Homebirth controversy

drkpower · 16-08-2013 12:38PM

Uriel. wrote: »

Not outside of a controlled environment. Homebirths... yes. Indemnification for elective practices... yes. Homebirth + elective procedure + identified risk = no insurance from HSE - rightly so in my view.

That's not accurate.

Homebirth + elective procedure + identified risk = insurance depending on the extent of the risk. Every pregnancy, even the most uncomplicated pregnancy with the healthiest mother, carries more risks that anyone would care to consider, some with the most tragic of consequences. The question is all about the extent of the risk, who assesses it etc, which are quite complicated matters.

And the HSE doesnt provide insurance.

Fred Swanson · 16-08-2013 12:42PM

This post has been deleted.

kippy · 16-08-2013 12:42PM

Rosy Posy wrote: »

I planned homebirths with all my children but transferred to hospital with the first two. In both cases the babies were stargazing (OP or face up presentation) and so the labour was prolonged. In both cases the midwife made the call that I would need chemical augmentation (be given drugs to increase the intensity of the labour in order to progress) which could only be done in a hospital, she drove me to hospital (20mins away) in her own car and I was admitted from there. She continued to care for me in the hospital with the doctors poking their heads in every now and then.

However, this was not in Ireland. Here in NZ all pre and post natal care is midwife led- so normal practice is for you to have all your check ups with the midwife, she will go in to hospital with you if that's your choice and deliver your baby. The doctors are only there if something out of the ordinary is happening and the call is mostly made by the midwife. So all midwives have a relationship with the hospital staff and are used to working in the environment. I'm not sure how it works in Ireland.

One thing I've learned from this thread is that, if what Lost in Kildare says is correct...

...if I had delivered in Ireland there is a high chance I would have had an unnecessary section which would have prevented me delivering my third (and hopefully fourth) babies at home.

It's pretty much the same in Ireland once you get to hospital. It is generally a midwife led event however any form of complications or otherwise and a doctor gets involved straight away.
I can appreciate why people may feel a homebirth is a "good idea" however when you look at it closely the risks of something going wrong that cannot be sorted out quickly outside of a hospital are high.
When you live more than 20 minutes from a hospital things can go wrong very quickly.

In this particular case the woman has been given all the best advise available yet she is intent on going against it. I don't know what the big issue she has with this is to be honest.

Uriel. · 16-08-2013 12:45PM

drkpower wrote: »

That's not accurate.

Homebirth + elective procedure + identified risk = insurance depending on the extent of the risk. Every pregnancy, even the most uncomplicated pregnancy with the healthiest mother, carries more risks that anyone would care to consider, some with the most tragic of consequences. The question is all about the extent of the risk, who assesses it etc, which are quite complicated matters.

And the HSE doesnt provide insurance.

Indemnification then if you want to be pedantic.

gobnaitolunacy · 16-08-2013 01:00PM

Just stop being awkward and have it in a hospital like everyone else. Damn hippy.

drkpower · 16-08-2013 01:07PM

Fred Swanson wrote: »

This post has been deleted.

I dont think so; isnt that the whole point, that the refusal of insurance acts as an effective prohibition on homebirthe for women with particular risks? She can only be provided with insurance through the State (I presume that privately owned insurance isnt possible but im speculating in that regard).

drkpower · 16-08-2013 01:08PM

Uriel. wrote: »

Indemnification then if you want to be pedantic.

They dont provide indemnification either.

Insurance/indemnification is provided through the clinical indemnity scheme, a state body which is seperate from the HSE.

drkpower · 16-08-2013 01:14PM

kippy wrote: »

It's pretty much the same in Ireland once you get to hospital. It is generally a midwife led event however any form of complications or otherwise and a doctor gets involved straight away.
I can appreciate why people may feel a homebirth is a "good idea" however when you look at it closely the risks of something going wrong that cannot be sorted out quickly outside of a hospital are high.
When you live more than 20 minutes from a hospital things can go wrong very quickly.

In this particular case the woman has been given all the best advise available yet she is intent on going against it. I don't know what the big issue she has with this is to be honest.

Those are sentiments that most would instinctively agree with (including myself). But the evidence (at least that presented by the woman to court) with regard to the safety of homebirths is quite compelling. It certainly surprised me (who wouldnt, and still wouldnt countenance a homebirth). I dont have them to hand (they are easily google-able) but the risk of certain/many complications in a hospital birth was much higher than for a home birth. And while the rates of homebirths in Ireland was extremely low, they were much higher in other countries (i think the rate was 20% or even higher in the Netherlands).

