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Friday, 30 July 2010

Home births under the spotlight

Regular readers will know that, every now and again, I do like to dive headfirst into a controversial subject, and today’s just such a day.

I read with interest this morning that, according to a top medical journal, women should not be allowed to choose a home birth if it puts their baby at risk.

New research has suggested that home births are twice as likely to result in the death of a newborn baby than hospital births. The study, of 500,000 births across the world found that 0.2% ended tragically.

As a result The Lancet has said that; "Women have the right to chose how and where to give birth, but they do not have the right to put their baby at risk."
I agree.

Mrs B and I have, so far in this pregnancy, had nothing but positive experiences of the NHS and, although no one has told us that we shouldn’t have a home birth, it has been made very clear to us that a hospital birth would be the safest option for mother and baby.

Having also been on a tour of the labour ward at the hospital it was hugely reassuring to see the equipment and facilities and to be shown the various delivery rooms, as well as the nearby operating room should anything go wrong or a caesarean be needed. We met the staff, were walked through the whole process – from arrival to the beds on the ward – and left confident in the ability of our hospital to ensure the health and safety of Mrs B and Baby B.

How can giving birth in your living room possibly compare?

I understand how some parents may want the peace and calm of familiar surroundings, but surely this is selfish on their part? What if the baby needs expert medical attention? What if the equipment and expertise is a drive away? Could you live with yourself if your baby suffers as a result of the time it takes to get him or her to hospital?

And why even put yourself in a position to face these questions in the first place?

I want nothing but the best for my wife and baby and would never do anything to put either of them at risk. A hospital birth is therefore the only thing we would ever consider and I cannot think of a single argument that would make me reconsider?

18 comments:

  1. I would only ever have a hospital birth. If my daughter had been born anywhere else other than hospital, she and I would probably have died.

    I have a friend who is a GP and she thinks it's totally irresponsible to have a home birth because of the risks involved.

    However I do understand why people choose home births, hospitals are stressful places. I think if you had the first one without any problems, then there is a stronger case for having your second at home.

    At the end of the day it's personal choice and you can't stop people from doing it.

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  2. So pleased to here that the hospital took care of you and your daughter, I have every confidence that they'll do the same for us.

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  3. I'm so tired of fighting this fight, I just strongly suggest this reading:

    http://birthfaith.org/home-birth/i-dont-agree-with-home-birth

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  4. The hospital botched my first birth, badly. I ended up with a difficult recovery from a (we found out later) completely unnecessary surgery, and PTSD and HUGE difficulties nursing from the experience.

    My second was born at home in an uneventful, peaceful birth attended by a trained midwife.

    The hospital wanted me to have surgery again, despite the science saying it wasn't as safe for me. Was it selfish of me to not want to repeat my first experience with the people who put me through it the first time?

    Homebirth is safe and legal, just not the best choice for everyone (just like the hospital isn't the best choice for everyone either). Get educated on it besides what you see in the media, and I think you'll see that.

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  5. Oh, and here's another article for you on the same study via NPR: http://www.npr.org/blogs/health/2010/07/30/128870837/giving-birth-at-home-could-be-risky-business?ft=1&f=1001&sc=tw&utm_source=twitterfeed&utm_medium=twitter

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  6. Important info about the Lancet study you referenced:

    "Of the largest studies included in this metaanalysis, only three (Hutton, et al 2009;
    Janssen et al 2009; & deJonge et al 2009) clearly distinguish between planned and
    unplanned home births. These three studies—which comprise 93% of the women included in the metaanalysis—found no significant differences in perinatal outcomes." (See here: http://www.midwife.org/ajog.cfm and click on "our statement about the study.")

    Failing to distinguish between planned and unplanned home births makes a HUGE difference. Much of the problem arises from the Lancet study pulling data from the Pang study which included preterm births from 34 weeks, as well as unplanned and unattended home births. Preterm births should always be handled in the hospital! Women planning home births are well aware of that as are their midwives.

