Outlaw births

[mrsflibble]

this post could get heated, so I appologise to mods in advance and will hold my hands up as the originator.

I just watched it on 5 on demand, and much as I respect these women's decisions to go it alone, and also think they are very brave an amazing women, I also think they're mad and worry about impressionable people.

I had all the antenatal checks, I knew I had a small pelvis and could run into difficulty (aparently though the hospital did not know this; dumb mothertruckers) but what if I'd not?! What if I'd gone into pregnancy blindly? Soph and I would be dead and still stuck together without the medical interventions we recieved. what if someone else like me researches the whole unassisted birth thing and therefore their outcome is not so happy?

omg. right, I'm off to watch the extraordinary people episode about the boys joinedat the head, and try not to think about these two sketches while I do...

http://www.youtube.com/watch?v=5Hv6pqRwwQA

http://www.youtube.com/watch?v=zIh18gWikS8

[barefootlinzi]

I watched this program with interest, especially since i had a homebirth and help to run a homebirth support group. and when I read your post mrs f i had to put my 2 pence in!!

my personal opinion is that it is a woman's right to choose where she births her baby. whether that is a hospital or on her own, that is her choice, her right. as far as i know, all other mammals birth alone, we are the only ones to have assistance. But then since man first stood upright, birth has been much harder as the pelvis has to be smaller in order to balance on 2 legs. I would hope that any woman who chose to freebirth would fully research it first, and make an informed decision. most births are normal births where birthing alone would be ok, but unfortunatly there are those that do go wrong and for that i am grateful for the interventions that save lives. Nature is cruel. imo, birth should not be treated as an emergency waiting to happen.

I can understand the women in some areas of the usa choosing to freebirth, in some states obstretrician (sp?) care is the only care available as unbelieveably midwifery is illegal. but in the uk we have favour midwifery led care, and if this is still too mediclised then like me you can choose an independent midwife to help you get the birth you want. my midwife came and did nothing, as i wished, but be a reasurring presence and had the experience and training to act if there was a problem.

sorry if i have waffled off the point a bit.i suspose i am saying that i respect the choices these women make, but would not make that choice myself having experienced the loving care of a midwife who has become a trusted friend.

i hope this post doesnt upset anyone..if it does then that was not my intention!!

[Silver Ether]

I didn't see the pro gramme but but that won't stop me talking

I chose home birth but my GP wasn't happy and made it very difficult for me to get any where with it this was 29 years ago .. god is he that old ... anyway so I was talked into going into a tiny maternity hospital where I was actually born and had worked for a while ... not as medical staff ...

But when it came to the push I was whisked of to a bigger hospital to deliver grrrrshhh but it turned out that was the best place for me as the poor we mite couldn't get out because of the cord wrapping round his neck and it kept pulling him back ... so I needed help ... but the arse wipes left me ages in labour before they fetched a doc who wasn't best pleased when he saw the condition of us both... but at least we are here to tell the tale ... and that might not have been the case if I had been as gobby then as now cuss I would just do want I wanted now

I think the option of home birth with a midwife at the ready is just brill ...and all women should be given that option as long as every thing is looking good.
he's 29 ...he's 29 ... how old does that make me than . ..

[snapdragon]

My first was in hospital, for similar reasons to Silver Ether (and even longer ago) - GP against etc, my time in hospital was also 'shut up and we'll say what happens' 'stop that silly breathing just beathe deeply' (which put me into full body cramp) 'we'll have to cut we want to go home' and a painkilling injection that i didn't ask for and sent me loopy (that's the short version - I could go on )

after the above I delayed telling anyone about the start of my second labour until it was too late and I gave birth on the living room floor. Have to say that was a much better experience. But then it was my second, I'd read loads of lit about it, and I did attend ante natal etc etc

[starchild]

I had a home water birth through choice. I had no prenatal checks, no tests, no medical intervention at the birth which is just as I desired.

The outcome was a 9 1/2 lb baby and to see me is to be believed - how on earth she came out of someone of my proportions I still don't know LOL! I used hypnosis instead of pain control and we used a water pool.
I'm glad I steered clear of the medical profession because they would never have 'let me' birth her at home. They would have whisked me off for a c/s.

