Home birth latest discussion

[Gussy]

I can't even bring myself to read it. I know it would make me too cross.

[verds]

In an ideal world, everyone should have the choice to give birth how they want.

Midwives tried to pressure me into a homebirth, which was disgraceful. I had considered it as an option, but had decided against it and told the midwife. The next day, I went into labour and when a different midwife arrived she told me I'd be missing out on a beautiful experience by going to hospital. I was fully dilated at that point. We spent the next 7 hours with me asking to go to hospital, and her leaving me to struggle on pushing at home. Eventually, I was taken to Kings by ambulance and fortunately had the baby safely.

I'm pregnant again, and this time round I'm with Kings midwives and have written down the fact that I want to have my baby in hospital. Obviously I'm terrified after my last experience.

Women shouldn't feel pressured either way. We're the ones who have to go through labour!

[littlemoo]

I have been wondering whether to post on this thread, as it is a subject that really hits home with many people for many different reasons. I for one was not surprised by the the findings last week, and whether you like the article or not, the findings of the legitimate research study do find that first time mothers attempting a home birth have a significantly increased risk of having serious complications.

My first son was born at home, after a seemingly easy labour, with amazing midwives present (the same group who have looked after me in my two subsequent pregnancies - I am currently pregnant with my 3rd). However, despite having been reassured that when things go wrong, there is usually a warning, and that we were only a few minutes away from kings if needed, we had the worst possible outcome.

My son experienced a shoulder dystocia at the end of my labour ( we think he had actually been trapping his cord for a significant period of time before hand, undetected - and I am also it turns out - Group B Strep +ve) and he came out unable to breathe. Despite being so close to Kings, it took 25 minutes to transfer to the critical care that he required (rescus at home consists of a bag and air - no oxygen) and sadly after a week of fighting for his life, he passed away due to the brain damage he suffered during his labour, which was intensified by the delay in him being intubated.

Now, he may have arrived in the same poor condition in a hospital, or on a different day, the outcome at home may have been different. But in hospital, he would have been immediately intubated, possibly saving his life. We will never know, but I will have to live with this for the rest of my life.

What is not mentioned when discussing homebirths, is that when things go wrong, it really is crucial how quickly the baby can be cared for, and the results can simply be catastrophic. Minutes away from a hospital is never really near enough.

Now, I know that many people have very successful home births,and people have horrible hospital births. But in retrospect had I been aware of the increased risks I would not have tried to labour at home.

As for the rarity of poor outcomes, the study itself states that the risk raises to nearly 1/100 of complications for a first time mum at home, which when put into perspective, is a figure considered high risk at a nuchal scan.

Generally we all live in blissful ignorance about the frequency of poor outcomes generally in pregnancy. SANDS (The Stillbirth And Neonatal Death Society) state that 17 babies (from 24 weeks gestation) die before, during or shortly after birth, every single day - that is also almost 1 in 100. When you consider the number of pregnant women in East Dulwich, it becomes less of a surprise that I know of two other mums who live within 3 roads of my house who have lost babies at term.

Of course I would never say to anyone that they should not have a choice about where to give birth, but for me there is far too much emphasis put on the "woman's birth" it should be remembered that it is actually our babies births, and that we have the duty to give them the best possible start and chances, what ever you consider that to be.

Sadly, I thought that was what I was doing for my first born, and instead he had no chance.

My second son was born by elective c section, as will this baby should all go smoothly. I feel no less of a bond to my son, I am simply grateful that he arrived safe and well and brings me constant joy.

[Sanne Panne]

> for me there is far too much emphasis

> put on the "woman's birth" it should be remembered

> that it is actually our babies births, and that we

> have the duty to give them the best possible start

> and chances

Littlemoo, how well said. Your story is heartbreaking :(

The reason I agree with you though is not sympathy but the fact that there is a lot of truth in what you say. I had an unplanned homebirth with #1 - would have had her in hospital if she hadn't come so ridiculously quickly - it was great of course but only because it turned out so well. We had #2 at home because #1 had no complications and I knew the birth would probably be so quick that travelling would be more of a risk - but if the first had not gone well I would have opted for a more "managed" hospital experience with #2 even if that had meant early induction to avoid another crazy fast labour.

