Home birth latest discussion

[Bumpkin]

http://www.guardian.co.uk/commentisfree/2011/nov/27/barbara-ellen-birth-marilyn-monroe

Did anyone read this at the weekend? I definitely fell into the 'heartbreakingly naive women' category (not a hot shot though in anything!). I had last minute very bad complications and the late journey to Kings having started with a home birth didn't help at all (probably made things a lot worse). My baby needed to be rushed to ICU straight after being born too and if he'd been born at home, I'm not convinced his problem would have been picked up so am extremely relieved we ended up in hospital for the birth.

Definitely worth considering if you're thinking of a home birth. Also the comment that this pulls midwives away from hospitals is one to bear in mind.

[Clare11]

All births come with risk.

I had a successful home birth with my son. My first child.

I think if you don't go into labour being open to the situation changing, whether for the better or worse, that's the problem, not women wanting to have a home birth.

It's very empowering to take birth out of a medicated setting, but ultimately the choice is with the parents where they want to give birth and where they are most comfortable.

[MichelleT]

What a miserable article by Barbara Ellen! And only her opinion after all - the study actually found that the risks were about the same. I hate the idea of women being put off home births because of scaremongering like this; home births are no more dangerous than hospital births and based on my experience at Kings probably a lot more hygenic, comfortable, and better monitored.

[amyw]

At the end of the day its up to each individual woman to make the right choice for her and her family. I think every first time mum is a 'naive first timer' - we all have preconceptions and apprehensions about how the birth will go whether it be a home birth or a hospital birth we are planning.

This kind of column is very 'this is what i experienced, so therefore you should think twice about your crappo decision missy' and is the kind of thing that really stressed me out in the last few weeks of pregnancy.

If you are considering a home birth talk to your midwife/doctor/consultant, don't read this column.

NB I'm sorry your baby was unwell and i hope he is well recovered.

[Monkey]

Great article. My thoughts entirely.

I also wish I had gone for the epidural instead of suffering like I did. Looking at it now, I think it was really pointless!

[The Nappy Lady]

Do any of us really know what birth is like until we have experienced it? Not sure this makes us naive. I've had two amazing home births. Some would say I was naive, or over confident, or brave, or stupid.....or just very lucky.

I would like to think I was pretty realistic but also confident that my body would be able to do what it was designed for & thankfully it was.

All women should have the choice to give birth where they are happiest and certainly shouldn't be forced to choose based on guilt about taking midwives out of hospitals.

[Lochie]

I find this article really patronising - I am sure that most women know that birth comes with risks. I think this BBC piece about the same study published last week is much more informative and useful - I am now 6 months pregnant and considering a home birth and was not put off by the stats here: http://www.bbc.co.uk/news/health-15861280

For every negative home birth story there is a negative hospital birth story. I really wanted to give birth in hosptial with my first child and found myself literally BEGGING to be let in for pain relief after 40 hours of contractions and no pain relief - chosing a hospital birth doesn't necessarily make it more straightforward and the doors are not always flung open to let you in when you want to go in.

I think the most useful thing for any woman making birth choices is to be aware that ultimately birth is an experience completely out of one's control, and if you do chose the home birth route, chose a midwifery unit specialised in home births.

[Lochie]

By the way bumpkin i'm not belittling your experience it sounds horrible

[new mother]

Badly written article with sloppy arguments. However I do agree with the underlying premise.

I am however interested in the other side of the argument. How can a well educated, mature woman who wants the best outcome for her baby and herself ever choose to be away from potentially lifesaving equipment and resources and voluntarily remain at home. I just don't get it.

The majority of women I know had had c sections, electively. Thus includes me. We all had easy pgcies, and births and my post birth scenario was possibly the worst with feet and wrist pain at around 12 months pp. We all drove soon afterwards and ran up and downstairs in my case on day two carting washing that noone else would do properly (!) around. I am so grateful for the immediate bonding we had and the massive euphoric post birth highs.

[Bumpkin]

Don't worry Lochie, I know there's no one answer to this. Just thought it was an interesting view as I was very uninformed when I chose a home birth and really had no idea what I was letting myself in for. Obviously it's great for some people, but I was quite shocked and surprised when my midwife told me very near the end that around 50% of home births end up in hospital anyway (or something like that, can't remember now, sure someone will correct me!). I hadn't even properly packed my hospital bag as I was sure it would be ok..

[new mother]

It doesn't make sense to say that for every home birth negative there is a hospital one when the vast majority of uk births happen in hospital.

Oh and birth of western sized babies is not "natural" as it often cited. Our pelvises are not designed to produce babies with heads this size!

Ps the answer is to lobby vigorously your(underworked) mp for improvements in hospital maternity care, and for maternity care to happen on a proper surgical ward rather thAn the hotch potch of care that is currently on offer in the nhs, rather than remove yourself to a non medical setting.

[MichelleT]

Sorry Bumpkin, I should say that I'm sorry that you had a bad experience and hope you and Bumpkinette are ok now.

This article made me see red. Worth reading the comments, I'm not sure that Barbara Ellen actually bothered to read the article she's quoting and the 'home birth propaganda' headline is just sensationalism. All births come with risks. So does crossing the road, and driving a car, and chopping up vegetables using a knife...