I spent 5 hours pushing (17 hours first stage) and again, there is no way they would have let me go that long in hospital.

I didn't see my choice as crazy or irresponsible, it was just my choice. And I'm still happy with it. Some people prefer the back up of the medical profession, some people prefer to go it alone. In nature, most animals will find a dark, quiet place to give birth naturally and that's what I chose too :)

As long as babies and mothers are healthy, then that's all that matters

[Ellendra]

When my nephew was born his mother chose to give birth at home, I've got to wonder what the rest of the apartment-dwellers thought was going on that night!

Unfortunately my nephew then had to be med-flighted to the nearest hospital because his lungs were full of fluid.

Home birthing is ok, but make sure you're ready for emergencies!

[lsm1066]

Ok. I've sat on my hands for long enough. Here goes, and it's going to be long and it's going to be contentious. You have been warned.

Home birth is far safer than hospital birth (Campbell & McFarlane - "Where to be born - the debate and the evidence"; Goer "Obstetric Myths versus Research Realities"; Enkin, Kierse, Nielsen & Crowther - "Effective Care in Pregnancy and Childbirth" ...................the list goes on). This is not just because high risk births happen in hospitals but because of the protocols attached to hospital birth. Midwives are prepared for most emergencies including chests full of fluid. They have a full resuss kit and drains with them for these and many other emergencies.

So what's the reason? Take the most basic normal birth to a primip (first time mum) as a f'rinstance and bearing in mind that statistics put the average length of a first labour at 16 hours

Standard hospital protocol:
First stage - 1 hour per cm dilatation = 10 hours to full dilatation
Second stage - 2 hours maximum
Third stage - 2 hours maximum
Total allowable without intervention for any labour - 14 hours

Then we have the length of pregnancy. Pregnancy is measured as being 266 days from the date of ovulation, or 280 days from the first day of your last period. So 40 weeks, because obviously everyone ovulates and conceives simultaneously on day 14 of their cycle. If you go beyond 40 weeks, you are induced. It used to be that this was done at 42 weeks but more and more hospitals have a protocol of induction at 10 days overdue because (and please don't laugh because this is serious) if you don't induce at 10 days over instead of 14, women tend to go into labour by themselves!

So what happens is something called the cascade of interventions. You go into hospital to be induced, which is rather like getting onto the sliproad of the motorway - once you're on you can't get off. So you start off being assessed for suitability for induction, using the "Bishops Score". This assesses the position of the baby and the condition of the cervix. I know of absolutely no-one who's been told "don't worry, your cervix isn't favourable. You can go home until it is". The stages of induction are:

• > Prostin pessaries to soften the cervix - up to 3 or 4 doses can be given at 4-6 hourly intervals
  > Syntocinon or Oyxtocin drip to artificially stimulate contractions.Because this is an artificial process, you have to be attached to an automatic blood pressure cuff and a CTG monitor (the belt monitor) and have a midwife present throughout.
  > Once you get to 3cm, your waters can be broken

In about a third of cases, labour progresses and babies are born vaginally without any further intervention. However, epidural rates (which require a whole stack of interventions of their own) are higher amongst women whose labours are induced and in the mid 1990s, caesarean rates in induced labours reached 65%, although that figure is falling. It is worth noting that induction of labour works best when labour is ready to begin, which tell you all you need to know. There are times when induction is absolutely vital, either for the safety of the mother or the baby (pre-eclampsia, gestational diabetes, intra-uterine growth restriction, unstable lie, obstetric cholestasis and so on). Being overdue according to figures calculated by a 17th century French doctor is not on the list and you have an absolute right to refuse. In 1993, approximately 9% of labours were induced. By 2001 it was 20%, and the only thing that changed in that time was the protocols. And nowadays, 70% of inductions are for post-term pregnancy.

