Homebirth controversy

gcgirl · 01-08-2013 10:20PM

Akrasia wrote: »

My Grandmother had 8 children and one of them died in childbirth.

Is 1 death out of 9 an acceptable mortality rate? it used to be, thankfully, we've moved on and improved our maternity services and massively improved survival outcomes.

I think the rate on my neighborhood back was if you had 20 if 15 survived that was result which 2 of the old dears friends had, I'd one aunt as well

Morag · 01-08-2013 10:25PM

http://nocountryforpregnantwomen.blogspot.ie/2013/08/aimsi-points-to-consider-discussion-of.html

Which clears up some of the facts about the case.

whatdoicare · 01-08-2013 10:29PM

I agree with MurdyWurdy with unrealistic expectations and it's effects on women's perception of their birth experience -
I gave birth two weeks ago today, I had no birth plan except that I would like to be told about anything before it was done to myself or baby. Other than that, I was happy to go along with the professionals.

I ended up with an emergency C-section as my baby had her umbilical chord wrapped around her neck, her heart rate was erratic and her life was in danger, she also had meconium in the fluid (dangerous for both baby and me). Doctors couldn't tell that the chord was wrapped around her neck until she was coming out, the only thing to give them a hint that that there was something wrong was her heart rate dropping and rising. I was totally at ease with my experience, I was not disappointed in any way and none of it upset me at all. I was relaxed going into surgery and trusted the doctors to do what was best.

As far as I'm concerned, the staff were brilliant, surgeons were amazing, I felt no pain, they talked me through everything without panicking me and my baby entered the world safe and sound. I healed very quickly, with no complications and baby is as healthy as a horse! The experience was a positive one. The one minor downside was the c-section stopped my milk coming down and I couldn't breastfeed after colostrum. No big deal.

Three other women in a group I'm in had exactly the same experience and all found it horrific and traumatising! I was shocked when they told me this! They all had perfect babies and are healing fine - it's the mental aspect that this isn't exactly as they planned it on their birth plan is what is getting to them!

In the same breath another girl had a totally natural birth, tore badly in three places and her baby came out with a misshapen swollen cone head and two black eyes and she's delighted with her experience as it was all "natural". The girl had to spend a full week longer than me in hospital and I would consider her experience far more traumatising! I'm pretty much recovered and she's hobbling around like an old woman and hiding her babys head with a hat at all times! It's insane!:eek:

I don't understand this womans line of thinking, why risk her own life and the life of her baby just to avoid a hospital? Especially if her first experience went the way it did. It would make me far more cautious and aware of what can go wrong rather than more willing to take the risks. I'd never be able to take the worry of something going wrong out of my mind enough to risk having my baby away from the safety of medical professionals - if I had insisted on a natural home birth with my pregnancy chances are my beautiful baby would be dead or brain damaged now and there's a good chance I wouldn't be sitting here writing about it either! It's an insane risk to be insisting on!

December2012 · 01-08-2013 10:39PM

I feel that medicalised births and c sections are unfairly demonised by a part of the media / society / other women.

The amount of women who think they deserve some sort of extra glory because they delivered "naturally" (as in vaginally / at home / no epidural , yada yada)!

When c sections are mentioned in the media it's usually under the following headings

1) woman is also having a tummy tuck;
2) woman is too posh to push
3) c sections are something to be terrified of
4) the increased rates of c sections are only for the above reasons and is a bad thing!

I am aware of this because I've had a few, and the amount of comments I got for having an "elective" section was unreal.

keith16 · 01-08-2013 10:40PM

Morag wrote: »

http://nocountryforpregnantwomen.blogspot.ie/2013/08/aimsi-points-to-consider-discussion-of.html

Which clears up some of the facts about the case.

Title of the blog is:

Ireland: No country for pregnant women.

Seems a bit much. Ireland is in the top 20 countries on Earth when it comes to infant mortality. In other words, there are 160 other countries where it is statistically more dangerous to give birth.

Morag · 01-08-2013 10:47PM

keith16 wrote: »

Title of the blog is:

Ireland: No country for pregnant women.

Seems a bit much. Ireland is in the top 20 countries on Earth when it comes to infant mortality. In other words, there are 160 other countries where it is statistically more dangerous to give birth.

Again if your only measure of a good outcome is a live baby then your doing women a disservice.