It's so difficult to give a general guideline to everyone. But yes, it's about the baby first and then about the mother. Very true.

[sophiechristophy]

Littlemoo, your story is so terribly sad and I am so sorry for your loss. It is very important I agree to remember the babies in all of this, and I do think that often in pregnancy we can get caught up with the 'sort if birth' that we would like, when really all we should be wanting is a birth where everyone is well at the end of it.

[bluesuperted]

Littlemoo, I'm so sorry for your loss, the most heartbreaking thing you could go through. Thank you for taking the time to write such an honest and measured account considering the terrible circumstances.

I planned a home birth for my (first, so far only) son, I got a very medicalised and protracted induction/emergency c-section and in the days afterwards my midwives (who were absolutely lovely) and others constantly asked me if I felt disappointed/unhappy/depressed about what had happened and how my expectations had not been met. I tell everyone that I just felt so lucky to have a positive outcome and a healthy baby and your story makes me feel even more fortunate. I don't know where I sit on home birth now. Very much on the fence I think, whereas when I was pregnant I felt very pro.

Wishing you a safe and healthy rest of your pregnancy for you and your whole family. Thanks again for sharing.

[Monkey]

So sorry for your loss. Thank you for sharing your story.

[MichelleT]

Littlemoo, thank you for sharing your story, I'm so sorry for your loss.

[snowboarder]

Littlemoo how dreadful - I am so sorry and your story serves as a sobering reminder of how wrong things can go...I think those of us who only have experience of a positive end result tend to forget. All the best for your third baby.

In reference to the study - I have only skimmed this but it seemed interesting - a doula's blog comment on the study : http://hackneydoula.co.uk/?p=492.

I had a 'failed' attempt at a home birth for my second son born earlier this year, after my first was born by elective c section. Even though I ended up with another c section at Kings this time I was glad to have the opportunity to labour at home with 2 amazing midwives, and have as undisturbed labour as possible, which would not have been the case in Kings. I would definitely try again if we have another child.

[Monkey]

The problem is that too many people without medical training, including doulas, opine. I have not read hackneydoula's blog because I cringed as soon as I read the bit about how she became "awe-inspired" with what the woman's body can do and that put me off! As Littlemoo's post shows, things can go badly wrong and very quickly. And when they go wrong, you need medical staff and equipement nearby.

[Lochie]

Littlemoo - I am so deeply sorry to hear of your experience, it is the worst possible outcome for any mother. Your post has been useful to me as it has given an insight into the transfer window from home to hospital. With my first birth I was told by a very persuasive NCT teacher that it doesn't matter if you are at home or hospital safety wise as if there are any difficulties then it takes 'just as long to prep a theatre for you as it does for a blue light to turn up at your home and get you into the theatre'. In your case however this point seems irrelevant and hospital was the safeest place to be.

I have to say my community midwife has been fully communicative of any dangers and I have had to sign a bit of paper saying that I understand that in the case of difficulties the best place to be is hospital. So my experience this time is improved and I am aware of the pros and cons of both choices.

I wish you the best of luck with the birth of your third child, it sounds like you are in good hands

[Monkey]

A sobering story to mention to persuasive NCT teachers and other people talking non-sense: there was a mix up when we ordered the ambulance. A doctor finally arrived, thinking he had been sent for a resuscitation. It was not - I needed an ambulance to take me to hospital. We had to wait more for the ambulance.