[mooncake]

Someone posted this in the Winter Babies Club:-

http://hackneydoula.co.uk/?p=492

I thought it was a much more informative view of what's actually in the study - and the links to the actual study itself are there for you to read for yourself.

I'm planning for a homebirth, but am under no delusion that I may well need to transfer to the hospital - midwives have been very open about it and gave lots of factual information at their monthly homebirth talk. The fact that the hospital is mere minutes away was probably the single biggest factor in deciding to at least try for it!

[EmilyE]

I'm no expert, but it seems that as well as taking midwifes out of hospitals, those people are also releasing hospital space and beds for those who need round the clock care, rather than a few hours for the birth.

Of course any women who plan for a home birth without considering the possibility of needing to move to hospital are probably naive, but that doesn't mean they are foolish to hope that they can stay at home.

[sophiechristophy]

That piece was awfully written and did nothing to empower women in birth, just to scare them. And New Mother, are you joking about pelvis size? Have we evolved so we just pop instead of giving birth then?

[MichelleT]

I'm sorry New Mother but why would I want more surgical intervention? Pregnancy is nit an illness.

[Moi23]

I don't think it's a western thing. Apparently humans pelvises became smaller due to bipedalism and our brains have become bigger. This has made birth harder and humans have benefitted from having fellow humans help out during the birth to avoid in particular tearing and other complications. I do think we're a far cry from a wild animal and its natural birth. I suppose we have naturally evolved to need/probably need help, be it an obstetrician, a midwife or whoever knows how to help a women deliver her baby in whatever culture you might be in.

I do think there needs to be a choice, but always keeping in mind that things might not go to plan.

[sophiechristophy]

That is why we gestate for only 9 months instead of 18 months, to allow delivery at a time when the head can pass easily through the pelvis. This shorter gestational period explains why our babies, when they are born, have a further 9 months of dependence and much more brain growth after birth, unlike other animals who birth at full gestation and whose babies can get up and walk and have a large degree of independence straight away.

[jollybaby]

Risk is very subjective. I can't help but look at the results below and think 'hang on why is the rate of complications in the planned home birth group nearly double that in all other settings?', but I know that others will look at this and find the results reassuring as the rate of complications was still less than 1%.

Rates of complications per 1000 births for first timers

Hospital midwife unit 4.5

Stand alone midwife unit 4.7

Hospital 5.3

Home. 9.3

I didn't want a home birth for several reasons including the wish to be as close to an operating theatre as possible. I know that if I'd gone for a home birth and something did go wrong then I'd have found it very difficult to live with my decision. This is despite being very aware that things can go wrong in hospital too.

In the end I got my wish - I had an emergency section and so saw the theatre from the inside! Would it have been different if I had opted for a home birth? In my individual circumstances I don't think it would but who knows. I suppose the most important thing is that you are informed and fully comfortable with your decision.

[ClareC]

I'm all for women having choice but a home birth is not everyone's want.

I felt pressured to have a home birth at every antenatal appointment, given I actually wanted a C Section, I found the situation very stressful.

Women should be provided with all information necessary for them to make an informed choice. They should not be pressured.

[gwod]

I find it hard to get the the bottom of the statistics, It reads as though, there is approximately equal risk/safety whether you choose a home birth or a hospital birth, but surely seeing as the majority of home births are considered "low risk" at the outset, this figure should be more in favour of the home deliveries than it is. Also are home deliveries that develop difficulties and conclude in hospital considered home birth or hospital deliveries as this could also skew the findings.

I ask these questions out of genuine interest in understanding the data, not because I feel strongly about what women should choose, but because I think it important that women can make an educated choice. (...and also because I am always wary of statistics!)

[jollybaby]

Gwod the study was designed to analyse on planned place of birth rather than eventual place of birth so home births that ended up being transferred were still considered as home births. This is what made it different to some of the previous studies, and allows for better comparison between complication and intervention rates.

[gwod]

Thanks Jollybaby, That does make it much more interesting reading than previous studies.

[mooncake]

I've read the study. You can find it here: http://www.bmj.com/content/343/bmj.d7400

They did the comparison against low risk mums in obstetric units - they also did an even more stringent test comparing low risk mums without any complicating conditions at onset of labour, but the rarity of poor outcomes meant they couldn't draw statistically significant conclusions...

[mrs f]

firstly "Also the comment that this pulls midwives away from hospitals is one to bear in mind" I'm not certain but I'd imagine that most of the midwives that deliver home births are community midwives and therefore not set up in a hospital environment and therefore are not being pulled away but actually doing their jobs where they should be, in the community.

I'd also argue that having two midwives at a home birth is a much better use of resources than having a hospital birth and all of those doctors etc.....

I would not ever dream of scolding people for their choice of birth.... I have quite strong views on the recent NICE guidelines saying women with no medical need should be able to choose a c section but I wouldn't dream of telling someone how unsafe (or a waste of resources) I thought that was... We are very luck to have a choice, and as long as we are all informed and educated about real risks then we can make our own decisions surely?