"Demedicalising" childbirth: women in the UK told to have their babies at home

[Cunctator]

An interesting story in today's New Zealand Herald (Monday 15 May) suggests a fairly radical shift in thinking on the part of UK Health authorities.

[Marlitharn]

It sounds nice, but who cleans up the mess afterwards? My husband can't even carry his empty glass from the living room to the kitchen.

[hawthorne]

This was the policy a while ago. I was born at home in the UK in 1968. My sister had been born without complications, so a midwife attended our house. All went smoothly.

[AngelicGemma]

While they may start offering it more as an option, I doubt the number of women actually doing it will change. Women who wanted one would have asked their doctor about it anyway. I think most women would feel they and their baby are safer in hospital.

[Dangerosa]

Originally Posted by Marlitharn

It sounds nice, but who cleans up the mess afterwards? My husband can't even carry his empty glass from the living room to the kitchen.

That's always my first thought with homebirth. Yes, I've known women with intense complications where being in the hospital saved one or two lives. And my brother in law is a CRNA who used to be involved in 600+ births a year - and brought back 100+ horror stories to go with them every year (most with happy endings thanks to medical intervention). But that isn't my issue with homebirth - its the "ewwww, I wouldn't want to do that to my mattress!!!" (And yes, I know, you cover everything up - but it was still a messy process).

My great grandmother gave birth to fourteen children in a farmhouse. And, by the time my mother knew her, was bat-shit crazy. Coincidence? I don't think so.

(Actually yes, bat shit crazy runs through my family and fourteen kids during the depression might be enough to send you over the edge even without homebirth, but I'm blaming the homebrith).

[NajaNivea]

I have to say that the home-birth that I attended was cleaned up faster than your average spaghetti dinner. No real blood or mess to speak of, and a couple sheets of newspaper and old towels laid down beforehand worked just fine as far as protecting the furniture.
I remember telling my sister that when we have kids I'll be having a home birth, and that was her response--" won't there be... carnage??" I asked a couple midwife friends what their response would have been, and they just laughed. Yeah, it's a little messy, but I'll sacrifice a couple old blankets to avoid a hospital birth any day of the week .

[NajaNivea]

Originally Posted by Dangerosa

(Actually yes, bat shit crazy runs through my family and fourteen kids during the depression might be enough to send you over the edge even without homebirth, but I'm blaming the homebrith).

I dunno, if the one I saw was anything close to representative of home birth in general, it was a very peaceful experience. Certainly more serene than a single day in the company of fourteen children

[irishgirl]

If the woman in question is healthy, the pregnancy uncomplicated, labour and delivery is expected to be quick and there is access to neonatal resuscitation equipment and blood on site, it all sounds perfectly safe and commendable.

No blood available, no neonatal resucitation equipment, a midwife not trained in ventouse or forceps deliveries and no access to epidural or general anaesthesia and the nearest hospital more than 15 minutes away and it all gets tricky.

For selected women, in selected places with proper help (midwife specialists or obstetricians on call and available to attend the home) this sounds like a great plan.

For someone having their first baby in a rural area with the district nurse (who normally spends her day dressing varicose ulcers) and GP (who last delivered a baby as a medical student, 40 years ago) as the only attendants- not such a great plan.

I'm thinking worst case scenarios, like a shoulder dystocia, when you have 6 minutes to get the baby out one way or another- especially difficult if you're the only person in the room with medical training and the nearest Operating theatre is miles away.

What this saves the health service in terms of procedures and beds, may cost it in compensation claims. All it needs is one ambulance to get lost, one midwive to think she's on top of a situation when she isn't, one baby that was bigger than previously thought, or who is lying in a different position than the last scan indicated and very, very bad things could happen.

So, if they do this, they need to do it right and not just hope that we can magically turn the clock back to the 1950s and hope everything works out well.

[slaphead]

The BBC take on the story - this is a continuation of a discussion that has been simmering away for years about what is the appropriate role of a hospital. Given that they could be caricatured as huge dirty demoralising concentration camps full of sick and diseased people, I suppose it makes sense to keep people away from hopsitals unless there's a real necessity for them to be admitted. Or at least until the NHS has got to grips with MRSA and the like.

However, given the tiny proportion (2%) of births that are currently at home, and the shambolic state of midwifery services in many areas, I doubt it's going to make a big difference anytime soon.

[Maastricht]

In the Netherlands, 30 % are home-births.

There's a whole care system equipped to deal with the care of the mother and infant afterwards, and generally things run smoothly. Of course, this is easier to do in a country where the distance to the nearest hospital is never more then half an hour's drive.