    Also troubling:

    "[A] meta-analysis is a way of combining the results of many studies. But in this case, there seems to be no clear reason as to which studies they included versus those they excluded. In fact, they actually did not include the best and by far largest study that's been done—which did not find a higher neonatal mortality rate." (See more here: http://acnm-midwives.blogspot.com/2010/07/acnm-responds-to-lancet-home-birth.html)

    This "best and by far largest study" was published in the British Medical Journal and can be found here: http://www.bmj.com/cgi/content/abstract/330/7505/1416

    From Michael C. Klein, MD, a University of British Columbia emeritus professor and senior scientist at The Child and Family Research Institute:

    “The conclusion that this study [Lancet study] somehow confirms an increased risk for home birth is pure fiction. In fact, the study is so deeply flawed that the only real conclusion to draw is that the motive behind its publication has more to do with politics than with science.”
    (http://ww.examiner.com/x-26184-DC-Family-Health-Examiner~y2010m7d10-International-expert-calls-study-deeply-flawed-and-politically-motivated)

    Women who plan home births do so for so much more than the "peace and calm of familiar surroundings." Safety is one of their primary motives! http://www.jmwh.com/article/S1526-9523%2808%2900338-3/abstract Planning a home birth is not something women do lightly!

    Choosing to plan a home birth was one of the most intense decisions I have ever made, and I made it after spending the previous 5+ years researching childbirth. Having "the peace and calm of familiar surroundings" had absolutely nothing to do with my decision (http://birthfaith.blogspot.com/2008/11/as-promised.html).

    Safety was extremely important to me which is why I interviewed several midwives before choosing those with the most experience (28+ years) and the most safe and impressive outcomes and stats. I think you'd be hard-pressed to find ANY doctor or midwife with stats as impressive as theirs.

    So do you still think we're "selfish"?

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  7. It is a very personal thing and yet how does a first-time parent know the difference? I think that if you've had a routine pregnancy and no reason to think that there could be complications, then go for a home birth. Trained midwives will know when you should be transferred and won't risk complications at home. You can always change your mind if you find baby is breech, go two weeks overdue, etc.

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  8. Following on from your comment above, the hospital failed badly. They induced me when I was 10 days overdue, however they didn't pick up that my daughter was only 2.2kg or that I had a form of pre-eclampsia. I ended up having an emergency c-section under general anaesthetic and we both stayed in hospital for 2 weeks. But it was still a better outcome than if I'd been at home. Next time I will go private.

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  9. Thank you to everyone for your comments. Having read your thoughts I accept completely that The Lancet's study may be flawed and that many parents choose a homebirth for reasons over and above those outlined in my original post, eg. for safety reasons and following previous bad experiences in hospital. I am so pleased to hear that homebirths were successful and safe for many of you and, similarly, am shocked to read how some of you had horrendous experiences in hospital. This is clearly a contentious issue and ultimately one that comes down to individual choice. I respect and admire those of you who chose to give birth at home, and your reasons for doing so, but my wife and I still feel that, for us, the hospital is the best place to bring our first child in to the world. I can only pray that it's the right choice.

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  10. I respect you and your wife's decisions. I was the same way when I got pregnant. There was no changing my mind that the hospital was the safest place for me because of my low blood pressure problems. Then I got an O/B who was bound and determined to cut me open. That was too terrifying to contemplate cause I'm allergic to so many medications. I dumped him and went for a certified nurse-midwife in a hospital. Yeah, I was really taken care of (read with extreme sarcasm). They gave me something in my IV that was stated in 3 different places, including my wrist that I was allergic to. I was starved for 24 hours, even though I was only in labor for 12. I was punished because I ate breakfast before leaving for the hospital. I was disconnected from my husband, even though he's the one I wanted with me the most. Sure, he was in the room, but he was shoved in a corner. There were so many other horrible things that happened that I just don't even want to go into here. My second two were born at home with only my husband (a trained EMT) as my attendant. I just couldn't go through that hell again. They were so peaceful and wonderful and how I imagined birth to be.

