty scary.

On the other hand, the evidence from research concludes that it is as safe/safer to deliver at home provided you are low risk.

Trying to reconcile those two things is difficult.

When considering the OP's question I suspect that many women are more convinced by the anecdote than the statistics. I 100% know what happened to my friend (low risk, sudden abruption, cat 1 section) and so that feels very real and possible to me. The statistics feel abstract and not very reassuring in comparison.

I know logically that the single anecdote I'm aware of is less significant and reliable from a risk assessment perspective than the well considered and extensive study but hospital just feels safer.

That's not rational I know and it is only my personal view but I wonder if perhaps others think similarly and that's why take up of home births remains low in spite of the evidence.

The irony is, the same was probably true when birth switched to hospital wards, @sunshinegirl82

There will have been horror stories about the hospital and the sick people and the procedures and why wouldn’t you just stay at home where you were safe, and my baby would have died in that there hospital.

I’d like to think we’d moved on, but there you go.

Why not concentrate not on women’s choices but on making both options equally safe, and postnatal care better?

It would have been a massive error for me to attempt a hospital birth. I don’t want to say ‘my baby would have died’ because I don’t like to scaremonger or compare. But the chances are fair that both of my births would have had worse outcomes had I attempted to journey to the hospital. It is pretty much a surety that my first baby would have been born by the side of the road without medical assistance, and showing signs of distress. My second baby could easily have suffered also, with an increased risk of infection for certain, and several other elevated risk levels.

I know and understand that it is only possible to know this in hindsight. But given the risk levels on both “sides” there can only be different risks, not better or worse choices. I believe women have the right to an unbiased choice without stigma or blame and to know that whatever their choice was, it was made with the best interests of their baby at heart. For the small percentage of births that have a sad outcome, home or hospital, answers should be sought and changes made, but women should be supported.

I don't disagree. Everything surrounding birth (and pregnancy and post natal care!) needs to be massively overhauled, there is so much wrong with it I don't know where to start.

In reality I could never have had a home birth as I had complicated pregnancies and ended up with two sections (one emergency, one elective). I feel very positive about both births despite having loads of complications and was well looked after by the hospital I delivered at.

I'm just wondering out loud really if my (admittedly potentially irrational) feeling about being safer in hospital is something experienced by quite a lot of people which might be one of (the no doubt lots of) reasons people choose for a hospital over home delivery.

I forgot about the meals in hospital I mean they was nice but the wait for food was so annoying I remember I had my son at 6pm and I'd just missed dinner cause I was in the delivery room so my partner asked 3 times please bring her dinner up and they did but if he didn't ask who knows what I'd of eaten!

This time I plan to pack so much food in my
bag because the next day I had cold toast for breakfast and some biscuits and I was crying with hunger by 1pm, so my dad sent KFC in with my partner.

Id love a homebirth but my fear is something will go wrong with the baby and we're not close enough to the hospital to get him there in time to get help but a homebirth would be so much nicer

What struck me was with my first labour (hospital birth) I was heavily discouraged from going into hospital, even after phoning the ward several times and spending hours and hours at home with contractions. When i was finally told to come in (after my waters breaking at home) I was already 8cm and gave birth very soon after arriving. The general attitude was ‘well done’ for staying at home so long. I have friends who have turned up to hospital fully dilated and ready to push, having spent 90% of their labour at home (not always through choice) and it’s been made out to be a positive thing.

Then I have friends who have had home births and have had health care professionals with them, caring for them, monitoring them from a much earlier point, at a point where many ‘hospital birth’ women are still going to spend hours alone at home away from any health professionals.

I just find it odd how it’s so common for women to be told ‘good job’ for spending most of their actual labour at home as long as they make hospital at the end but home birth is viewed by many as irresponsible and dangerous. By that way of thinking surely women who delay getting to hospital would be seen as risky too?

@converseandjeans I think it's actually cheaper for the NHS- no overheads associated with hospital and more likely to be low intervention- doctors are less likely to be involved because they aren't to hand, no chance of an epidural and associated intervention risks etc etc.