[Dangerosa]

Originally Posted by MixieArmadillo

I have to say that the home-birth that I attended was cleaned up faster than your average spaghetti dinner. No real blood or mess to speak of, and a couple sheets of newspaper and old towels laid down beforehand worked just fine as far as protecting the furniture.
I remember telling my sister that when we have kids I'll be having a home birth, and that was her response--" won't there be... carnage??" I asked a couple midwife friends what their response would have been, and they just laughed. Yeah, it's a little messy, but I'll sacrifice a couple old blankets to avoid a hospital birth any day of the week .

That assuming you find cleaning up from a spaghetti dinner to be tolerable. Restaurants and hospitals both provide a great service for those of us not interested in our own messes.

[Weirddave]

Does anyone at all seriously believe that this is anything at all other then an attempt to cut costs? (Nothing against home birth, in the abstract I think it's a kinda cool idea-if both parents want it) How long before NHS starts making home births mandatory unless complications are expected? This is about money, pure and simple. Ahh, government controlled universal health coverage, gotta get me some of that over here .

[Kalhoun]

I know two women who got horrible staph infections when giving birth. My general feeling about hospitals is that you don't want to be in one unless absolutely necessary. They're cesspools of evil.

[NajaNivea]

Originally Posted by Dangerosa

That assuming you find cleaning up from a spaghetti dinner to be tolerable. Restaurants and hospitals both provide a great service for those of us not interested in our own messes.

My thought--everyone's got their own priorities. I love restaurants, but not because they do my dishes afterwards. Keep in mind that as the birthing mother, you're not going to be the one cleaning up, it's the midwives or attendants who take care of it. You're too busy bonding with your little one.

A midwife is reading over my shoulder as I'm typing this, her response was "cleaning up after the birth is the easiest part of the process. Now, changing diapers during teething, that gets messy. If someone's really put off by the idea of washing a couple towels after the birth, they may want to reconsider the decision to have a baby." Said with a smile and tounge-in-cheek, of course.

I don't dishonor the choice to give birth in a hospital, so please don't get me wrong. I'd do just about anything to avoid it, but I'm willing to bet I'm looking for a very different experience in the birthing process than you (generic "you"), and that's perfectly okay. For me, I'm more than comfy with messes, particularly those of my own making, and for me, the benefits of being in a comfy, quiet, serene place--my home--surrounded by my loved ones and not folks sick or in pain, with good music, in a water bath, being able to move and eat and drink to suit my needs, and not being rushed to avoid inconveniencing anyone's tee time far outweigh any prissiness about a little mess produced by my own body. As always your mileage may (and clearly does) vary. Good thing we each have ideal options available to us

[beebee]

if i ever (God forbid), give birth to another child, i do not intend to be more that 10

feet from a large I.V. filled with painkillers. and 45 extras in case the first one doesn't

work. the little monsters father will probably be in need of major reconstructive

surgery, so i vote for a hospital.

[Snooooopy]

I hope this trend doesn't extend to soap operas. If you don't give birth at the hospital, how can your baby be switched with your mortal enemy's?

[kambuckta]

Having given birth on a number of occasions, I feel qualified to step in to the fray here.

I don't know about the situation in the UK, but here in Australia 'elective caesareans' are the flavour of the month....I'm guessing that it might be similar in the UK. Part of this is driven by the mother wishing to avoid the pain of childbirth, and another part is encouraged by Obstetricians who are able to charge huge fees for the surgical intervention needed......much more than a normal vaginal delivery.

The other issue is that, being in close proximity to emergency care in hospital, many delivering mothers who might not NEED such attention are given the cocktails of painkillers/epidurals/forceps that end up with a baby in distress. Erring on the side of 'caution' in childbirth oftentimes ends up counterproductively.

Personally, I'm all for homebirthing. Unfortunately in Australia, you need private health insurance to do it. I attended the births of two of my nephews back in the early 80's and it was quite a delight. The Doc who rocked up was an amazing fellow, leaving the hard work to my sister and the midwife, and spending most of the time chewing the fat with me and my BIL in the kitchen drinking tea.

Me? I've had one overmedicalised birth, and three that were damned fine without any intervention. It was just a piss-off that I had to drive myself to the hospital with the last two (with 1 hour and 1/2 hour to spare respectively)........if I'd had a home-birth option, I could've saved myself the trouble of finding the car-keys between 30 second contractions.

[Happy Clam]

Does anyone at all seriously believe that this is anything at all other then an attempt to cut costs? (Nothing against home birth, in the abstract I think it's a kinda cool idea-if both parents want it) How long before NHS starts making home births mandatory unless complications are expected? This is about money, pure and simple. Ahh, government controlled universal health coverage, gotta get me some of that over here.