[srisky]

A very brave post, littlemoos, it must have been ever so hard to write it. As described, shoulder dystocia and cord prolaspe (as well as other complications) can happen quickly, unexpectedly and the situation can deteriorate rapidly. Importantly, you need to factor how long the transfer from home to labour ward/theatre could take:

- community midwives realise there is something wrong

- call 999

- ambulance dispatched

- ambulance arrives

- paramedics get a handover from midwife +/- your observations are taken (hopefully can be done enroute)

- transfer you into the ambulance (not necessarily straightforward if the labour is becoming complicated)

- drive to hospital

- transfer from ambulance to ward (hopefully there will be an emergency lift)

- arrive on ward

- handover from midwife to doctors/hospital midwifery team

- rapid assessment by doctors

- treatment commences/transfer to theatre

I was told repeatedly told by my (wonderful) midwives that if they think anything is going wrong then they will call for an ambulance and bluelight me to hospital but the length of time was never emphasised.

I am not trying to convince anyone against homebirths, as the majority have a wonderful outcome, but an informed decision should be empowering. If what I write seems like scaremongering, then please re-read littlemoos post. It is scary and deeply traumatising.

I think sometimes the dream of having a natural delivery in the comforts of your home and then curling up in your own bed with you newborn overshadows the ultimate dream of a healthy mother and baby. It definitely sounds better than the alternative of being in hospital with increased chances of interventions and then spending the night on your own in a noisy post natal ward. When it's put like that, I know which I would prefer! It's not the mother's fault but sometimes not enough gravitas is put on the 'when things go wrong scenario' by the health professionals.

> 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

Having not read the study (so do correct me if my interpretation is wrong), the rates of complications of home births do seem high if you take into consideration that:

- those having home births ought to be considered very low risk

- the rates of complications at hospital would include those who have high risk pregnancies, as well as the low risk ones.

All the very best for your pregnancy, littlemoos (and anyone else who's expecting).

[srisky]

Gosh, sorry for the long post and well done if you bothered reading it ;-)

[Lochie]

I think you are completely right srisky, and your post was very well put! To be honest the only reason I am considering a homebirth is because of your comment about hospital intervention and postnatal wards, and having had an unpleasant first experience I don't really want to repeat it. However I will do whatever is right on the day.

It is a shame when I compare the options today with my own mother who gave bith to me and my brother 30 odd years ago at Kings - an 8 day stay in hospital after both births (despite not having any complications) so that the mother could rest and recover and be fully confident breastfeeding when discharged. And a strict matron on the ward to tell any noisy residents to keep the noise down!

Perhaps if today's hospitals didn't treat delivery like a conveyor belt then more women would enter hospital to give birth with confidence. I'd love to see more home from home environments locally attached to hospitals.

[Bumpkin]

littlemoo, again thanks for sharing and so sorry to hear of your loss.

I fortunately had a positive outcome and little B and myself are fine and healthy. However I had very late onset pre-eclampsia which didn't manifest the day before so I thought all would be well with the home birth with local well regarded community midwives. The fact that my blood pressure had suddenly sky rocketed to very dangerous levels was only picked up as my partner begged the midwife to come out and give me some pain relief and had to be quite forceful. She wanted to have her tea and wait another couple of hours as I was only 4cm dilated at her previous visit (they don't stay with you the whole time you are in labour until you're established). She reluctantly came, didn't give pain relief and took blood pressure as an afterthougth. As it was extremely high she told my partner to drive me to the hospital and park nearby, she wouldn't come in the car with us or drive us in her car. We couldn't find a parking space outside so had to walk quite some distance which pushed my blood pressure even higher. As soon as I got into hospital, the fantastic emergency team took over and I was so relieved to be in professional hands. The aneathetist came to visit me the next day to check I was ok and said I was very high risk of having had a stroke or major organ failure...

I really don't want to just scare people, but I strongly feel I was very naive about the risks espcially being an older mother (post 30) and feel very lucky everything turned out ok. I personally would never recommend any one to have their first birth at home, but everyone has their own view coloured by their own experiences.

[jollybaby]

srisky - I think the study only included women with low risk pregnancies otherwise you couldn't really make any comparison of intervention rates etc.

