Stupidly ignorant article on homebirth in the Times this morning!!

[sparkle12mar08]

Here.

Had me practically bouncing in my seat with rage - I've never been so close to shouting out loud in public. Melanie Reid - you should be ashamed of yourself. Why let perfectly good research get in the way of your own petty, ignorant opinions eh?!

I could take her article apart line by line (it's that riddled with crap), but I'm just to incoherently angry an amazed right now!

Aaaaaarrrrrrrgggggggghhhhhhhhh

But it's not a good article, Mags. For a a start, it's shoddily written and feels the need to insult people in order to get the point across.

Oh and by the way

I have actually read the paper on which these latest 'same as hospital delivery' reports are based.

Lets just say my interpretation of the results (and that of most of my medical colleagues who I have discussed it with) is rather different to the way it has been portrayed in the news.

It is a fairly poor trial actually. But apart from that, consider this.

The 'homebirths' group came from the lowest risk 1/3 of women. Their babies had the same rate of admission to special care as in the whole other 2/3 of women, who include all high risk deliveries - who would be expected to have a higher rate of problems as they include prem births, inductions for IUGR etc etc).

So to say they had the same rate... (in fact if these are supposedly low risk pregnancies you would expect the rate to be a. a lot less than that of high risk pregnancies (it isn't, which says a lot) and b. less than hospital simply because there are were half the number of women (but there were the same).

Just think about that for a minute.

Does that put a different perspective on it?

It's all about personal opinion and I hear what you're saying mags98 but I personally know a senior Consultant Obstretician (I get word blind with that one.. never sure if it's right) who gave birth at home very happily.

It's horses for courses. I think that Ms Reid hasn't provided a balanced article. I think she's hopping up and down on one foot and not actually looking either at statistics or people. I've supported women at home and in hospital. Sadly the unexpected can happen anywhere with good or bad outcomes. I have had friends lose babies in hospital due to all sorts of reasons. I would never tell a woman that she shouldn't give birth in hospital because of that any more than I would tell her not to give birth at home.

An alternative article

news.bbc.co.uk/1/hi/health/7998417.stm

Of course it is about personal opinion. All I am saying is that the opinion should be based on actual reality, not some rose-tinted of view of it.

Of course some consultant obstetricians might choose to have a homebirth (and I would hope they at least would be fully informed!). However of the ones I know and have discussed it with, all have chosen hospital births, and several think (with quite a lot of justification) that in fact the safest option taking EVERYTHING into account is probably elective C/S.

I know hundreds of doctors. I don't know any (or their wives) who had a home birth.

Its just my experience, though! Not saying everyone should agree.

Mags, are you really saying that an elective CS is safer than a vaginal birth in a woman with no other risk factors? (or have I got it wrong?) Surely major abdominal surgery cannot be safer than a natural process which are bodies were designed to perform?

I don't think it's a very good article because she doesn't point out just how different the Dutch set-up is to what we have over here (although their stats are always touted over here regardless of difference). Dutch paramedics are all trained in the specifics of how to resuscitate a flat baby, for example; ours are not.

this is why i dont buy papers. i can get angry for free.

I've just read the article in the times. I had my 2nd child at home and it was a great experience best of all I got to sleep in my own bed and my eldest slept through the whole thing. I had my 3rd in hospital simply because I was nearer the hospital than home when I went into labour it was coming up to rush hour and she was so speedy I would never have made it home. I'm now planning to have #4 at home in fact my midwife said that due to the speed of my last labour they'd want to give me a homebirth box anyway as they wouldn't want me to give birth in the car. In my area they are really promoting homebirths for low risk women and you can still have gas and air to help with the pains. I think it's so important for women to have the choice and for everyones choice to be equally respected.

MAGS98 - I was at the pub with mums from school recently. One was a consultant obstetrician who said that she felt an elective cs was the safest way to have a baby (though she put lots of caveats in). Another mum is a consultant paediatrician and laughed for ages; she said that it was the first time she'd heard an obstetrician actually come out with that, but that she's always suspected that they think that, and that in her medical experience an elective cs is the worst possible choice for the baby (also with caveats).
They were both pissed so saying things they wouldn't normally!

The rest of us thought it was very funny how the difference of educated medics differed so much according to whether their department!

