Wednesday, 30 April 2008

Another great Home Grown Babies film

A mum called Bel has put a condensed version of her Home Grown Babies episode on Youtube.

Monday, 28 April 2008

Home Birth after C-Section: Daily Telegraph 28 April 2008

Telegraph Birth Guide: 'I couldn't have done it without her help'
Last Updated: 12:01am BST 28/04/2008
Page 1 of 3
Rowan Pelling on the independent midwife who coached her towards the home birth she thought she'd never have
Telegraph Birth Guide - get the birth you want
When I found out I was pregnant with my second child, I knew exactly what I sought in my ideal midwife. I told my husband I wanted a "white witch" - the kind of earthy, charismatic wise woman whose understanding of the uterus owed as much to vocation, experience and instinct as to medical textbooks.
The reason for my quest was that - despite being 40 years old with one previous Caesarean section, rendering me a "high risk" labour - I was, to my astonishment, considering a home birth. I am hardly the masochistic, tree-hugging yoga freak of natural childbirth cliché, after all.
Indeed, I love my creature comforts and abhor physical exertion. So I had much sympathy for aghast friends who wailed: "Doesn't that mean no drugs?" and: "What if something goes wrong?" An obstetrician warned me sternly of the "small but real" risk of my Caesarean scar rupturing.
But after several years spent scrutinising British maternity services and all the relevant data, I had been persuaded that skilfully overseen home births were as safe as hospital ones - some would say safer, as there's less threat of contracting MRSA.
Key to my decision was the research I carried out with midwives and mothers at the Albany Midwifery Practice, a pioneering community-based group of self-employed midwives in Peckham, south-east London, and part of the King's College Hospital NHS Trust.
Every woman is assigned two midwives to attend to her throughout pregnancy and is guaranteed to have at least one of those named carers by her side during labour. In addition, I discovered that the majority of the NHS's 25,093 midwives each worked on more than 28 births per year, the figure recommended in the Safer Childbirth Report, with some involved in the delivery of 40 babies.
But what makes the Albany practice unique is the fact that no woman has to choose where she wants to give birth until she goes into labour. Tellingly, when the choice is left to maternal instinct, most of its patients choose to give birth at home - some 75 per cent, as opposed to just 1.8 per cent nationally. Of those Albany mothers I spoke to, none talked of feeling "abandoned" or "out of control", phrases often used in the same breath by critics of home births.
My observation of the Albany midwives at work made it clear that home birth actually offered mothers far more control and genuine choice over the way they laboured. The first time I gave birth, in hospital, I thought I, the patient, would be the one at the centre of things; but the minute I was on the ward, my choices were restricted by the relative inexperience of my young midwives and the medics' ticking clock. When my labour slowed, no one looked for likely causes; instead, I was given a drug, Syntocinon, to "speed things up". My panic-strewn and agonising progress to an emergency C-section was, in retrospect, depressingly predictable.
But I also knew I could not have a home birth unless I found a midwife who could persuade me to believe in birth as a normal, natural process, rather than an emergency-in-waiting. If I failed to find that practitioner, I'd decided - somewhat perversely - that I'd rather have an elective Caesarean section than risk the vagaries of a labour ward again.
I was contemplating these polarised options last autumn when a chance playground conversation led me to the extraordinary Jane Evans, an independent midwife based in Hertfordshire who is renowned in natural birth circles for her skill in birthing breech babies and twins. The minute Jane walked through my door I knew from her long grey hair, wry gaze and kooky, striped socks that I'd found my white witch.
Jane's centre of gravity was so strong I felt myself immediately in her reassuring orbit. She coaxed the story of my first labour from me and fired off questions. How far had I dilated? (Nine centimetres.) How had my scar healed? (Swiftly and well.) Finally, she looked at me and said she could see absolutely no reason why I couldn't give birth naturally at home. And I began to believe her. Having said that, it took me three months to commit myself to the home birth process. The effort of will required to overcome the residual terror from my first labour and to believe in my body often seemed insurmountable. Jane reminded me of a horse-whisperer standing in a paddock while a crazy mare careered round her, knowing that eventually it would stop its jig and walk straight to her.
In early January, I finally bit the bullet, phoned Jane, and said I would like to hire her to attend my home birth. Suddenly I was on a different track. From Jane's regular home visits, I gathered all the advice you would normally have to seek from a GP, a community midwife, a nutritionist, a shrink, a priest, a life coach and an ante-natal teacher. I was amazed by how Jane could tell exactly how the baby was lying and judge his growth through her hands on my belly; during my last pregnancy, I had to have a scan to get this kind of information. As Jane's visits progressed, I could feel we were developing the camaraderie and trust, not to mention black humour, which seemed essential in approaching childbirth with confidence.