The whole homebirths issue has been painted as some kind of hippy-esque life choice (and to be honest i would have had a knee jer reaction in that direction untiil recently, and i have a fairly decent knowledge of the whole area) rather than a type of birth that actually reduces the risks. That is a very unfair charachterisation.

2013Lara · 16-08-2013 01:17PM

Haven't read most of the replies. I have had two sections. The second, I tried naturally. Things went well for a while but changed quite quickly and if I hadn't been sectioned straight away, I don't know if my baby would be here today, or myself for that matter.

Woman needs to cop on and do what's right for her baby.

padd b1975 · 16-08-2013 01:17PM

gobnaitolunacy wrote: »

Just stop being awkward and have it in a hospital like everyone else. Damn hippy.

Classic attention seeking and more money than consideration for the welfare of her child.:o

kippy · 16-08-2013 01:20PM

drkpower wrote: »

Those are sentiments that most would instinctively agree with (including myself). But the evidence (at least that presented by the woman to court) with regard to the safety of homebirths is quite compelling. It certainly surprised me (who wouldnt, and still wouldnt countenance a homebirth). I dont have them to hand (they are easily google-able) but the risk of certain/many complications in a hospital birth was much higher than for a home birth. And while the rates of homebirths in Ireland was extremely low, they were much higher in other countries (i think the rate was 20% or even higher in the Netherlands).

The whole homebirths issue has been painted as some kind of hippy-esque life choice (and to be honest i would have had a knee jer reaction in that direction untiil recently, and i have a fairly decent knowledge of the whole area) rather than a type of birth that actually reduces the risks. That is a very unfair charachterisation.

I suppose the reason why the risk in homebirths may appear to be low is the fact that the mother may have been screened before making the decision to have a homebirth.
She would possibly consult with medical practictioners and experts in the field and once they looked at the patients history, scans, risk factors, would decide whether a home birth was a suitable option.
Everyone else is told to come into hospital as their birth may be seen as a higher risk of issues.
The statics are completely misleading in that regard I would think.
ie, home births may show lesser issues but that may be because of a pre-screening process before hand.

This woman, has gone to the best people, they have told here there is a significantly high risk of complications during birth and that she should come into hospital for the procedure........

Things can go wrong either way, all that being said, but I know I would prefer my partner and bumb/new baby to be at a location where specialist medical equipment and advise are on hand IF there are issues.

seamus · 16-08-2013 01:25PM

drkpower wrote: »

Those are sentiments that most would instinctively agree with (including myself). But the evidence (at least that presented by the woman to court) with regard to the safety of homebirths is quite compelling. It certainly surprised me (who wouldnt, and still wouldnt countenance a homebirth). I dont have them to hand (they are easily google-able) but the risk of certain/many complications in a hospital birth was much higher than for a home birth.

You need to tread caution with a lot of these statistics though. You could equally say that people who are admitted to hospital are more likely to die than those who aren't, therefore you should avoid being admitted to hospital.

In reality the vast majority of woman who would otherwise have chosen a homebirth but were deemed high risk, will have a hospital birth. Therefore homebirths are effectively self-selected for low risk births for statistical purposes.

A proper statistical comparison would compare complication rates between HBAC and normal homebirths, and leave hospitals out of it altogether. Did she present this kind of information?

drkpower · 16-08-2013 01:32PM

kippy wrote: »

I suppose the reason why the risk in homebirths may appear to be low is the fact that the mother may have been screened before making the decision to have a homebirth.
She would possibly consult with medical practictioners and experts in the field and once they looked at the patients history, scans, risk factors, would decide whether a home birth was a suitable option.
Everyone else is told to come into hospital as their birth may be seen as a higher risk of issues.
The statics are completely misleading in that regard I would think.
ie, home births may show lesser issues but that may be because of a pre-screening process before hand..

I havent looked any deeper than some of the media reportage so I didnt get a chance to look deeper than the face-value statistics and particularly whether the studies allowed for the considerations you raised. I simply dont know but you raise a fair point.

But what we cannot get away from is that the rates of homebirths are far higher in many western countries than our own. That stat is unaffected by the point you have made. If countries with healthcare systems at least as good as our own are showing rates of 20%+ (with our own being somehwre in the region of 1%) we need to ask ourselves why we differ so radically. Its easy, as some people do, to close ones eyes and say that homebirths is for hippies, or is tantamount to child endangerment but that approach is shortsighted.

