Home births

SanFran07

It's not exactly scaremongering - the lead Obstetricians are in the papers every day (including today)highlighting the risks to women and babies because of the lack of investment in maternity care.


http://www.rte.ie/news/2012/0124/limerick.html

http://www.independent.ie/health/staff-are-so-busy-lives-are-at-risk-rotunda-boss-admits-2933622.html

nesf

I'm sorry but this is just unacceptable. Link to some actual independent stats showing home births in Ireland are safer than hospital births not including high risk births which will only be done in hospital or retract the statements about it being riskier to have births in hospitals.*

This is a very, very serious topic. If you're going to make claims to fact you're going to have to back them up if they are at all contentious.


*It is absolutely fine to argue that home births may be a more preferable experience for mothers-to-be on the other hand. That's an opinion not a claim to fact.



Edit: The problem here is that medical facts are being discussed. I'm sorry but this has to be very seriously dealt with and people are not entitled to their own facts here. If you want to claim something is more dangerous in general you're going to have to back that up with official stats or some other independent source.

SanFran07

January wrote: »

Sounds like the OP is being supportive if you read back over the post...

Apologies to the OP if that's what was intended - when a homebirth discussion starts off with the word 'brave' more often than not it implies a less than supportive position.

nesf

SanFran07 wrote: »

It's not exactly scaremongering - the lead Obstetricians are in the papers every day (including today)highlighting the risks to women and babies because of the lack of investment in maternity care.


http://www.rte.ie/news/2012/0124/limerick.html

http://www.independent.ie/health/staff-are-so-busy-lives-are-at-risk-rotunda-boss-admits-2933622.html

Think about that for a second. They are talking about emergency cases, serious complications and the like. You'll be treated in hospital for these regardless of whether it's a home birth or not.

SanFran07

nesf wrote: »

Think about that for a second. They are talking about emergency cases, serious complications and the like. You'll be treated in hospital for these regardless of whether it's a home birth or not.

Unfortunately this is not just about complicated cases but basic 1:1 Midwifery care that all women should have access to.

nesf

SanFran07 wrote: »

Unfortunately this is not just about complicated cases but basic 1:1 Midwifery care that all women should have access to.

True, I missed that part of the article.

mickydcork

nesf wrote: »

Edit: The problem here is that medical facts are being discussed. I'm sorry but this has to be very seriously dealt with and people are not entitled to their own facts here. If you want to claim something is more dangerous in general you're going to have to back that up with official stats or some other independent source.

I agree, the stats I quoted regarding worldwide maternal deaths were taken from the following paper in the noted medical journal Lancet

Hogan MC et al (2010). "Maternal mortality for 181 countries, 1980—2008: a systematic analysis of progress towards Millennium Development Goal 5". The Lancet 375 (9726): 1609–1623. doi:10.1016/S0140-6736(10)60518-1.

I think the links to the articles in post #31 should be removed as the stats quoted within are not referenced properly

edit: I have reported post #31

nesf

mickydcork wrote: »

I think the links to the articles in post #31 should be removed as the stats quoted within are not referenced properly

The poster will be given a chance to withdraw them before that happens.

GoerGirl

The problem with Ireland's maternal death rate is that our classification system in Ireland masks a bigger issue. In Ireland only direct deaths in pregnancy, at the time of delivery or within 42 days post partum are classified as maternal death. In the UK, for example, a maternal death is classified at a death in pregnancy, delivery, up to a year post partum and includes direct and indirect death (suicide, homicide, abortion, etc). If Ireland used the same classification system as the UK, our rates would go from 2 per 100,000 to 10 per 100,000, which would put us on par with other EU countries (but without the option of abortion...currently Irish maternal deaths relating to abortion are classified in UK stats).

In terms of maternity services, our staffing level ratios (for midwives and obstetricians) were deemed inadequate during the celtic tiger.... this is only intensified as with the moratorium on hiring new midwives/doctors in conjunction with soaring birth rates.....

The UK is seeing similar issues - low staff levels means 1 midwife to an inadequate and unsafe level of women in labour - for example this case in which 1 midwife to 9 women resulted in the loss of a baby: http://www.midwiferyonline.co.uk/threads/2167-Midwife-rushed-off-feet-in-Derriford-baby-death-case

Hobbitfeet

nesf wrote: »

The poster will be given a chance to withdraw them before that happens.