Well its an interesting question about which is safer.

Yes, a vaginal birth with no complications is clearly safer than a C/S.

However, it is not as simple as that.

You have to look at the chances of actually having no complications at all. And to most peoples surprise, the chances of that are really quite low. For a first time birth, its maybe 1 in 3, or possibly even less in some hospitals. By complications by the way, I include significant tears, episiotomies, instrumental deliveries, forceps, ventouse use of epidurals, and everything ranging up to emergency C/S, plus postnatal complications.

Now if you end up with an emergency C/S and in some hospitals the rate of that is 20-25%, then the risk is more than 10 times that of an elective one. And a third or fourth degree tear, while strictly a 'normal' birth will take some getting over too! Thats not to mention later problems with feelings that the birth did not go as you wanted. And of course, pelvic floor damage that might appear later in life.

So yes, a totally uncomplicated vaginal birth is clearly the safest. And if you knew you were guarantted to have one, then there would be no debate. But if you only have a 1 in 3 chance of having one of those, and the risk of any emergency procedure is higher (emergency C/S is 10 times the risk on an elective for example) then on balance, is it better to choose a known low risl over a potentially lower but potentially much higher risk? it actually is a very evenly balanced risk/benefit question.

Yes, must admit you make sense mags! However, I think the key phrase that you mention is ''possibly even less in some hospitals'' - if the rate of having no complications varies by hospital it seems likely that some interventions may be caused by the hospital in the first place...
Also, I presume the risk of a vaginal birth is less if you've had previous uncomplicated vaginal births?

At the risk of going totally off-topic, I find your post really interesting, Mags98 (speaking as someone who has chosen to have an elective cs for first baby). Having done lots of research on the matter, I'd come to pretty much the same conclusion: i.e. it's a very balanced risk/benefit question. Given this, and given that so many consultant obs do see elective cs as an equally safe option, why do you think it is that women still have to fight and stand their ground to get one for first time pregnancies on the NHS? Is it simply an issue of cost to the NHS?

Many of the risks of giving birth naturally are CAUSED by giving birth in an 'unnatural' environment.

If I was told I had to be induced, or even give birth in one or two consultant units I know of I would choose a c/section in a flash. The 'unknown' risks are not worth it to me,plus the fear would stop me labouring properly and increase my chances of the risks becoming reality.

However, the complications you mention Mags98, are much less likely to occur in a homebirth.

I have a friend who had all 3 of her children at home over a beanbag with just a bit of gas and air with absolutely no problems.
I however had both children stuck and would have lost them had I not been in a fantastic hospital with all the medical help I needed. I am having twins and will go for a CS this time.
It's a risk I just would not take with my child or my life when it's available for me to choose a safer option.

My problem with the article is the insinuation that anyone who chooses a home birth has turned their back on medical help, which is a nonsensical thing to say. I don't think anyone blindly stumbles down the home birth path thinking they'll refuse everything except a stick to bite on no matter what happens.

Neddie It would be impossible to say whether hospital practice and procedure led to your children getting stuck, - but the 'hospital way' is not one which enables the mother and baby to work together in an optimal way to avoid/prevent the majority of these cases.

In addition, hospital risks are very real. The transfer alone is a potential hazzard for mother and baby. There are risks of being sent from one full hospital to another, risks of contamination and risks of having very limited care particularly if you are considered low risk.

Oy Starlight, what about your NY resolution?!

Starts properly tomorrow......

And I'm allowed to finish on the threads I'm on

And,......... - well no wonder I can't lose weight. No self discipline at all!

I caught you red handed

I'm so with you with the self discipline!

lets not forget that this is an 'opinion' piece rather than pure investigative journalism, so is intended to be a very personal / definite view.... i doubt jeremy clarkson could have done better!

i have to throw in my vote with mags - while homebirth may well be a wonderful choice for many women (as the article states), i personally feel much more comfortable knowing that i will be in hospital for my second, and that (touch wood) if anything does go wrong, the best help and attention is right there. this is far more important to me than being able to sit on my own sofa while out of my mind with pain! i think it's all about risk - if my nearest hospital was an hour away i would probably have a different view.

and yes, i have been repeatedly been offered a home birth by my midwives.