So to get back to the standard protocols. I've known midwives "accidentally" drop the scissors on the floor to avoid doing consultant-ordered episiotomies because they know that second stage is progressing fine, if a little slowly. I've seen midwives write down the time of the onset of 2nd stage an hour later than it was to keep their women from being interfered with by consultants. Midwives are our first line of defence when it comes to normal labour. Which makes it such a travesty that not only do they not learn to participate in breech births any more, there are midwives qualifying now who've never seen a fully normal, natural birth! Incidentally, breech presentation is unusual, not abnormal. With correct handling it does not require an elective caesarean. A baby's bottom is the same circumference as their head (which is a proportion that many of us can sadly no longer boast), so if the mother is dilating, chances usually are that she can give birth on her own (Mary Cronk - "Keep your hands off the breech" - AIMS Journal Autumn 1998, Vol 10 No 3).

Obstetricians kind of have an excuse for their extraordinary attitude to labour (it's a disaster waiting to happen that sometimes, mercifully, works out ok). After all, their job is the abnormal and the difficult. Which is why in a survey of London obstetricians conducted in 1997, 17% overall and 31% of the female obstetricians stated that if they or their partners had an uncomplicated singleton pregnancy at term, they would choose cesarean delivery (Al-Mufti R, McCarlin A, Fisk MN. Survey of obstetricians’ personal preference and discretionary practice. Eur J Obstet Gynecol Reprod Biol 1997;73:1–4). This is really quite shocking. The fact is, there is no justification for more than 10-15% of births actually to require a caesarean in any geographical location, according to the World Health Organisation's Fortelesa Declaration in 1985. Evolution hasn't happened so fast that women and pregnancy have changed much in that time. Yet the current caesarean rate for the UK fluctuates wildly and it's a postcode lottery, with some areas having a rate of 10-13% while others hit the 25-30% mark.

Which brings us neatly to the point. When faced with all this and more, what chance do women having normal, natural, healthy pregnancies have? And when you have GPs like one I saw who told me that home birth was child abuse, what do you do? Midwives love home birth, but they have to work in a setting where the doctors don't. And the doctors are the ones who design the protocols. So women try to book their home births but are faced with the very real possibility that even if they can book one, their attending community midwife might be called into the hospital to cover a staff shortage. No hospital midwife ever goes out to a home birth when the community midwives are short, so in these scenarios, women are forced to go into the hospital.

Stress has the effect of slowing labour down, or even stopping it altogether (you only have to look at an animal in labour who suddenly comes into danger to work this out. Their labour stops, they get to safety and they start up again). Women most often display this when they get to hospital in labour. The unfamiliar surroundings cause adrenalin to kick in, their labour slows and they risk intervention in order to kick start it. Better to stay somewhere familiar and comfortable, with your own sounds and textures and smells (and most importantly, your own familiar bacteria). And if you have to do it by yourself to get that, so be it. So it's little wonder that some take the completely legal option of an unassisted birth. They do it all by themselves, with no help at all. Because the only illegal thing is for someone to practice as a midwife when they're not one, so it's all alone or nothing, lest your birth partners end up inside.

If labour is allowed to progress uninterrupted and unencumbered by rules and examinations, women will choose the best position to be in, the sounds to make (labouring women make characteristic sounds at different stages of labour), the things to do. She will do it instinctively and she'll be calm. If a woman in a completely natural labour starts to panic, something is going wrong and she needs to be with a doctor (this is not the same as the transition phase, I mean proper panic). When you interfere with that process, you interfere with nature. And it's not nice to mess with Mother Nature (Poison Ivy, "Batman and Robin" - D : Joel Schumacher 1997)

Anyway, enough of me. Anyone who's read this far down will be disappointed to hear that there is no gold star. Give yourselves a sweetie though, on me. And all power to the homebirthers and the solo-bearthers. We do what you can to get what should rightly be ours.

Lynne

[Annpan]

I haven't read all of your post lsm1066 but frankly - It is great if it is your choice to home birth and it works, It is great if you prefer to be in a hospital and it works.