Are you referring to the links I have posted? If so what is the problem with them?

GoerGirl

Just another point on the Midwife led vs hospital birth issue - the evidence has shown that low risk women have higher rates of intervention and adverse affect in consultant led care vs midwife led care. As the majority of maternity care in Ireland follows consultant led policy, this would suggest the same woman is more likely to have interventions/instrumental outcomes in hospital than she would under midwife led care at home or in a MLU setting.

The choice to have a baby at home is individual - its not for everyone - but it has been shown to be a safe option. Like everything, it is a case of finding the care options that fits you individually best. Removal of choice is never best practice and homebirth is a care option which should be viable for women in Ireland.

nesf

Hobbitfeet wrote: »

Are you referring to the links I have posted? If so what is the problem with them?

You posted them as proof of hospital being more dangerous than home births. Neither link shows this to be true to any reasonable degree of proof, neither link is neutral or independent (i.e. neither is from Government sources or independent peer reviewed journals) and the second link's stats dealt with a US State not Ireland so have nothing to do with the point.

This is a matter of fact, not opinion, if you're going to argue that death rates are higher in hospitals you're going to have to show this very clearly.


This thread is extremely close to being locked if these kinds of claims are going to be made. There is a line here with regard to medical advice and it shall not be crossed.

nesf

GoerGirl wrote: »

Just another point on the Midwife led vs hospital birth issue - the evidence has shown that low risk women have higher rates of intervention/caesarean section and adverse affect in consultant led care vs midwife led care.

I've seen this before myself but if you could link to some evidence for this it would be good.

nesf

I am sorry for intervening in this thread and I don't like doing so in general in this forum but there is only one way we're going to have a discussion about the safety of hospital births and that's an evidence based one. As such people are going to have to provide good quality evidence to support their assertions from this point forward or this thread will be locked.

This is far too serious a topic to be dealt with in any other way, I apologise for the hassle this will cause when debating it.

Hobbitfeet

nesf wrote: »

You posted them as proof of hospital being more dangerous than home births. Neither link shows this to be true to any reasonable degree of proof, neither link is neutral or independent (i.e. neither is from Government sources or independent peer reviewed journals) and the second link's stats dealt with a US State not Ireland so have nothing to do with the point.

None of my posts on this thread say that giving birth in hospital is more dangerous, I did not say here is the proof in these links I said you will see the differences in outcomes between both. If you read fully through the 1st link you will see the info comes from WHO former Director of the Women’s and Children’s Health for the World Health Organization Dr. Marsden Wagner. The second link stats can also be seen in the 1st link and is stated in this link the research is from 1994, the American Journal of Public Health. The reason I included The Farm link is because is a long running home birth centre and there is nothing like this in Ireland to reference.


This is a matter of fact, not opinion, if you're going to argue that death rates are higher in hospitals you're going to have to show this very clearly.

Please show me where I have argued death rates are higher in hospital? I never said this. Please do not put words in my mouth. Show me where I have said this or retract your post.


This thread is extremely close to being locked if these kinds of claims are going to be made. There is a line here with regard to medical advice and it shall not be crossed.[/QUOTE]

nesf

Hobbitfeet wrote: »

Please show me where I have argued death rates are higher in hospital? I never said this. Please do not put words in my mouth. Show me where I have said this or retract your post.

The original quote:

Too many times I have felt that women's lives have been put into jeopardy by setting foot in the hospital at all.

The obvious implication is that home births are safer, since a woman has to give birth somewhere and I doubt the OP was suggesting giving birth in a car driving around a roundabout or similar.


Evidence for this was asked for. You replied with your links. This is where I'm getting it from. The implication of your post is that the links support the OPs assertion. If you did not want this implication you should have made your post clearer.

Hobbitfeet

nesf wrote: »

The obvious implication is that home births are safer, since a woman has to give birth somewhere and I doubt the OP was suggesting giving birth in a car driving around a roundabout or similar.


Evidence for this was asked for. You replied with your links. This is where I'm getting it from. The implication of your post is that the links support the OPs assertion. If you did not want this implication you should have made your post clearer.