"Having not read the study (so do correct me if my interpretation is wrong), the rates of complications of home births do seem high if you take into consideration that:

- those having home births ought to be considered very low risk

- the rates of complications at hospital would include those who have high risk pregnancies, as well as the low risk ones"

[mrs f]

I believe the rates for home births in the uk are well under 1% no?? So really most people do go for a more medicalised environment. It probably seems higher in ED due to the demographic / proximity to kings / volume of community midwives etc... Having had a very positive one I can see why people encourage / evangelise about them but it has to be right for you & you should be no / low risk clearly.

Seeing as the study has proved that midwife led units are the safest place to have your 1st baby I do hope that this encourages more funding their way as they seem like a fantastic idea.

[sillywoman]

Monkey Wrote:

-------------------------------------------------------

> A sobering story to mention to persuasive NCT

> teachers and other people talking non-sense: there

> was a mix up when we ordered the ambulance. A

> doctor finally arrived, thinking he had been sent

> for a resuscitation. It was not - I needed an

> ambulance to take me to hospital. We had to wait

> more for the ambulance.

I think you might find that some of those "persuasive NCT teachers" are fully aware of the failings in the system - both for hospital and homebirth. They just want women to be fully aware of their choices. They hear a lot of sobering stories Monkey, so feel free to add another into the mix. They're also reading this thread & this one in particular is a bit cross at the unfounded accusation that I am 'talking nonsense'.

I for one welcome this study - though I haven't yet read it in it's entirety, I do intend to very shortly. Anything that gives clarity on risk factors with accurate & relevant statistics is useful when making people aware of their choices, and the reality of what those choices might mean to them. Also I am very fond of statistics.

For me I'm not too sure where I stand on homebirth from a professional standpoint, I do support it, but with reservations for first timers. Like littlemoo, I've pondered long & hard on whether to post on this thread or not, but I feel I should come clean at this point - I was littlemoo's NCT teacher and have travelled the journey through the death of her first baby, the joy and anxiety of babymoo2, and am now delighted all over again to be looking forward to welcoming babymoo3. Like Littlemoo, the supportive words I spoke to her regarding her homebirth during her first pregnancy will haunt me for the rest of my life and the part I played in babymoo's story is something I'll carry to my grave. When tragedies happens everyone involved must surely examine their own consciences?

On a personal level I've had 2 homebirths myself, so I do know how much better they are in terms of birth experience, which can have a knock on impact on the speed of a womans recovery, and so to the physical resources she has available to deal with those tough first few weeks with a new baby. Why wouldn't I want other woman to have the opportunity to experience that if they chose? But there are risks. Babymoo's death has certainly informed my teaching and changed my view (as do many of the birth stories I hear) - I wouldn't be a thinking, reasoning being if it didn't. I no longer advocate homebirth with quite such gay abandon, BUT I do advocate it, within certain parameters and with appropriate support and circumstances.

Giving birth is not risk free wherever you do it. If we approach this risk in a climate of fear then we may well end up with a birth situation like the Brazilians have - 80-90% caesarean section in their cities. Whole generations of women who don't know anyone who has given birth vaginally. Midwives and Obstetricians who are de-skilled at delivering babies vaginally. Part of what Midwives, Doula's and Antenatal teachers do is to protect the culture of birth. We only have to look across the pond to see what happens when fear of birth & fear of risk is allowed to escalate and an Obstetric, risk averse culture prevails.

Yes, this research seems to suggest that first time Mums would be better off in a MLU (Tommies or Lewisham being our closest - come on Kings, get your finger out!). Yes the main aim for every woman should be, & is a safe Mum & a safe baby, (I've yet to encounter a woman who feels otherwise) but also stuff happens. Weigh the evidence, examine your beliefs and ethics, make the decisions that are right for you & your set of individual circumstances. But it's important to acknowledge that the decisions we make for ourselves aren't always right, the decisions we make for our babies and children aren't always right. We can only do our best with the information available at the time and live with the consequences. We are only human.

[Saffron]

It would be nice if there were (more) ways to give birth in a hospital environment without the birth becoming necessarily medicalised.