Jester252 · 01-08-2013 10:52PM

kunst nugget wrote: »

I'd imagine that a midwife wouldn't be held there under duress - they'd be doing it for the moolah. The court case is basically about letting a midwife be there without any risk to her job.

They is nothong about protecting the midwife. The case is about her getting to have a homebirth.

ceadaoin. · 01-08-2013 10:53PM

I gave birth in the UK in a midwife led birthing centre attached to a hospital. This is the perfect set up- a woman can have the birth she wants in a comfortable environment but still be close to life saving services if needed. Why are there not more of these here?

It seems a lot of people have an issue with the fact that she wants a home birth at all and not just because she is being advised against it. A recent study found that home births have a lower chance of complications than those in hospital.

http://m.bbc.co.uk/news/health-22888411

Many women are left traumatised by over medicalised childbirth experiences. Should women give up any rights over their own bodies once they become pregnant?

keith16 · 01-08-2013 11:18PM

Morag wrote: »

Again if your only measure of a good outcome is a live baby then your doing women a disservice.

Ok, can you provide me with any statistics that shows Ireland is unsafe for mothers?

Meangadh · 01-08-2013 11:23PM

ceadaoin. wrote: »

Should women give up any rights over their own bodies once they become pregnant?

Not at all. I understand the legalities of the whole thing are what are in the way for this woman, but technically, it should be her choice.

I just know that for me, if I was pregnant- my choice would be to give priority to the successful delivery of my baby. My comfort, whilst still important, would still come second to the comfort of my baby.

I know our hospitals aren't perfect, and I know awful things have been well publicised that could understandably lead an expectant mother to be wary of hospitals- but I still would place my trust in them that they know best.

Morag · 01-08-2013 11:30PM

ceadaoin. wrote: »

Should women give up any rights over their own bodies once they become pregnant?

Currently with the 8th amendment in place and the new legislation (which defines 'unborn' as an embryo from the moment of impantation) this is exactly what happens.

The only two rights a pregnant woman has in this country which are inviolate are the right to life and the right to travel. Every other right can be over ridden by the right to life of the 'unborn'.

ceadaoin. · 01-08-2013 11:37PM

Meangadh wrote: »

Not at all. I understand the legalities of the whole thing are what are in the way for this woman, but technically, it should be her choice.

I just know that for me, if I was pregnant- my choice would be to give priority to the successful delivery of my baby. My comfort, whilst still important, would still come second to the comfort of my baby.

I know our hospitals aren't perfect, and I know awful things have been well publicised that could understandably lead an expectant mother to be wary of hospitals- but I still would place my trust in them that they know best.

Any labouring woman, if faced with a real risk to the safety of their baby, would put the baby's health first and undergo any necessary interventions.

Most births don't come down to that choice though so unless there is a an actual risk to the baby's life or health then a woman should be allowed to give birth how she wants without being judged.

Mrs. Draper · 01-08-2013 11:37PM

keith16 wrote: »

Title of the blog is:

Ireland: No country for pregnant women.

Seems a bit much. Ireland is in the top 20 countries on Earth when it comes to infant mortality. In other words, there are 160 other countries where it is statistically more dangerous to give birth.

keith16 wrote: »

Ok, can you provide me with any statistics that shows Ireland is unsafe for mothers?

Keith, did you open that link and read the document? Maybe skip to point no. 3

December2012 · 01-08-2013 11:39PM

ceadaoin. wrote: »

. Should women give up any rights over their own bodies once they become pregnant?

Not at all.

She has her choice - she is not compelled to attend hospital.

She can have her baby at home if she wants.

But that doesn't mean she should be entitled to have the State tailor what they provide simply to her desire.

keith16 · 01-08-2013 11:56PM

Mrs. Draper wrote: »

Keith, did you open that link and read the document? Maybe skip to point no. 3

I did read it. Seems like a lot of bluster with little in the way of sources for their claims.

In point 2 they say

VBAC is safe.

Where is the evidence for this?

This is followed by:

The risk of uterine rupture during a VBAC is actually lower to those of other possible birth complications.

Well what are those other possible complications? Why shouldn't we consider those risks? And how much lower is the risk of uterine rupture during VBAC? 1%? 1 million?

I'm not saying these people aren't right for pushing for higher standards in maternity care BTW. It just seems like there is a better way of going about it.