I think my post was very clear I said here are some links that show different outcomes of giving birth at home v hospital from WHO and the American Journal of Public Health, I think both are very creditable sources. You stated my links were " neither link is neutral or independent (i.e. neither is from Government sources or independent peer reviewed journals) "which is untrue, Is the WHO not a good place to get info on births??

You also accused me of arguing death rates are higher in hospital which I have not. Show me where I have mentioned death rates?? I think maybe you make your posts clearer instead of putting words in others peoples mouths and accusing them of making such statements. I think you have my posts mixed up with what someone else on her has said? "Too many times I have felt that women's lives have been put into jeopardy by setting foot in the hospital at all." This is not my post you have quoted that it is

Would you like to show some evidence that giving birth in hospital is safer than giving birth at home?

GoerGirl

nesf wrote: »

I've seen this before myself but if you could link to some evidence for this it would be good.

Sorry, just seeing this.

Midwife led care vs consultant led care in low risk women: women more likely to suffer adverse affects (episiotomy, instrumental birth, etc)

Women who received midwife-led care were less likely to have fetal/neonatal loss before 24 weeks, episiotomy, regional analgesia/anaesthesia, instrumental birth, or antenatal hospitalisation; and were more likely to have no intrapartum analgesia/anaesthesia, spontaneous vaginal birth, to feel in control, to be attended at birth by a known midwife and to initiate breastfeeding. http://www.biomedcentral.com/1471-2393/11/85

MidU study: The 'MidU' ('Midwifery Unit') study showed that midwifery-led care, as practised in these units, is as safe as consultant-led care but uses less intervention in pregnancy and childbirth. Almost half of the women in the CLUs (49%) had their labours speeded up by either having their waters broken or having oxytocin, a hormone, given intravenously by 'drip', compared with a third (34%) of women in the MLUs. At birth, women in the MLU had a higher rate of spontaneous pushing and 20% used upright positions for birthing compared with 6% in the CLU. In addition, 13% did not require any drugs to speed up the after-birth, compared with just 1 woman (0.2%) in the CLU. http://www.hse.ie/eng/services/newscentre/200920082007Archive/dec09/MidUstudy.html

cochrane: http://summaries.cochrane.org/CD004667/midwife-led-versus-other-models-of-care-for-childbearing-women

In terms of Caesarean section - ESRI has shown there is a rise in caesarean section for private led consultant led care which cannot be explained by risk factors.

http://www.independent.ie/national-news/csection-rate-50pc-higher-for-mothers-who-go-private-2967937.html

There is also significant evidence which suggests that induction increases your chances of Caesarean Section. Consultant led policy varies on induction for post dates; ie not medically indicated (anywhere from EDD to term+10 in some units). Midwife led Units and homebirth follow the term+14 guidelines for induction.

However, I should not have included caesarean section into the reduced benefits of midwife led over consultant led care as the evidence suggests there is little or no reduction and I will edit that out of my post in order to keep my post fully in keeping with the evidence alone.

nesf

Hobbitfeet wrote: »

I think my post was very clear I said here are some links that show different outcomes of giving birth at home v hospital from WHO and the American Journal of Public Health, I think both are very creditable sources. You stated my links were " neither link is neutral or independent (i.e. neither is from Government sources or independent peer reviewed journals) "which is untrue, Is the WHO not a good place to get info on births??

You also accused me of arguing death rates are higher in hospital which I have not. Show me where I have mentioned death rates?? I think maybe you make your posts clearer instead of putting words in others peoples mouths and accusing them of making such statements. I think you have my posts mixed up with what someone else on her has said? "Too many times I have felt that women's lives have been put into jeopardy by setting foot in the hospital at all." This is not my post you have quoted that it is

The problem is that it was not clear enough since me and another mod saw your post as arguing proof that home births were safer and another poster reported it. If you quote someone asking for proof and provide a bunch of links then it's always going to be interpreted as providing the evidence that was asked for! You need to make it extremely clear that you're not providing said evidence in your post, which you did not do I'm afraid.

The issue with your link is that it's not a primary source. So linking to the WHO saying something is fine, linking to someone using the WHO to argue a point from is different. Just because someone is using the WHO for references doesn't mean they are being independent only that their sources are independent. This goes for both sides of the argument.

Hobbitfeet wrote: »

Would you like to show some evidence that giving birth in hospital is safer than giving birth at home?