When I lived in Switerland, I noted that birthing centres directly attached to hospitals seemed popular. You and your family/friends could stay at the birthing centre basically from the first twinge of labour until the birth and beyond if needed, with hospital facilities literally walking distance from your unit. It's like a home away from home.

In addition to labours being overly medicalised, another problem with hospital births is women getting turned away b/c staff think labour is not established, and a bed can't be spared for the woman. My friend was turned away from the hospital 3 times in 3 hours b/c they didn't think her labour was estblished. She eventually gave birth on her hands and knees on the floor behind a curtain in triage, and the midwife barely made it in time.

It also needs mentioning that an elective C-section is certainly not without its risks, to both the mother and the baby. It's not the easy or safe option the media often hypes it as.

When you weigh up the risks as you understand them, you have to believe that you make the best decision for you and your baby at the time, and try not to blame yourself for the outcome one way or another. xx

[Monkey]

Lochie Wrote:

-------------------------------------------------------

> I think you are completely right srisky, and your

> post was very well put! To be honest the only

> reason I am considering a homebirth is because of

> your comment about hospital intervention and

> postnatal wards, and having had an unpleasant

> first experience I don't really want to repeat it.

> However I will do whatever is right on the day.

Could not agree more. Post natal care at king's is poor and it puts people off. All my cousins and friends in France have had such easier birth experiences. Over there, women don't ask themselves where to give birth. They go to hospital, get given pain relief if they want it without having to beg for it, and are looked after properly after the birth. Post natal rooms have a maximum of two ladies per room and an en suite bathroom. They can give the baby to the midwives for the night if they wish to and get given proper meals. Yes they are tired but nothing like what I have seen and experienced over here. It is a very medicalised environment, yet none of the people i know have had c-sections. I really think thathis proving hospital care or having more home from home environments are the way forward. Maternity care needs to be improved and in lieu of improvements we're being sold a dangerous (and painful) alternative which o me sounds more like a big "f off" than anything else.

>

> It is a shame when I compare the options today

> with my own mother who gave bith to me and my

> brother 30 odd years ago at Kings - an 8 day stay

> in hospital after both births (despite not having

> any complications) so that the mother could rest

> and recover and be fully confident breastfeeding

> when discharged. And a strict matron on the ward

> to tell any noisy residents to keep the noise

> down!

>

> Perhaps if today's hospitals didn't treat delivery

> like a conveyor belt then more women would enter

> hospital to give birth with confidence. I'd love

> to see more home from home environments locally

> attached to hospitals.

[Monkey]

Lochie Wrote:

-------------------------------------------------------

> I think you are completely right srisky, and your

> post was very well put! To be honest the only

> reason I am considering a homebirth is because of

> your comment about hospital intervention and

> postnatal wards, and having had an unpleasant

> first experience I don't really want to repeat it.

> However I will do whatever is right on the day.

Could not agree more. Post natal care at king's is poor and it puts people off. All my cousins and friends in France have had such easier birth experiences. Over there, women don't ask themselves where to give birth. They go to hospital, get given pain relief if they want it without having to beg for it, and are looked after properly after the birth. Post natal rooms have a maximum of two ladies per room and an en suite bathroom. They can give the baby to the midwives for the night if they wish to and get given proper meals. Yes they are tired but nothing like what I have seen and experienced over here. It is a very medicalised environment, yet none of the people i know have had c-sections. I really think that improving hospital care or having more home from home environments are the way forward. Maternity care needs to be improved and in lieu of improvements we're being sold a dangerous (and painful) alternative which to me sounds more like a big "f off" than anything else.

>

> It is a shame when I compare the options today

> with my own mother who gave bith to me and my

> brother 30 odd years ago at Kings - an 8 day stay

> in hospital after both births (despite not having

> any complications) so that the mother could rest

> and recover and be fully confident breastfeeding

> when discharged. And a strict matron on the ward

> to tell any noisy residents to keep the noise

> down!