Actually, I don't think it will cut costs, nor is it intended to (the mother is still supposed to be attended by a trained midwife and have painkillers, meaning that she'll get exactly what she would in hospital- except that they will have to come to her, not vice-versa). It's designed to cut down on the number of beds being used in hospitals (a related, but different issue), and also to try and tackle what is perceived as the current attitude in the UK, that everything medical has to happen in a hospital. Dismantling that position might ulitmately result in cutting of costs- and I'm glad, because if we can provide equally beneficial healthcare at a lower cost, what sane society wouldn't want to do so?

Mind you, this isn't the place to discuss such things. I'll just end by saying that a) if you desperately want a hospital bed to have your baby in, you can still have one (mandatory home birthing is not being mentioned) and that b) the government's role should be to provide advice as to how to use the services it funds, no?

[irishgirl]

Actually, no, she won't get exactly what she would get in hospital Happy Clam- painkillers, meaning pethidine and entonox (gas and air) yes, epidurals, no.
An epirdural requires a qualified anaesthetist, requires bladder catheterisation, and restricts movement. It is highly unlikely to be offered routinely as a part of home birth.

Now, a lot of women want a natural delivery, and more power to them. The ones with the strongest held beliefs are usually women who have either had previous sucessful natural births, or who have negative experience of medical delivery and/or epidurals.

There is a fairly significant proportion of women (especially first time mothers or VBAC after emergency section, who have no previous experience of labour) who find that although they thought they wanted a natural delivery, at some point during labour they find that they really, really appreciate the option of an epidural.

There are other women, of course, who have such positive experiences of epidurals they wouldn't dream of giving birth without them.

An epidural is an option in hospital, it might be a safety net for some women, an absolute pre-requisite for others, or it might be something to be avoided at all costs- but at least it's still there.

So, while home birth might appeal to some, they will always be women who won't want it, and that should absolutely be respected, either because they want the security of knowing that should they change their mind they can have an epidural, or because an epidural is on their lists of absolute necessities.

kambuckta- may I clear something up?
An elective C-section is any section performed for any reason before labour starts. Some of those reasons are really good ones (they include foetal distress, malposition or presentation, active genital herpes, big baby, twins or higher order multiples, mother having previous history of two or more sections and certain maternal and foetal illnesses).

An emergency section is as it implies, a section performed as an emergency, usually during labour, often for the same reasons the elective sections (only the problem was thought to have been minor enough to try vaginal delivery), sometimes because something new and unexpected has cropped up.

Very, very rarely is an elective section performed on a woman in her first pregnancy simply because she asks for one (believe me, in the cash-strapped NHS it's almost unheard of). There is usually a good medical reason for an elective section. In a lot of cases it is true, the woman may have delivered vaginally, but it is felt to have been safer to deliver by section, and obstetrics is all about risk management, whatever option is more likely to give you a live baby and a healthy mother wins.

[Elza B]

Originally Posted by MixieArmadillo

I have to say that the home-birth that I attended was cleaned up faster than your average spaghetti dinner. No real blood or mess to speak of, and a couple sheets of newspaper and old towels laid down beforehand worked just fine as far as protecting the furniture.
I remember telling my sister that when we have kids I'll be having a home birth, and that was her response--" won't there be... carnage??" I asked a couple midwife friends what their response would have been, and they just laughed. Yeah, it's a little messy, but I'll sacrifice a couple old blankets to avoid a hospital birth any day of the week .

My first choice for this pregnancy was a home birth - but ElzaHub immediately nixed the idea. He's still trying to get used to the fact that I plan on a drug-free water birth, even if it IS in a hospital (that's my only option, there are no birth centers around here). I've gotten quite a few 'looks' and attitudes about the water birth itself, I can't imagine if I tried to tell people I was planning on a home birth.

But in my case, I can't imagine going into the hospital with the epidural and medical intervention being the first things I ask for - I'd like to do everything humanly possible NOT to get an epidural. But I've seen other women who are due around the same time who plan to ask for the epidural first thing. I'm lucky in that I come from a family that has INCREDIBLY short labors (on my mom's side - we have not had ONE baby born in more than four hours - and that's been probably about 12 babies), so while I'm not expecting a labor that short, I'm still going to use the thought to go as long as possible without drugs.

Eh. It would be nice if these kind of births were a better option for women - it seems like you have to fight to get a med-free, more natural birth, but if you want the epidural or tons of medical intervention, that's pretty easy to get. I'm seeing a midwife 35 minutes away and giving birth at a hospital 40 minutes away to try for the birth that I want - there are no midwives in my town, and just a couple in the city north of us. I think it'll be worth it in the end.