I've been very careful not to make that claim (actually I've argued that for the vast majority of women home births should be perfectly safe, so on average home births should be safe, so you should be asking me for evidence of this!), so no I don't need to provide evidence for that.

pippington

I think everybody is getting away from the fact that the lowest risk pregnancy can end up, for no reason, in a high risk birth or unexpected difficulties for mother and child.
For those who would like home birth then it is unfortunate that it is not more readily available for them, but you cannot argue for or against home birth when every single pregnant woman will have an individual pregnancy, delivery etc. I could have a low risk pregnancy and want a home birth and everything could go perfect, then great, but I could also be in the unlucky minority who have a low risk pregnancy and everything goes wrong, be it at home or in hospital. Home birth will, most likely never be the norm because people are so afraid of the just in cases. No Consultant/Midwife can guarantee that everything is going to go 100% perfectly, they can be as amazing at their job as they like and the tiniest thing can go wrong, for this reason it will never be the norm.

Also, we are an increasingly litigious society, things go wrong in birth, any professional would like to be seen to do everything possible for the child or mother and thats more difficult to prove in a home birth scenario. Midwives who are fantastic in their field are often brought up for malpractice cos we always feel the blame has to lie somewhere.

I think you cant tell anyone home birth is wrong or that hospital birth is wrong, its individual choice and yes for fairness those who want home birth should be able to have one without ridicule. So should people who choose to have a hospital birth.

GoerGirl

pippington wrote: »

I think everybody is getting away from the fact that the lowest risk pregnancy can end up, for no reason, in a high risk birth or unexpected difficulties for mother and child.
For those who would like home birth then it is unfortunate that it is not more readily available for them, but you cannot argue for or against home birth when every single pregnant woman will have an individual pregnancy, delivery etc. I could have a low risk pregnancy and want a home birth and everything could go perfect, then great, but I could also be in the unlucky minority who have a low risk pregnancy and everything goes wrong, be it at home or in hospital. Home birth will, most likely never be the norm because people are so afraid of the just in cases. No Consultant/Midwife can guarantee that everything is going to go 100% perfectly, they can be as amazing at their job as they like and the tiniest thing can go wrong, for this reason it will never be the norm.

The most current evidence is from the Uk. It looked at planned place of birth and maternal and fetal outcomes. The conclusions were that for women who have birthed before (multiparious), midwife led care and homebirth led to less interventions than hospital births without increased risk to the baby. For first time mothers, the study also showed that homebirth had less instances of intervention but had higher rates of transferring to an obstetric led unit and increased risk to the baby. http://www.bmj.com/content/343/bmj.d7400

Full study available here: https://www.npeu.ox.ac.uk/birthplace

http://www.nhs.uk/news/2011/11November/Pages/hospital-births-home-births-compared.aspx

The main point to this study is that women make an informed decision on place of birth. It is up to individuals to weigh up the benefits and risks in order to decide on the place of birth which suits them. The evidence here shows us for women who have birth before, there is no increased risk birthing at home. For first time mums, there is a slight increased risk either way (consultant led = increased risk of intervention vs homebirth increased risk of transfer and perinatal outcome). Women have to weigh the risks to decide what is best for them.

pippington wrote: »

Also, we are an increasingly litigious society, things go wrong in birth, any professional would like to be seen to do everything possible for the child or mother and thats more difficult to prove in a home birth scenario. Midwives who are fantastic in their field are often brought up for malpractice cos we always feel the blame has to lie somewhere.

The majority of claims are obstetric. There were 4000 perinatal incidents and more than 100 obstetric claims reported to the Irish state claims agency in 2009 alone. As a result, there have been calls for a review of "catastrophic birth" by the HSE funded group Patient Focus.

pippington

Im not arguing with any of the research. I am not saying they are wrong in anyway and I am not condoning either home birth or hospital birth. I am simply saying yes there should be both available but at the end of the day it is down to a mothers choice and doing what you feel safe with and what you feel right doing. There should be no telling people either is right or wrong. And you can have all the statistics you want, but at the end of the day its all counting the numbers. If your the woman at home giving birth and it all goes fantastic then brilliant same goes for the woman is hospital. Like I said, when your the woman who is left with life threatening complications for either you or baby then you dont care about the statistics, you care about whats happening, and it wont matter whether its in hospital or home. Everyone has to feel they are doing whats right for them.