Edit: I think i have dealt with Seamus' point here too.

kippy wrote: »

This woman, has gone to the best people, they have told here there is a significantly high risk of complications during birth and that she should come into hospital for the procedure.........

Agreed, and a previous c-section seems in most healthcare systems to be one of the risks which, by itself, leads to advising against a homebirth.

kippy wrote: »

Things can go wrong either way, all that being said, but I know I would prefer my partner and bumb/new baby to be at a location where specialist medical equipment and advise are on hand IF there are issues.

Same here.

fibonaccii · 16-08-2013 01:36PM

Let me get this straight

Have baby in hospital surrounded by medical equipment and professionals?

or at home with none of the above.

Its a bit of a know brainier isn't it?

If you want to give your baby the best chance of surviving and being healthy have deliver it in the hospital that's what its there for......

Larbre34 · 16-08-2013 01:37PM

This is pure Kathy Sinnott syndrome.

People is this country are entitled to carry on their lives with a good degree of personal freedom, but within reasonable social, lawful and safety norms. Its a better than average Country to live in in that respect.

What they do not have cause to do is assert those rights to the N-th degree in a vexatious way, a way that attempts to drag public services outside of their normal operation to meet their personal views or wants, pubic services which are there to provide a fair level of support to people when they need them in particular circumstances.

SEPT 23 1989 · 16-08-2013 01:37PM

she is on the news at one now

Uriel. · 16-08-2013 01:39PM

drkpower wrote: »

They dont provide indemnification either.

Insurance/indemnification is provided through the clinical indemnity scheme, a state body which is seperate from the HSE.

More Pedantry.

The NTMA operating the CIS is largely advised by Boards/Committees/Individuals working policy in both the HSE, Dept. of Health and other relevant Depts/Agencies. The HSE has advised, through its policies that the case in question contains a risk that they will not sanction. Through this policy/because of it, no indemnity is provided for this particular circumstance. Generally CIS payouts come from Dept of Health, parent Dept. for the HSE. The CIS don't make the rules as such, they manage the claims procedure. The policies are Government made, including input from the relevant Gov Departments and agencies.

kippy · 16-08-2013 01:39PM

drkpower wrote: »

I havent looked any deeper than some of the media reportage so I didnt get a chance to look deeper than the face-value statistics and particularly whether the studies allowed for the considerations you raised. I simply dont know but you raise a fair point.

But what we cannot get away from is that the rates of homebirths are far higher in many western countries than our own. That stat is unaffected by the point you have made. If countries with healthcare systems at least as good as our own are showing rates of 20%+ (with our own being somehwre in the region of 1%) we need to ask ourselves why we differ so radically. Its easy, as some people do, to close ones eyes and say that homebirths is for hippies, or is tantamount to child endangerment but that approach is shortsighted.

That's a fair point, but it's not something that would overly bother me. There are/can be many factors leading to that but I assume the whole model of healthcare provision in this country has been set up to promote hospital briths, for many years now and probably on the behest of some report at the time of the policies.

It could very easily be a societal thing, not easily changed by any policy or fundamental shift in attitudes from a healthcare perspective.

Perhaps the higher rates of homebirths elsewhere are as a result of a significently larger distance between the populace and the medical centres.....
There are many potential reasons for it.

drkpower · 16-08-2013 01:40PM

seamus wrote: »

A proper statistical comparison would compare complication rates between HBAC and normal homebirths, and leave hospitals out of it altogether. Did she present this kind of information?

I'm not sure; i havent read the transcript.

I agree with the points you make - there certainly will be a skewing of the data based on self selection. Of course, that wont be the case with all risks. For instance, the risks of maternal infection is radically lower with homebirth as is the risk of 3rd and 4th degree tears (both of which shouldnt be radically affected by the increased numbers of higher-risk pregnancies delivered in the hospital setting).

Of course, a major factor against homebirths is that certain neo-natal outcomes are worse with homebirths (which probably comes as no surprise).

drkpower · 16-08-2013 01:41PM

Uriel. wrote: »

More Pedantry.

The NTMA operating the CIS is largely advised by Boards/Committees/Individuals working policy in both the HSE, Dept. of Health and other relevant Depts/Agencies. The HSE has advised, through its policies that the case in question contains a risk that they will not sanction. Through this policy/because of it, no indemnity is provided for this particular circumstance. Generally CIS payouts come from Dept of Health, parent Dept. for the HSE. The CIS don't make the rules as such, they manage the claims procedure. The policies are Government made, including input from the relevant Gov Departments and agencies.