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  11. Where a woman feels most safe is where she will have the safest birth, for both mother and hopefully baby. Sometimes the hospital is just as dangerous as people perceive home to be, depending on the situation and the people involved... some doctors believe in God, other doctors believe the ARE God... and some of the Dr. Gods don't believe they make mistakes and that as long as the baby is fine they did a good job. I am glad that you're at least willing to understand why some of us feel safer at home, whereas some people feel like burning us homebirthers at the stake as potential baby killers for wanting to go against the grain. Where a woman feels safe, honored, loved, and respected is the safest place for her to birth... this is important for her partner as well, because how she fares her labor and birthing can predict how she will cope with her postpartum period. Yes, there can be complications wherever a woman births and a competent midwife will guide her to safety. Generally, midwives require their clients to educate themselves on safe birth practices and just a general knowledge of how the process goes so the woman and her partner know and understand that if something isn't right it is neither a failure nor a fearful thing to admit and seek more advanced help. Three of my friends have done just that, and they made it to hospital long before the baby was in distress. It was all okay. It was not the horrible scenario the television shows us.

    I respect that you and your wife both feel safer in hospital than out. To each their own. I'll pray for the three of you just as I do all my friends who are approaching their births because it is a time of great change for a woman, her partner, and whomever may be attending the birth. There are many emotions from all corners. I URGE you and your wife to both seek out as much information as you possibly can about possible procedures and know ahead of time what you'd like to avoid and what you'd like to embrace, and you as her husband need to be ready and willing to advocate for her if she needs it. Birth is a humbling and vulnerable moment in the life of you and your wife. Don't allow yourself to be shoved into a corner unless your wife asks you to be. Stand beside her and be her voice if she needs it- and most of all, don't allow fear to make your decisions. If there's a medication she doesn't want (like oxytocin) or if she'd like to try everything to avoid a caesarian, you've got to help her make that happen by knowing enough to call the staff out on it. Don't ever forget that as the dad-to-be, you have a 50% part in making that baby, so you've got a say too. Believe me, your wife will admire and appreciate your strength later.

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  12. I am glad you are able to listen and respect us homebirthers. I do get sick and tired of people calling us selfish and assume that all we want is a good birth experience no matter what. That is simply not true.

    When I was expecting my first son I thought the idea of homebirth was crazy. That the safest place was the hospital. I was wrong. Although I had a vaginal birth, I got a lot of Doctor caused complications, and he even admitted to it. I suferred from PPD for a year from that, and I am still haunted by that birth, 3 years later. I just had a homebirth with my second a few months ago. The prenatal care, labor, birth and recovery has been so much better. No PPD, no complications, and I felt so safe at home with my Midwife. I did not feel safe in the hospital.

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  13. I am choosing a homebith with this baby as there isn't a Dr or hospital in my area that will allow me a trial of labor since I had a c-section with my first. Unless I wait to go in until I am in labor and refuse to consent to another c-section which would be very stressful.
    I am extremely confident in my midwife and have learned so much from taking a 12 week childbirth class. I'm looking forward to laboring in a peaceful environment, which for me, is not the hospital.
    I hope that your hospital birth is a peaceful, wonderful experience.

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  14. Midwife forever31 July 2010 at 11:54

    As a Midwife I want to assure everyone reading this that skilled, trained Midwives know how to check the PG woman for risk factors and assess for safety in a homebirth. Most women, with education, a Midwife, and trust in the natural process do feel safer at home and that emotional sence of safety can prevent a lot of complications that come up in a hospital; which are usually the result of shift changes, not knowing the Doc on call, staff needing to adhere to time limits due to mal-practice ins. rules, the woman having to stay on her back for monitoring, no eating, IV's, pain meds being pushed on women, etc. Then there can be serious problems with bonding with BB, breastfeeding due to staff giving BB a bottle, a depressed BB struggling to breathe due to pain meds mom took.
    Some women need to birth in the hosp, due to pre-natal risk factors or history.
    However, 80+ % of babies born world-wide are not born in hospitals and the US has one of the highest infant/maternal death rates amongst the 26 industrialized nations - despite the majority of babies being born in hospitals!