>

> Perhaps if today's hospitals didn't treat delivery

> like a conveyor belt then more women would enter

> hospital to give birth with confidence. I'd love

> to see more home from home environments locally

> attached to hospitals.

[SBryan]

I too have thought long and hard about adding to this thread, but at this point feel I must (apologies in advance for the long post).

I am an obstetrician and gynaecologist in East London, and, as such, have read the study in great detail. Home-birth is a controversial subject amongst healthcare professionals, and tends to divide doctors and midwives into big pro- and anti- camps, due to the lack of robust data on the subject. The problem then is that people have to rely on their own anecdotal experiences which are highly emotive, as you can clearly see after Littlemoo's courageous post above. It is often bandied about that obstetricians are vehemently against, and midwives passionately for, whereas in reality I know as many obstetricians who have had homebirths as midwives who've opted for elective caesareans.

So, this study is valuable in providing us with the evidence we can use to give women informed choice. This isn't about telling women how and where to have their babies, it's about informing them of all the relative risks and benefits, and allowing them to make their decisions based on full knowledge of these facts (however unpalatable they may be). In basic terms, it backs up what most of us have thought for a long time; that home-birth for a low-risk second or subsequent delivery is as safe as delivering in hospital, but carries increased risks if it's your first labour.

The primary outcome measure of the study was neonatal outcomes: this is the one that was shown to be 4.7 /1000 in a midwifery unit and 9.3 /1000 at home for first pregnancies. The take home message about these outcomes is that, although relatively rare, they were almost all catastrophic. Death, brain damage, and nerve plexus injury. They also measured meconium aspiration, but as passgage of meconium would necessitate immediate transfer to hospital, it's unlikely this contributed significantly. The results weren't statistically significant enough to break down the individual risks of each, (ie to work out whether homebirths or hospital births result in more or less severe brain damage) so, for the time being, these are the only figures we can use.

The secondary outcome of the study was intervention levels. I think this aspect of the study was less well conducted. The "low-risk" group in hospital included many groups that would have been excluded from home-births and midwifery lead birthing units(eg. high blood pressure, obesity) so I don't think the results are comparable. That said, it is well known that you are more likely to have intervention if you are on an obstetric unit even if you are low-risk; some of this (eg increased instrumental delivery rates) can be attributed to use of epidurals. This doesn't mean they are inherently evil; they are safe, effective pain relief, and for many women experiencing long, hard, difficult first labours they are a godsend.

The other statistic I think it is important for all first-time mothers to be aware of is the high transfer rate into hospital; almost 50%. It's not just about needing to be transferred; it's an awareness of the fact that, once transferred, the majority need obstetric intervention in one form or another (although some just need epidurals).

The other thing to point out, as people have mentioned, is the difficulty in extracting from the statistics how experienced the midwives are at home-births, or how far away they are from hospital and therefore how much this contributes. It's not true that all community midwives are experienced, with a passion for home-birth, as many people think; newly qualified midwives often have to rotate through the community, and although they are usually accompanied by a more senior midwife, this isn't necessarily the case if the services are stretched. If 2 or more home-births are happening at the same time, midwives then have to be sent out from delivery suite.

What keeps coming out time and again is the safety and attractiveness of midwifery lead units for low risk women. The unit I work at has a beautiful home-from-home birthing unit, attached to the main delivery suite, but run independently, and our homebirth rate is therefore very low, despite serving a population very similar to King's. We obstetricians have nothing to do with it unless asked (or crashed) but as a continuation of the unit, neonatologists are just an emergency buzzer away. It's a fallacy to say that it's the takes the same amount of time to transfer from home to an operating theatre as from a delivery suite room; in a true "crash" emergency in a hospital or adjacent midwifery lead unit, the time from the buzzer going off to delivery of the baby can be as little as 6 minutes.