Like asking why the rates of C-Sections in Killkenny are so high as opposed to, "I'm having this at home at all costs"

LostinKildare · 02-08-2013 12:27AM

keith16 wrote: »

Like asking why the rates of C-Sections in Killkenny are so high as opposed to, "I'm having this at home at all costs"

This may be the crux of the matter. It looks like the hospital doesn't make much of an effort at VBAC if their rate is only 2% (when best practice is 70%). If she wants a chance to labour and deliver vaginally, not to be prepped for surgery as routine, then I can see why she'd want to give it a try at home.

Perhaps she believes that her first caesarean was unnecessary, and wants to avoid that happening again.

Very surprised that the caesarean rate for first-time mothers at that hospital is 43%! Really? 43% of first births are so risky that they require caesareans?

I had my baby in a hospital in NYC. It was a very very difficult labour -- he was posterior (face up) -- but we got there. When I told the story to a midwife friend here in Ireland, she said that in an Irish hospital I would have been given a caesarean as a matter of course as soon as they saw the baby's position (even though the baby was not in any distress).

Ciarabear · 02-08-2013 12:36AM

The right to be stupid is a stupid right. Some people need protecting from themselves and their ridiculous ideas. The state aren't responsible for people's personal screw-ups

Cee-Jay-Cee · 02-08-2013 12:48AM

Akrasia wrote: »

There are some independent midwives who are totally in favour of home births (that's how they make their money) but they are prevented from 'HBAC' deliveries because of the medical council guidelines (which are legally binding)

If Aja Teehan wins her case she'll have no problem finding a Midwife

I don't think she'll win her case. Judges have started to rule with abut more sense recently. There's far too many people tying up court time and wasting tax payers money fighting cases that should never have been allowed in the front door, this is one of them. If something went wrong you can be guaranteed the same woman would be back in court looking for compensation. I sincerely hope she loses her case and has to pay full costs, why should the tax payer have to foot the bill for one persons arrogance.

marizpan · 02-08-2013 12:57AM

I disagree that women should lower their expectations of birth.

I had my first birth naturally in hospital and I needed counselling afterwards as I was traumatised by the experience.
It was a cold cattle mart. Stressed and pressured by policies and procedures.

I had two more birth. These were home births. I was low risk and was attended by two very experienced midwives. The hospital was near and my file on hand should we need to be admitted.
The memories of these births are the best memories of my life.
These children were born quicker, unstressed and alert. Bright pink instead of grey. I was up and about immediately. Doing the grocery shopping the next day because I felt great.
There was no comparison.

I do think that a midwife led birthing unit adjoining hospitals are ideal. Our choices are either extreme in ireland unfortunately.

Mrs. Draper · 02-08-2013 01:04AM

A review of the evidence states that

VBAC is a reasonable and safe choice for the majority of women with prior cesarean. Moreover, there is emerging evidence of serious harms relating to multiple cesareans

Source: Vaginal birth after cesarean: new insights.
Guise JM, Eden K, Emeis C, Denman MA, Marshall N, Fu RR, Janik R, Nygren P, Walker M, McDonagh M.

And comparing VBAC to repeat C-section....From: Neonatal Mortality Risk for Repeat Cesarean Compared to Vaginal Birth after Cesarean (VBAC) Deliveries in the United States, 1998–2002 Birth Cohorts

Investigators have noted a lack of sufficient evidence on the benefits and risks of planned VBAC vs. planned repeat cesarean delivery [26, 27]. Zweifler, et.al, reported higher mortality only for very low birthweight infants delivered by VBAC (possibly due to precipitous delivery) [15]. Several studies found that infants in planned VBAC deliveries had much lower rates of respiratory morbidity and NICU admission than infants in elective repeat cesar- ean deliveries.

For low-risk women, in terms of neonatal mortality risks, our findings suggest that a VBAC may be at least as safe as or safer than a repeat cesarean. The neonatal mortality rate was higher for low-risk women who had a repeat cesarean delivery compared to those who delivered vaginally.

josip · 02-08-2013 01:17AM

Mrs. Draper wrote: »

A review of the evidence states that

Source: Vaginal birth after cesarean: new insights.
Guise JM, Eden K, Emeis C, Denman MA, Marshall N, Fu RR, Janik R, Nygren P, Walker M, McDonagh M.

