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Melanie Batley

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Time to Reconsider Whether the NHS Should be Encouraging Home Births

Posted: 25/11/2011 10:22

An Oxford University study out today reported that first-time mothers that go for a home birth are almost three times more likely to have complications than if they had their baby at the hospital. Plus half of them end up having to be transferred to the hospital during labour.

These findings alone should re-open the debate about the safety of home births, and make the government reconsider whether NHS professionals should be actively promoting it to new parents, like so many midwives do.

Before I get an angry crowd of home birth advocates beating down my door, let me just say this: Congratulations if you had a home birth and it was the most wonderful experience of your life. Great news if it made you feel empowered. Well done if your baby was born perfectly healthy in the blissful environment of your candle-lit bedroom and the two of you snuggled down happily for the rest of the night.

I remember vividly those first few months of my first pregnancy when the information about childbirth started flowing in. Midwives, doctors, NHS professionals, clinicians, friends and books all talked eagerly about "birthing options", telling you to think about "what's best for you" and "the kind of birth you want to have", including whether you want to consider having the baby at home.

The fact remains that a home birth is not as safe as having the baby in the hospital. And not one professional I've ever encountered through two births on the NHS was ever willing to say that.

Why not?

For one, it costs the NHS more money and resources for women to have their babies in the hospital. Maybe they've beent told to do everything they can to keep costs down.

Secondly, maternity care in this country is lead by midwives who on the whole are heavily biased toward "natural" birth. Propaganda against pain relief during labour is prevalent, as is an underlying suggestion that any form of assistance or intervention somehow presents an inferior type of birth.

Not only that, but there have been a number of smaller scale studies claiming that home births in developed countries are generally just as safe as hospital births. This study, however, is the largest and most comprehensive of its kind, involving over 65,000 women.

So much can go wrong during labour. A baby could suffer permanent brain damage if it loses oxygen for just a few minutes. Sure, midwives are skilled at dealing with foetal distress, but I certainly wouldn't want to take even the tiniest risk that those minutes were lost while we scrambled for an ambulance.

Or say the labour gets to stage two and an unplanned intervention is needed, such as forceps, ventouse, or even a caesarean. What about a postpartum haemorrhage? For any of these, you need to get to the hospital, and sometimes, albeit in a minority of cases, minutes could be the difference between life and death or permanent damage to the baby. These points aren't actively discussed with pregnant mothers.

The statistics even from this study say that home births are generally safe for "low risk" pregnancies. Then again, the thing about statistics is that no one knows whether they will be the outlier, the unlucky one. Even the healthiest pregnancies often end up with unpredicted complications during labour. At the hospital, the midwife need only press the call bell at the first sign of trouble and more professionals can pour in within minutes. Not at home.

Certainly women should continue to have a choice about having a baby at home and the NHS has a proud tradition of supporting that choice by deploying midwives to assist. But perhaps it's time that parents are told that it's not without potential serious risks, instead of carrying on as though it's just as safe as having baby at the hospital. The findings from this study would certainly support that.

 
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07:51 PM on 11/29/2011
This is a soap box article. "The fact remains that a home birth is not as safe as having the baby in the hospital." Oh really, says who? Sounds to me as if there is an underlying resentment of women who successfully give birth at home. Why not push for informed decision making, rather than slating home birhts?
09:55 PM on 11/25/2011
This kind of writing makes me want to vomit. The only thing that gets picked up out of this huge report is that home birth is less safe. As if it wasn't almost impossible in most parts of the country to get a home birth at all. I attended Commons working parties showing that everyone from mothers to doctors to people in parliament all wanted to see more home birth and midwife led births. Does that happen in spite of parliament? No chance. As the ob-gyne Professor, Wendy Savage, says, it just goes on getting worse. For twenty five percent of women birth is now a major surgical operation. This is needless and dangerous for women and their babies. None of the journalists pick up the fact that home birth mothers have far fewer interventions and their babies have much better apgar scores. That means the babies are healthier at birth. So one percent are worse off, ninety nine percent are better off. You write about the one percent.
And yes, you can write me off as a ranting lobbyist. I founded the Oxford Prenatal and Perinatal Research and Awareness Trust to try to help people understand birthing. It was mostly a waste of time. The hostility among professionals outside midwifery was awful. But midwifery at least understands how it should be. See http://www.midwiferytoday.com/articles/birthlovedeath.asp by my good self.
08:38 PM on 11/25/2011
My wife gave birth to both of our kids at home. She was robust, healthy and had pregnancies without complications (leaving aside the fact that pregnancy is a complication in itself). We had the support of a great midwife team who encouraged us to have these home births and who were genuinely delighted at our choice.

The key, and rather unexpected, point for me is that by making birth almost as "unmedical" an event as conception it created a powerful bond between us all. Birth remained linked to the rest of life, rather than being detatched from it by the experience of hospitalisation. I don't feel able to express in words how deeply I felt this and how rich and wonderful this feeling was and remains.

I don't deny for one moment the need for caution and care. But in balancing the scale of risk against rewards of home and hospital births I would - at least for myself - want this wonderful benefit of homebirths to be given the weight it deserves.
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JennyHatch
in my Kitchen...
07:19 PM on 11/25/2011
Who funded the study?

Just Curious...

Jenny Hatch
03:02 PM on 11/25/2011
Agree - based on two NHS pregnancies/births. The ever-under-pressure midwives recommended home births as the preferred option since it meant having guaranteed one-on-one care throughout the birth as opposed to the hospital where a midwife is inevitably shared.

Sharing a mid-wife and being close to doctors was the better option for me due to the first baby being stuck and needing ventouse assistance (when a Dr became available 5 hours later) and also because the baby had developed septicaemia (due to me suffering strep throat during pregnancy - yet I was never told of the risk). Second baby - peace of mind.

It was also better for my health given the 'birth injuries' involved - something else no-one talks about. Immediately following birth you must care for a newborn, master feeding/breastfeeding, recover from birth whether straightforward or one involving a scalpel wound from a Caesar, an episiotomy or 1st, 2nd, 3rd degree tearing, deal with ‘baby blues’ and detect whether your baby is responding normally and whether you have an infection from your stitches. All of that at home with no medical support is asking an incredible amount of women. Even if you are in hospital for the birth, you can be discharged 6 hours later.

Women should be given more info to make an informed decision about one of the most important events in the lifecycle of human beings. Raising care levels of pregnant women/new mothers may also reduce post-natal depression.