A lot of things in Hackneydoula's post is nonsense, I'm afraid, particularly the assertion that birth is "safe". It isn't, and you only have to look at the statistics from the third world to back this up. We have made it safer and safer, and it's easy to forget the risks, as demonstrated from Littlemoo's poignant post. It's natural, as are bad outcomes, and the key is to manage those risks appropriately with the right level of intervention.

I'm sorry, Sillywoman, but I object to your comment that antenatal teachers, midwives, and doulas protect the culture of birth, with no mention of obstetricans. I am vehemently pro women's choice, pro normal vaginal delivery, and pro low intervention, as long as mum and baby remain safe. Most obstetricians are; the days of patriarchal medicine are long gone. I'm therefore pro homebirth, (despite having delivered 3 babies that subsequently died after homebirths went wrong) as long as women and their partners are fully aware of the risks and benefits. It's comments like this that develop an "us and them" culture and makes women feel as though obstetricians are out to intervene, medicalise, and meddle, just for our own satisfaction. And that leads to women feeling like a failure if they are in the 40% of women that don't have their ideal delivery, and an obstetrician delivers them instead. The reason the rates of intervention are as high as they are, are due to pregnancies becoming more high risk; in particular obesity, higher rates of twins due to fertility treatments, more diabetes, high blood pressure, etc. The rates of intervention in truly low risk women are the lowest they've ever been, and we want to drive them lower, whilst keeping women and their babies safe, and giving women a positive birth experience. It's a difficult task, but we're trying.

Littlemoo, my heartfelt condolences at your loss.

COI: I had a very medicalised induction with a growth restricted baby due to severe pre-eclampisa at 35 weeks, that resulted in a forceps delivery. The day I was in labour was hideous, the 10 days afterwards in hospital bloody awful, but I cherish the fact we are both alive, well, and happy. If I'm lucky enough to be low risk in any subsequent pregnancies I'll aim to deliver in an attached midwifery lead birthing unit.

[littleEDfamily]

Fantastic post, SBryan. I had a beautiful homebirth, but I would have chosen an attached midwifery led birthing unit if I had the choice, particularly in view of the information I have extracted from reading this thread.

I adored the midwives who delivered our second baby at home and their skills certainly put me in the best possible position to labour and deliver our baby naturally and easily, but if I am 100% honest with myself, I do not know how they would have coped in an emergency situation (but the midwives who attended me with our first at Kings seemed much less competent, and I have my doubts about whether they would have escalated any concerns appropriately).

I do not think the future of birth in the UK should be the American model of highly medicalised birth (although I suspect that it may not be as bad as we are told it is), or a homebirth revolution. It is very heartening to hear a medical professional express balanced views which recognise birth as a natural process, as well as the vital role science plays in giving us and our babies the best chance of a positive outcome.

Edited to add - the one point on which my pespective is slightly different from Sbryan's - although I have no doubt the factors you mention (obesity etc) are all significant contributors to the rates of intervention, I firmly believe that women's lack of belief in their ability to birth naturally (caused primarily by cultural factors) is also responsible for the rates of intervention we continue to see. It may be that many women feel fine about having intervention-heavy births, but for the health of women and their babies in general, I believe the medical profession and society need to focus on the psychological and cultural aspects of birth much much more than we currently do as this is so important for the birth outcome no matter what the setting.

[sillywoman]

Lovely post sbryan, I was cheering you all the way to the paragraph where you've made me sound like I'm anti Obstetrician and that I'm making women feel as though they've failed if they don't get the perfect birth. Ouch, really - ouch.

I apologise for not mentioning Obstetricians in my 'protectors of birth' list, many of them very much are. It was an oversight rather than an indicator that I believe in an "us & them" culture. I don't. I hope I am more balanced than that.

Edited to add that I would be gutted, just gutted if I felt that I was leading women to feel that they had 'failed' in any way whatever kind of birth they have. I am fairly broken hearted that you could have managed to interpret what I've written to make it seem as though this is what I do. Really, I cannot tell you how low that inference of yours has cast me. And that it should come from someone with such influence.

Retiring now to consider whether I'm in the right job, & lick my wounds.