And comparing VBAC to repeat C-section....From: Neonatal Mortality Risk for Repeat Cesarean Compared to Vaginal Birth after Cesarean (VBAC) Deliveries in the United States, 1998–2002 Birth Cohorts

I suspect that Aja Teehan did similar "research".

I don't know why doctors spend years studying and doing clinical research any more.
If they just learned how to google properly they would save so much time and money

seamus · 02-08-2013 09:18AM

LostinKildare wrote: »

Very surprised that the caesarean rate for first-time mothers at that hospital is 43%! Really? 43% of first births are so risky that they require caesareans?

Yeah, it's an ongoing issue in Irish hospitals that our caesarean rates are so high, and it stems from the "cattle mart" attitude that pervades every maternity hospital in the country. The doctors and nurses want deliveries to take place on their terms, they're less willing to wait for things to happen naturally.

When I told the story to a midwife friend here in Ireland, she said that in an Irish hospital I would have been given a caesarean as a matter of course as soon as they saw the baby's position (even though the baby was not in any distress).

You see, the problem here is that this is not necessarily just about the pregnant woman and what she would like. There is a baby too which needs to be delivered safely.
This is an issue of reproductive rights - not far removed from the abortion debate - so I can certainly understand the position of many of the respected posters here who are fighting this woman's case. But it's more complicated than that.
As Morag quite rightly points out, the only measure of a successful birth should not be a living baby, but at the same time a traumatised mother doesn't automatically make it an unsuccessful delivery. Sometimes **** happens, gotta roll with the punches. Sometimes you can chalk a delivery down as "successful" even if the mother has had the most horrifying 10 hours of her life.

The reason I quote your piece above is because the Irish health system is so heavily weighted in favour of a quick delivery of a living child. In virtually every case that a child does not present normally, caesarian section is the quickest way of delivering the child with the least risk - to the child. The risk to the mother is obviously raised by cutting her open.
And that's where the issue is and why we need to look at our terrifying c-section rates and reconsider our approach to labour and birth.

I don't believe it's really a relevant debate in this woman's case though because she's already had the c-section. I can understand that she's worried about another one, but she's asking the state to support in a relatively risky endeavour which places herself and her child at an unnecessary level of risk.

VBAC is known to be safe in relative terms. Home births are proportionally more risky than hospital births, but not exceptionally so. However we don't know the risk posed by HBAC. You're stacking multiple risk elevations on top of eachother which overall turns it into a risky procedure.

December2012 · 02-08-2013 09:23AM

seamus wrote: »

Yeah, it's an ongoing issue in Irish hospitals that our caesarean rates are so high, and it stems from the "cattle mart" attitude that pervades every maternity hospital in the country. The doctors and nurses want deliveries to take place on their terms, they're less willing to wait for things to happen naturally.You see, the problem here is that this is not necessarily just about the pregnant woman and what she would like. There is a baby too which needs to be delivered safely.
This is an issue of reproductive rights - not far removed from the abortion debate - so I can certainly understand the position of many of the respected posters here who are fighting this woman's case. But it's more complicated than that.
As Morag quite rightly points out, the only measure of a successful birth should not be a living baby, but at the same time a traumatised mother doesn't automatically make it an unsuccessful delivery. Sometimes **** happens, gotta roll with the punches. Sometimes you can chalk a delivery down as "successful" even if the mother has had the most horrifying 10 hours of her life.

The reason I quote your piece above is because the Irish health system is so heavily weighted in favour of a quick delivery of a living child. In virtually every case that a child does not present normally, caesarian section is the quickest way of delivering the child with the least risk - to the child. The risk to the mother is obviously raised by cutting her open.
And that's where the issue is and why we need to look at our terrifying c-section rates and reconsider our approach to labour and birth.

I don't believe it's really a relevant debate in this woman's case though because she's already had the c-section. I can understand that she's worried about another one, but she's asking the state to support in a relatively risky endeavour which places herself and her child at an unnecessary level of risk.

VBAC is known to be safe in relative terms. Home births are proportionally more risky than hospital births, but not exceptionally so. However we don't know the risk posed by HBAC. You're stacking multiple risk elevations on top of eachother which overall turns it into a risky procedure.

This is exactly the kind of negative hysteria that makes women feel bad for having c sections!

seamus · 02-08-2013 09:28AM

December2012 wrote: »

This is exactly the kind of negative hysteria that makes women feel bad for having c sections!

Care to elaborate?

What part of my post is "negative hysteria"?