I really don't think there is any need to try to convince people either way and I am sure that someone (um... not me) could quote just as many medical papers that say home birthing can be disastrous. I am sure many which state birthing alone can be dangerous. (as in - no one within earshot who can help if it all goes wrong)

Personally, I gave birth in a hospital with a bunchof people (at least 10) who obviously didn't know how to cope with me in labour... luckily my body did, so we were OK. Though the way they sewed me up later made my (very nice) GP comment on how they perhaps didn't know what *one* was supposed to look like

[barefootlinzi]

Lynne....you put into words all my thoughts and feelings. My homebirth group is showing a film by ricki lake on saturday about homebirth...the businessof being born (www.thebusinessofbeingborn.com) have a look at http://www.saveindependentmidwifery.org/ for the showing locations,we are newbury.

Lynne, did you used to live near me (berks?) My midwife used to work with another midwife called lynne.

[lsm1066]

You're absolutely right Annpan, when you said "It is great if it is your choice to home birth and it works, It is great if you prefer to be in a hospital and it works." I personally believe that birthing alone is a dodgy choice, but in all this, the point is choice. You see, it used to be that home birth was the norm and you only went to hospital if you were high risk. Then all these funky machines were invented (The Meaning of Life - The Miracle of Birth part II is the perfect example and not too far off in some countries - remember the "machine that goes ping"?) but no-one was using them. So the Peel Report (1970) was produced which took, as its central argument, the notion that birth is a disaster waiting to happen and stated that 100% of all births should take place in hospital, because that was the policy of the government of the day. That's where our current terror of birth stems from, and it is terror. The Winterton Report of 1991 which gave rise to "Changing Childbirth" and emphasised the safety of normal birth and a woman's right to choose, didn't get nearly as much publicity. As an antenatal teacher and birth doula, most of my job has been to dispel fear caused by the outright lies told to women by doctors in order to steer them away from home births. (No Linzi, I'm not a midwife. But I am a maternity specialist in what I do).

There are certainly a lot of research studies into home birth. Some say that home birth is safer - pretty much all of them are related to unusual or abnormal pregnancy, labour or outcomes. The one that's bandied about the most by doctors and consultants is the report into outcomes stemming from unplanned home births (and can I find it? Of course I can't! Linzi?) The vast majority of studies conclude that, in the absence of any clinical need, home birth is the safest option for any woman. Yet we still have a lower than 10% home birth rate in the UK.

Thanks for the link Linzi. I'll keep an eye out.

Cheers
Lynne

[mrsflibble]

Im not against home birth, I just think women should be better informed of what complications may happen. My sister was a home birth and mum did it wonderfully, Lucy slipped straight into Ward family life but my mum had had two other uncomplicated vaginal births, and me. I was a complicated vaginal delivery, mainly due to my mum being too young and naieve to do it her own way. She tore very, very badly as I was a very small baby and she was trying to fight against her own body's normal reactions. believe me, with Tom, Ollie and Loo she was as gobby as hell!

I agree that women should and do have a choice, but I'm just worried that some women may go into it un-informed, and in that case I agree with the medical people on the show who said basically yes, this is how we used to do it, but back then inafnt death was really high, and childbirth was the second biggest killer of adult women. Do we want to go back to that? I sure as hell don't.

However, I thought it was disgusting how the UK woman was treated by her local hospital when she voiced her plans; for those who havn't seen it she was treated as a total paraiah and was refused any care by the hospital whatsoever. She didn't even get ther free home birth kit which she would have got if she's agreed to midwife care. This includes the clamps, umbilical peg, scissors, pads etc all hygenically wrapped and sterilised.

[lsm1066]

The thing is, most women who go into home birth do a lot of reading up about all aspects of birth before they make the decision. They're also more likely to go to antenatal classes, where all aspects of birth are covered, good and bad. They're probably among the best informed, next to their carers. And obviously, if they have a condition which makes home birth inadvisable, they should listen to their carers and get themselves into hospital. But remember, when you have a home birth you have a midwife with you pretty much constantly, rather than someone sticking her nose round the door for 5 minutes every 4 hours. So they pick up much more quickly if something is going wrong and get you into the hospital and in with the right help far quicker in a lot of cases than women who are already there (because of the aforementioned 4-hourly examinations).