GoerGirl

pippington wrote: »

Im not arguing with any of the research. I am not saying they are wrong in anyway and I am not condoning either home birth or hospital birth. I am simply saying yes there should be both available but at the end of the day it is down to a mothers choice and doing what you feel safe with and what you feel right doing. There should be no telling people either is right or wrong. And you can have all the statistics you want, but at the end of the day its all counting the numbers. If your the woman at home giving birth and it all goes fantastic then brilliant same goes for the woman is hospital. Like I said, when your the woman who is left with life threatening complications for either you or baby then you dont care about the statistics, you care about whats happening, and it wont matter whether its in hospital or home. Everyone has to feel they are doing whats right for them.

I agree with much of what you are saying. My point is that being in hospital does not automatically mean that something bad may not happen, for you or baby. Which is generally the concerns raised on the debate on homebirth. In terms of the evidence and statistics, these are incredibly important. We all have to make our own choices, very true, but more importantly, our choices should be based on informed decisons.

mickydcork

Hobbitfeet wrote: »

Would you like to show some evidence that giving birth in hospital is safer than giving birth at home?

The only true experiment for providing evidence in this matter would be to carry out a randomised controlled trial where a large group of women are divided randomly (say 1000), where 500 of them are forced to give birth at home with no access to hospital and emergency medical intervention and the remaining 500 are forced to give birth in a hospital.

I think even the most ardent supporter of home births would agree that this type of experiment would be an extremely bad idea, not to mind completely ethicallly un-sound.

Rosy Posy

I'm not going to weigh in with empirical evidence here, just wanted to speak from my personal experience. I have had two babies in hospital and one at home. We had hoped to have all of them at home but after things dragging on a bit we transferred to hospital.

You can read my home-birth story here

http://www.boards.ie/vbulletin/showthread.php?t=2056422580&page=2

For me the biggest advantage was being comfortable, relaxed, in control and empowered by the experience of birthing in my own home. Also it was so nice to get into my own bed, and to have a glass of champagne afterwards! In all of my labours I found that any kind of change in environment, bright lights or people coming in and out of the room interfered with the progress of the labour so being at home helped to stabilise these things. I have never been on a communal labour ward but the very concept seems to me to be totally counterintuitive to facilitating a natural birth.

I also think that one of the most important things for me was having a good relationship with my midwife. In some ways, having transferred to hospital the first two times made me more confident that my midwife was looking out for my safety and the safety of my baby. By knowing that she would make the call to transfer if necessary gave me the confidence to feel safe birthing in my own home.

For the record, my husband and my husband's family are all medical professionals with experience of delivering babies, and they were totally supportive of my decision to birth at home, while my parents, whose experience started and ended with my birth some thirty years ago were terrified at the prospect.

mickydcork

Rosy Posy wrote: »

I'm not going to weigh in with empirical evidence here, just wanted to speak from my personal experience. I have had two babies in hospital and one at home. We had hoped to have all of them at home but after things dragging on a bit we transferred to hospital.

You can read my home-birth story here

http://www.boards.ie/vbulletin/showthread.php?t=2056422580&page=2

For me the biggest advantage was being comfortable, relaxed, in control and empowered by the experience of birthing in my own home. Also it was so nice to get into my own bed, and to have a glass of champagne afterwards! In all of my labours I found that any kind of change in environment, bright lights or people coming in and out of the room interfered with the progress of the labour so being at home helped to stabilise these things. I have never been on a communal labour ward but the very concept seems to me to be totally counterintuitive to facilitating a natural birth.

I also think that one of the most important things for me was having a good relationship with my midwife. In some ways, having transferred to hospital the first two times made me more confident that my midwife was looking out for my safety and the safety of my baby. By knowing that she would make the call to transfer if necessary gave me the confidence to feel safe birthing in my own home.

For the record, my husband and my husband's family are all medical professionals with experience of delivering babies, and they were totally supportive of my decision to birth at home, while my parents, whose experience started and ended with my birth some thirty years ago were terrified at the prospect.

That's a lovely story.

But it's relevance to the safety or otherwise of giving birth in a hospital over giving birth at home is negligible.

Home-birthing in Ireland is a self-selecting procedure only available for mothers with uncomplicated pregnancies and ready access to emergency medical intervention.