Jeez, relax, it was a side issue. Deal with the substance.

drkpower · 16-08-2013 01:44PM

kippy wrote: »

That's a fair point, but it's not something that would overly bother me. There are/can be many factors leading to that but I assume the whole model of healthcare provision in this country has been set up to promote hospital briths, for many years now and probably on the behest of some report at the time of the policies.

It could very easily be a societal thing, not easily changed by any policy or fundamental shift in attitudes from a healthcare perspective.

Perhaps the higher rates of homebirths elsewhere are as a result of a significently larger distance between the populace and the medical centres.....
There are many potential reasons for it.

Indeed, but it a stark difference, one that warrants exploring (and certainly one that should lead us to challenge many peoples initial knee jerk reactions against homebirths to the point that many equate homebirths with willful child endangerment).

Uriel. · 16-08-2013 01:45PM

drkpower wrote: »

Jeez, relax, it was a side issue. Deal with the substance.

I already have. In post #19

kippy · 16-08-2013 01:48PM

drkpower wrote: »

many peoples initial knee jerk reactions against homebirths to the point that many equate homebirths with willful child endangerment).

This is very obviously one reason why we don't have more homebirths (it's a societal thing from the get go)
Where that reasoning came from or what has brought people to that point is the question that needs to be answered.

drkpower · 16-08-2013 01:50PM

Larbre34 wrote: »

What they do not have cause to do is assert those rights to the N-th degree in a vexatious way, a way that attempts to drag public services outside of their normal operation to meet their personal views or wants, pubic services which are there to provide a fair level of support to people when they need them in particular circumstances.

In fairness, one would expect that homebirths actually involve less consumption of public services (rather than more). Of course, you would need to factor in the costs of indemnification (which would be a complex enough calcualtion) but ultimately i dont think the issue here is a diversion of resources issue.

drkpower · 16-08-2013 01:52PM

Uriel. wrote: »

I already have. In post #19

Well thats a much more reasoned argument than you made in post 203

!

Uriel. · 16-08-2013 02:00PM

drkpower wrote: »

Well thats a much more reasoned argument than you made in post 203 !

I can't decide if I am having a bad day today or if I had a good day when I posted #19 :pac:

Ciarabear · 16-08-2013 02:01PM

This woman's sense of entitlement is actually off the Richter

nicowa · 16-08-2013 02:07PM

drkpower wrote: »

I'm not sure; i havent read the transcript.

I agree with the points you make - there certainly will be a skewing of the data based on self selection. Of course, that wont be the case with all risks. For instance, the risks of maternal infection is radically lower with homebirth as is the risk of 3rd and 4th degree tears (both of which shouldnt be radically affected by the increased numbers of higher-risk pregnancies delivered in the hospital setting).

Of course, a major factor against homebirths is that certain neo-natal outcomes are worse with homebirths (which probably comes as no surprise).

It seems the reason 3rd & 4th degree tear stats are radically affected by being in hospital is that that is where the doctors are. From a report I read (link was in the pregnancy forum, I'm on the phone) episiotomies can often cause a greater tear than simply having a tear occur. It reasoned that if you cut a piece of fabric it's much easier to tear. Whereas if you try and tear without a cut made its much more difficult.

One more reason I won't be getting an episiotomy.

As for the higher rates of home birth elsewhere - that has to do with a greater number of birth centres not a lesser one. The closer you are to a medical birthing centre the easier it is to transfer you should the need arise the more likely you'll be allowed and want a home birth. (I believe someone mentioned this earlier in the thread so it's not just me supposing.)

Fred Swanson · 16-08-2013 02:13PM

This post has been deleted.

Allyall · 16-08-2013 02:26PM

Freaky thing is, her fella's house in Thomastown used to be some sort of birth clinic, or abortion clinic in the early 1900's, i'm not sure. I realise there is a massive difference, but i'm only going on the stories he used to tell years ago, that there was a load of babies buried under the rosebush at the front of his house.

I realise it may all be BS of course, but he was convinced it was true (At maybe 22 years of age), and he used to tell everyone that story.

Why would anyone want to homebirth there, if they believed that to be the history of the house?

Although it's no longer the same house as they built a replica behind the original one, the original still stands.

Homebirth controversy

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