As for the doctors who said that childbirth was the second biggest killer of adult women, of course they're right. But not childbirth. Post-partum infection, since this was in the days before anti-biotics and when doctors still didn't wash their hands between patients. You'll see it listed as "childbed fever" and it was what killed people like Jane Seymour (Henry VIIIs third wife) and Mrs Beeton (who died because the doctor who attended the birth of her baby had just come straight from laying out a corpse and didn't wash his hands. It's called iatrogenesis - illness or death caused by medical treatment). With the founding of the British Home for Mothers and Babies, the first midwifery training school in the country, came a big change in the care of women in the "childbearing year", including the introduction of the standard antenatal tests (urine, blood pressure, palpation etc). Indeed the rate of maternal and infant mortality declined sharply in the 1930s (with the introduction of washing hands etc) and infant mortality stands at 1/3 the rate it was 30 years ago. Unfortunately, since the rate has been decreasing for more than twice as long as we've been "recommended" into hospitals, you can't actually pin the improved survival rate on hospital vs home., but it amuses me that doctors still use it as an example. The leading cause of maternal death remains suicide. I'd love to see them pin that on home birth.

And finally, to the "carers" who refused the woman who wanted to go it alone any kind of assistance at all, that's called gross professional misconduct and they can be struck off for it.

Lynne

[barefootlinzi]

The leading cause of maternal death remains suicide

this shocked me, but re reading it i am not surprised. it is a sad symptom of our society today that new mothers feel they have to go to these lengths.

[red]

And finally, to the "carers" who refused the woman who wanted to go it alone any kind of assistance at all, that's called gross professional misconduct and they can be struck off for it.

Lynne

unfortunately, I suspect the reason they did not provide the mother to be with an at home medical package was for fear of being sued/struck off. It's the very fact that people do threaten action that makes people hold back from helping.

[red]

The thing is, most women who go into home birth do a lot of reading up about all aspects of birth before they make the decision. They're also more likely to go to antenatal classes, where all aspects of birth are covered, good and bad. They're probably among the best informed, next to their carers. And obviously, if they have a condition which makes home birth inadvisable, they should listen to their carers and get themselves into hospital. But remember, when you have a home birth you have a midwife with you pretty much constantly, rather than someone sticking her nose round the door for 5 minutes every 4 hours. So they pick up much more quickly if something is going wrong and get you into the hospital and in with the right help far quicker in a lot of cases than women who are already there (because of the aforementioned 4-hourly examinations).

some interesting points. you do have to be careful with statistic though.. yes the mothers who choose home births might well be better informed - however if you want to look at the outcome, you have to include those you chose a home birth at first, then opted for hospital after all, because perhaps they had a medical condition etc. Of course statistically home births have a better outcome, as those with a known medical condition are likely not to be at home! I remember when I had my son (some years ago) it was reported on the news that they had found, byt studying the stats, that people that had more scans than average were more likely to have a disabled child. It resulted in some people I know refusing scans! but of course. you have to turn it around.. people like me were having more than average scans *because* there was a problem, not the other way around.

you are right about the extra attention you will get from a midwife at home. for a start community midwives usually have a lot more experience. And I was in hospital for some time before the birth of my son, and when it began I was not given a lot of attention, and nobody, including me (as a first timer) realised how far along i was. I had a 20 minute second stage. Only when the waters broke in the antenatal ward did they really take me seriously, and my son was partially born in the lift on the way to the delivery suite.
On the other hand, a 20 minute second stage would probably have resulted in no midwife, had I been at home, as she would not have got there in time.
The other question to ask, is are there enough midwives for everyone to have a home birth.. or is it just for the lucky few....
The program in question was about mothers giving birth at home without a midwife. I wonder what the stats for that outcome is.

As for the doctors who said that childbirth was the second biggest killer of adult women, of course they're right. But not childbirth. Post-partum infection, since this was in the days before anti-biotics and when doctors still didn't wash their hands between patients. You'll see it listed as "childbed fever" and it was what killed people like Jane Seymour (Henry VIIIs third wife) .

to be fair though - didn't Jane Seymour have her child at home? (albeit some palace...), poor hygiene can happen anywhere.. and puerperal fever can occur due to natural strep A bacteria.

sometimes you are safer at home, and sometimes you are safer in a hospital.