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  15. There is a really great book called "Freakanomics" by Steven D. Levitt and Stephen J. Dubner in which they look at common perceptions people have and prove them or misprove them using statistics. For example, on of their studies was to prove that it is WAY WAY WAY more dangerous for your children to have a swimming pool in your home than it is to have a handgun in your home. They said that given the number of children who drown in home swimming pools compared to those who are killed by guns (controlling for variables in both cases) that according to their study it appeared a parent would be totally irresponsible to have a swimming pool in their home or send their child to a friends house who had a swimming pool. Yet when polled most paretns felt that guns were a bigger saftey threat than swimming pools and many of them said that they wouldn't send their children to a friend's house if they knew there were guns but that they would send them if there was a swimming pool. Their perceptions of danger didn't align with the statistical reality... but that didn't make them change their minds.

    I guess what I am trying to say is that when you really sit down and look at the ALL of the research that has been done of homebirths you discover that they are safe--- sometimes safer-- than hospital births for LOW RISK women. Yet for most people this is a radical paradigm shift and no matter how much they see the research. It is really a matter of perception and what your experience has been in the past. If a mother has had a bad experience with a swimming pool in the past then she is likely to be more wary of them for her children in the future. Whereas a woman who has had a good experience with a swimming pool may feel it is totally safe.

    I think it is vitally important that women have the right to choose. It makes me sad to see mainstream articles like the one you cited that are used to justify taking away women's choices.

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  16. I have done both, each preganancy is different, every baby is different and as mothers we change with time and age. I believe women need the choice to feel safe. My homebirth was amazing and much quicker, safer, (I recovered quicker because there was no scalpal!) than my hospital births (I have four children). I do think that as long as both Mum and Baby are well it doesn't really matter where they arrive! Good luck with your new arrival ;)
    xxx

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  17. Looks like you have already received some detailed comments, so I will try not to write a book here, but I'd really like to encourage you to find out a bit more about both types of birth. I had a negative hospital experience the first time around and a homebirth with my second. It was a night and day difference.

    My midwives are licensed by the state and are extremely knowledgeable. I saw an OB twice for bloodwork and to get prescriptions, just in case (the same things they use in the hospital), and my midwives checked for risk factors at every prenatal like my OB did with my first baby. If anything had indicated high risk, I would have transferred to the hospital. The two biggest differences were that my midwives were SO much more encouraging of exercise and a healthy diet. Also, when I asked them their stats (c-section rate, transfer rate, etc) they not only knew them but shared them. Many OBs, like my previous one, will not do this, and if you ask me, as a paying client, you deserve to know!

    Women are not selfish for choosing homebirth. I still feel guilty for how rough the hospital birth was on my older daughter (the failed vacuum delivery in particular). Also, a mother who feels safe and empowered and recovers faster IS good for the baby. The mother and baby are a unit and one's welfare affects the other. Breastfeeding went ten times better with my homebirth, and my baby gained weight quickly.

    It's not that hospitals are all bad--they just aren't the best environment for my family. If your wife wants to go to the hospital and feels safer there, that's where she should go. Taking choices away from women just makes no sense, though. There are certain things some women need that are unavailable in a hospital setting. Here are my two birth stories if you want more info on why we chose homebirth:

    http://babyfingers.blogspot.com/2008/02/suzis-birth-story-eight-months-late.html
    http://babyfingers.blogspot.com/2009/08/iveys-birth-story.html

    I hope everything goes well with your baby's birth!

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  18. I really hope you thoroughly educate yourself on this topic after reading all the comments that have been posted.

    Speaking from personal experience, a hospital birth does not exempt you from a horrifying childbirth or guarantee you a live and thriving baby. My nephew suffered brain damage and eventually died at the hands of a very prestigious Nashville hospital. It was heart wrenching and could have been avoided. You will never hear about these happening from the medical establishment. NEVER. We had an impossible time just obtaining the medical records for legal purposes...

    What you will hear about is the homebirth gone wrong, and you will believe that it happens far more frequently than it does. You will believe hospital horror goes on far less frequently than it does. And it is your CHOICE to believe what you may, despite the facts.

    When I had my first child, I had unassisted prenatal and childbirth. No complications whatsoever. He couldn't be healthier.

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