E.

[Szlater]

Originally Posted by Elza B

It would be nice if these kind of births were a better option for women - it seems like you have to fight to get a med-free, more natural birth,

Forgive me for asking but, what's the attraction of a 'natural' childbirth?

[Elza B]

Originally Posted by Szlater

Forgive me for asking but, what's the attraction of a 'natural' childbirth?

For me, I don't want a needle in my spine. It's as simple as that - I'm more terrified of the epidural than I am of the pain.

I'd also like to limit the effects of any medication on my baby - and the easiest way to do that is to try not to have any.

I don't get the appeal of the epidural (I don't like the idea of being flat on my back, stuck in the bed while giving birth), just as others may not get my reasons for wanting a natural birth. But I think both should be viable options, and from my limited experience so far, less medical intervention seems to be the more difficult choice to obtain.

E.

[theunfounddoor]

I personally haven't had any babies. But both of my good friends have had children in the last 2 years. One of them got really upset w/ her OB because she kept suggesting she should have a C-section. I thought this was very strange (and a little scary). My friend told me there weren't any complications expected, but at every check up the doctor would bring up that a lot of women are choosing to get a C-section over vaginal birth. Mainly because you could choose the day of birth for convenience. Thats the only time I've heard (personally) of a doctor pushing a mother to be to have an invasive surgical procedure. Why would a doctor recommend this for no apparent reason?

PS: this is in the US, BTW.

[WhyNot]

Originally Posted by theunfounddoor

I personally haven't had any babies. But both of my good friends have had children in the last 2 years. One of them got really upset w/ her OB because she kept suggesting she should have a C-section. I thought this was very strange (and a little scary). My friend told me there weren't any complications expected, but at every check up the doctor would bring up that a lot of women are choosing to get a C-section over vaginal birth. Mainly because you could choose the day of birth for convenience. Thats the only time I've heard (personally) of a doctor pushing a mother to be to have an invasive surgical procedure. Why would a doctor recommend this for no apparent reason?

PS: this is in the US, BTW.

This is veering into GD territory, not to mention a hijack of this thread. Just quickly, I'll mention that at least two doctors have been fired from their hospitals (and one had her license yanked) for not performing enough c-sections. Hospitals, unlike doctors, do make considerably more money for a c-section birth as opposed to a vaginal birth, and there's some (controversial) evidence that hospitals in the US want to keep their c-section rate high not for patient health, but for their bottom line. If a doctor won't cooperate, they'll fire her and hire someone who will make them money. Google "Dr. Helen Sandland" and "Dr. Colleen Murphy" for more information on this topic.

[dangermom]

Well, right about then I would start looking around for a new OB, unfounddoor.

I did have an 'elective' C-section (that is, after my first difficult baby, I had to have a scheduled section for the second; I didn't actually get much of a choice). But my OB was always very good about not pressuring me into anything. I had my first kid on a Friday night and he didn't push the C-section at all, until it became obvious that a vaginal birth was not going to work. (They opened me up and everyone went, "Oooooohhh, that baby wasn't coming out on her own!" She was over 10lbs. and flipped over, she never even descended, but bounced off my pelvic bone.)

I did want a natural birth, and held out until exhaustion made it impossible to keep going. That's when the epidural gave me a chance for a nap (not all of us actually wanted it, Elza, but sometimes that's just what happens). Some of the appeal is that birth is usually something that your body can manage without drugs, and it's a neat feeling to know that it is strong and all that stuff, then the drugs do affect the baby somewhat, and if it's an easy birth you can just stand right up and not fuss with all the other stuff. Being de-catheterized isn't such a fun time that you just happily go along with it.

[Elza B]

Originally Posted by dangermom

I did want a natural birth, and held out until exhaustion made it impossible to keep going. That's when the epidural gave me a chance for a nap (not all of us actually wanted it, Elza, but sometimes that's just what happens). Some of the appeal is that birth is usually something that your body can manage without drugs, and it's a neat feeling to know that it is strong and all that stuff, then the drugs do affect the baby somewhat, and if it's an easy birth you can just stand right up and not fuss with all the other stuff. Being de-catheterized isn't such a fun time that you just happily go along with it.

Yeah - I'm not completely ruling out the epidural, but to be honest, it does scare the hell out of me for a variety of reasons. It'll definitely be when I feel like I can't go any further, though.

The epidural actually helped my friend's labors twice - once she got the epi, her labor sped up (her second daughter's labor was about 22 hours shorter than her first because she got the epi earlier). It worked for her, definitely.

E.