If someone self selects where they give birth based on their belief system, and has a good outcome, then they are more likely to conclude that they had an good experience. It's human nature.

For every story like yours there is one of a mother who was so glad she decided on the epidural in the hospital because she couldn't take the pain of childbirth anymore.

Anecdotes are not evidence.

But I agree that evidence is not available at moment to make a conclusion one way or the other.

However my position is in defence of hospital birth, not in offense of home birth.

And in saying that what we can do is look at mortality rates before the advent of modern medicine with it's blood transfusion, cesaraeans and excellent pre-natal care and judge that the advent of modern medicine and the dreaded hospital has been a good thing for society because now the vast majority of babies and mothers survive childbirth.

Rosy Posy

Deliverance wrote: »

I have a friend whom has chosen this option. Any experiences or advice in this sense? It is his first and I think that it isi a brave choice to say the least. Any advice and experience that I can pass on would be appreciated.

Thanks.

If you have a look at the OP you'll see that my 'lovely story' is more relevant to the question being asked than the largely pointless batting back and forth of 'research' and 'evidence' presented in this thread. The OP didn't ask 'is it safe'. They have a friend who has already made the decision to birth at home and is looking for guidance from those who have experience of home birth so that they can offer their support.

mickydcork

Rosy Posy wrote: »

If you have a look at the OP you'll see that my 'lovely story' is more relevant to the question being asked than the largely pointless batting back and forth of 'research' and 'evidence' presented in this thread. The OP didn't ask 'is it safe'. They have a friend who has already made the decision to birth at home and is looking for guidance from those who have experience of home birth so that they can offer their support.

Mea culpa.

I thought you were responding on the direction that the topic has gone down, which was one of safety and evidence etc.

But in fairness the OP did ask for advice and someone responded that they would advise giving birth in a hospital for a first birth as home birthing is not safe, then someone responded that hospital birthing was more unsafe, hence the direction the topic went in.

Rosy Posy

mickydcork wrote: »

Mea culpa.

I thought you were responding on the direction that the topic has gone down, which was one of safety and evidence etc.

But in fairness the OP did ask for advice and someone responded that they would advise giving birth in a hospital for a first birth as home birthing is not safe, then someone responded that hospital birthing was more unsafe, hence the direction the topic went in.

Having been at the confluence of these arguments between family and friends, I find it fairly pointless. Its one of those emotive topics, like breastfeeding or vaccinations. There is a wealth of inconclusive 'evidence' on either side, ultimately each person is going to chose with their heart and defend their own position. I believe that no one is likely to change a heartfelt opinion with pseudo-empirical evidence when, as you yourself pointed out, a randomised controlled trial would be completely unethical.

The focus of the OP was on how to support someone who has already decided on a home birth and I can clearly say that one of the least helpful ways is of presenting them with a load of horror stories. Instead I would say

- cultivate a good relationship with a competent midwife
- write a comprehensive birth plan which includes how your midwife would advocate for you should you not have a normal birth, make sure you are on the same page re conditions in which you would transfer
- pack a bag! (so you don't end up in hospital as I did with no shoes or knickers :P)
- have a real think about who you want to be present at your birth, NOT who you feel you should have- be firm with friends and family members
- have a sign for the door so you won't be interrupted by random callers (this is good for after the baby is born too)
- invest in a cheap plastic shower curtain and some old towels & sheets (nuff said)

GoerGirl

mickydcork wrote: »

The only true experiment for providing evidence in this matter would be to carry out a randomised controlled trial where a large group of women are divided randomly (say 1000), where 500 of them are forced to give birth at home with no access to hospital and emergency medical intervention and the remaining 500 are forced to give birth in a hospital.

I think even the most ardent supporter of home births would agree that this type of experiment would be an extremely bad idea, not to mind completely ethicallly un-sound.

Agree, RCTs - limit the potential of bias due to the selection process, however, much evidence with regards to maternity care and outcome are not RCTs due to ethical considerations.

This works both ways.

For example, a study published in Obstetrics and Gynaecology concluded that only 1/3 of clinical guidelines set by the ACOG met the standards of good quality/high standard evidence. They found instead that the majority of ACOG guidelines were based on limited or inconsistent evidence or expert opinion. http://www.ncbi.nlm.nih.gov/pubmed/21826038