I've had two and they've been great. Use of some diy store plastic sheeting and there was no mess left behind at all.

For me personally I’d prefer to be in the hospital so if anything were to go wrong me and my baby are Already in the best place possible.

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"

But in a case where hospital staff could have done life saving interventions if the mother had been there rather than at home, they did make a choice to take that risk, did they not?

Obviously hospitals should be held accountable if they make mistakes. Imho they intervene early/quickly because they err very much on the side of caution. Not because they just love doing interventions.

Fwiw I had 2 uncomplicated hospital births, didn't need any interventions or have them suggested, didn't see any Drs either, had 1:1 midwife care.

Each to their own of course. I know someone who's sister died in a home birth but still chose to have home births herself.

@ferrier That was also what I concluded from doing my research and the main reason as to why, should this pregnancy continue to be classed as low risk, I am very keen to have a home birth 😊

@DrinkSangriaInThePark A private room? I'm assuming you paid for this privately?

I disagree with the opinion that hospitals ONLY ever carry out interventions for best interests - I very strongly believe mine were to speed up the process as the room was needed. Of course I'm absolutely not saying this is always the case.

@RainMinusBow I live in Ireland, but yes, a lot of people pay privately here. It doesn't get you a private room usually, as they are given on a first-come- first- served basis, but I had an emergency section with twins so got one. In fairness, my experience would have been much less positive if I was in a big ward, and I'm shocked by reading on here about partners being allowed to stay overnight in wards! Is that the case all over England? My husband thinks that's a great idea, I am horrified by it!

I would have had a home birth for DC2, however we live a stone's throw (a three minute drive) from a community birth center, so I opted to go there. It was a "home from home" experience and avoided the faff of hiring a birthing pool, etc. It was just me, DH and the midwife in the building when DC2 was born (early hours of the morning) and was incredibly peaceful.
We were back home a few hours after the birth.

Had I lived a significant distance from the nearest suitable birthing location, I would absolutely have had a home birth.

I planned a home birth... firstly I was asked to go to hospital to be checked when waters broke as there was no midwife available. I quickly progressed and they still had no midwife availability due to another home birth. We had to call an ambulance as I couldn't sit in a car... thankfully I did as baby was breech and started coming in ambulance... he was out in 12mins of arriving at the hospital.. would I plan a home birth again- I'm not sure... I love the idea of it, but if I had stayed at home I do not know if my baby would have been ok. I know what happened to me is extremely rare, I do think more info should be given out re home births tho.

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.

I absolutely blame the hospital for a large percentage of what went wrong with dc1's arrival. As does virtually everyone else I know who had a traumatic for whatever reason hospital birth. Mine came about in part because I wasn't listened to/taken seriously by midwives. Afterwards at my debrief (v. long labour, pushing, failed forceps and a traumatic emcs) I was told that they didn't think he'd come vaginally because of my sub optimal pelvis but that I gave it a "good go". In fact the midwife who was trying to deliver him didn't even think I'd get to full dilation (I did) because he wasn't properly on the cervix, a fact she failed to mention to me instead choosing to tell dh whilst they were running my bed down a corridor to theatre.

Ultimately though, a home birth would not work for me because I can not stand strangers in my house. The thought of two random midwives arriving whilst I was I was in pain/vulnerable fills me with dread.

velveteenfruitbowl, look up the cascade of interventions.

Besides, it's not a choice between intervention in a hospital and no intervention at all. I was always prepared, when I laboured at home, to be transferred if my midwife said it was necessary. But if you labour at home with the expectation of delivering there, you massively reduce your chances of unnecessary interventions even though your midwife is constantly alert for any signs that she needs to call the ambulance. She will have quite an elaborate set of kit with her. Yes, there are some situations (sudden massive abruption being one of the few) where she will be overwhelmed, but still the stats remain that a homebirth for a low risk woman is safer for her and her baby than being in hospital.

Why? We don't know, but I suspect that the cascade of interventions has a lot to do with it.

Am I correct in thinking there are two midwives present during a home birth? Think I read this somewhere but not sure?