JuliusCaesar · 02-08-2013 09:59AM

anto3473 wrote: »

and I've heard some very very worryingly stupid things said by midwives ("Keep the surgeon away, a tear heals better than a cut").

:rolleyes: Here

December2012 · 02-08-2013 10:49AM

Terrifying .... Cattle marts...need to reconsider our approach...

Presumably reconsidering birth options has increased the rate of c sections.

We also have better screening, lower mother and infant mortality rates.

I'm not saying c sections for everybody, but what I'm saying is just because the rates are increasing does not mean that there is anything sinister or terrifying going on.

marizpan · 02-08-2013 11:13AM

December2012 wrote: »

Terrifying .... Cattle marts...need to reconsider our approach...

Presumably reconsidering birth options has increased the rate of c sections.

We also have better screening, lower mother and infant mortality rates.

I'm not saying c sections for everybody, but what I'm saying is just because the rates are increasing does not mean that there is anything sinister or terrifying going on.

Seriously! Have you had one yourself in a hospital?
Woman just wish to be treated with more care and consideration and less of a production line. How is that asking too much or risking anything???
I have not had a c section but any friends I spoke with were glad to have had a section if otherwise was to endanger the life of the baby.
What terrified them was feeling like a piece of meat and control being removed totally from them to medical staff.
Or to sum it up, medical staff talking amongst themselves while looking between your legs and nobody making eye contact and or discussing procedures etc to yourself, like your not even in the room!

Akrasia · 02-08-2013 11:20AM

Why can't women just accept that the birthing process for humans is horrific, It's dangerous, it's long and painful and tiring and stressful and traumatic.

The process of giving birth is awful, but the payoff is afterwards when the baby is born.

There are two schools of thought here that are equally harmful IMO.

1. The idea that a painful childbirth is some kind of rite of passage that a woman needs to endure to be a 'real woman' And therefore, a 'real woman' should have a 'natural' birth without pain medication and the longer the labour, the better (bragging rights afterwards)

2. The idea that childbirth is a magical wonderful positive natural experience that should be embraced and enhanced, and if the child birth doesn't go the way 'nature intended' that this will harm the baby's early emotional development and the bond between mother and baby.

Both of these are harmful because they set arbitrary and often unrealistic expectations for what the experience should be, and then attach a sense of guilt or inadequacy if the experience does not go according to plan.

As has been repeatedly pointed out, giving birth naturally without any medical intervention is extremely risky, as we have developed better Maternity services, the outcomes have improved significantly and they are at an all time high, better than at any point in history.

Bearing in mind that maternity services are constantly reviewed and updated to refine the procedures and improve the outcomes for women and babies, If there is harm caused by the medicalisation of childbirth, what is the best way to deal with this?

Is it to roll back the advances that result in better survival outcomes and go back to nature?

Is it to better manage expectations and not romanticise the process of childbirth so much and just accept that childbirth is a medical procedure that needs to be controlled by the medical experts to maximise survival outcomes?

Is it to invest more money in our maternity services to give women more space and more comfort as they try to deliver their baby in a hospital setting in the manner of their choosing but while still giving utmost priority to safety?

Friend Computer · 02-08-2013 11:25AM

marizpan wrote: »

Or to sum it up, medical staff talking amongst themselves while looking between your legs and nobody making eye contact and or discussing procedures etc to yourself, like your not even in the room!

Without wishing to sound patronising (and I apologise if I do sound like that)...

I really don't see what's so unusual about that. Medical staff tend to be under a lot of pressure in situations like that and spending time explaining everything to the patient would be impractical, I'd imagine. There comes a point where you just have to accept that--as professionals--they know what they're doing.

kunst nugget · 02-08-2013 11:25AM

marizpan wrote: »

What terrified them was feeling like a piece of meat and control being removed totally from them to medical staff.
Or to sum it up, medical staff talking amongst themselves while looking between your legs and nobody making eye contact and or discussing procedures etc to yourself, like your not even in the room!

My wife had 2 c sections and never once was she made to feel uncomfortable or like a piece of meat. Every part of the procedure was explained to her and she was given advance warning of any discomfort she might feel. The doctors did talk amongst themselves at times but let's be honest it's an operation and as a team they have to relay information to each other - they're not telepathic. Can't say we felt like we're herded about like cattle in any way.

Why would they be looking between your legs during a c-section?

Homebirth controversy

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