Most of my friends still thought I was being eccentric in my birth choices. One said cynically: "You mean you've paid several thousand pounds not to have an epidural?" And that, curiously, was exactly the point. I was beginning to understand why people climb mountains or walk to the North Pole: you need to go into training and the actual process is unbelievably arduous and painful… but then there's the - ah! - endorphin-flooded exhilaration when you reach your goal. At least, that's the theory.
In the small hours of Monday, March 17, I was about to put the theory into practice. The first contractions started tweaking shortly after midnight and Jane arrived at 7am. She found me kneeling on my grandfather's old armchair in the front room, munching toast and listening to the Today programme.
It became clear as the labour slowly progressed that my biggest enemy was my own head. I was constantly resisting the tidal flow of my own body. This is when the groundwork we had put in over the proceeding months really kicked in: Jane worked with me to find reserves of energy, helping me find positions that best dealt with the pain and keeping me on the move when my willpower faltered. With her trained hand, she was able to recognise my unborn baby's steady heartbeat. This proved far more reassuring than my earlier experience with a hospital's taped-on monitor that panicked me with unexplained bleeps and then flatlined every time the baby turned.
When I needed rallying, Jane was vocal - "There's only one person in here who can get that baby out, Rowan!" - and fell silent during long bouts of contractions when we both withdrew into a meditative state. I felt I was coping until around 5.30pm when I hit a slough of despond. I didn't know I was experiencing a textbook case of a tough transition period (before a woman moves to pushing), when you start fantasising about morphine, Caesareans and shooting your husband. Jane rallied me magnificently, like a games mistress telling the lacrosse team to pull their finger out and do the business.
I eventually staggered from the sofa to my feet and set about pushing, which didn't come instinctively to me. Jane literally had to put her hands on my lower back as I clung to grandpa's chair, talking me through the down-force I needed to generate. "Spread the energy down through your hips and bottom," she guided. Eventually my husband was commandeered into supporting me by sitting on a birthing ball and locking his arms under my armpits, and I suddenly grasped what pushing meant. At the same moment I heard a strange, guttural howl and realised it came from me.
After 20 minutes of this, however, the baby's head was still no lower and Jane realised that he had turned so that his spine was facing mine, a problem I had encountered during my first labour. She made me move immediately so that I was back on my knees clinging onto the wings of the armchair and suddenly - suddenly! - I felt the baby's head begin to descend. The pain was now so overwhelming that I had moved beyond comprehending or minding it. I could find the strength to rise to meet it because it was bringing me my baby. This was the instinctive pushing I had heard about, when your body takes over.
My second son was born at 10.15pm, and I can honestly say that when his head came through, it was the most emotional moment of my life. My husband said he will never forget the way Jane moved with lightning speed to catch him, simultaneously twisting him round to release the umbilical cord that had become entwined twice round his neck. My boy opened his eyes and was immediately, gloriously present, while the atmosphere in the room was one of sheer wonder. "I always said you could birth that baby," said Jane happily.
Jane was as invaluable after the birth as during it. She got my son on my breast within the hour, helped me birth my placenta (which is now in the deepfreeze waiting to be planted under a rose bush) and supported me as I crawled upstairs to bed. She visited daily for the first five days and then at regular intervals for a month, making sure my body was recovering and helping me with breastfeeding.
My positive experience of labour not only exorcised those old ghosts from my first birth, it gave me an incredibly strong bond with my new son. As my normally parsimonious husband said of Jane's £3,000 fee: "She was worth every penny and more."
Sadly, there are not nearly enough Jane Evanses to go round. It's only now that I fully comprehend how a positive experience of childbirth helps you bond with your baby and dramatically decreases the chance of post-natal depression.
Clearly, many women can't afford the option of hiring an independent midwife, and even when independents volunteer their services for free (which they often do with desperate mothers), the NHS can be hostile to practitioners they frequently regard as renegades because they won't kowtow to hospital protocols.
The Independent Midwives Association (IMA) is campaigning for a new model of maternal care where independents and like-minded midwives can contract their services in to the NHS and make their extraordinary home-birth skills more widely available, but Primary Care Trusts still need to be persuaded.
The IMA is urging all women to write to PCTs and demand that such a gold standard of care be available to all. Surely British mothers deserve no less.

Sarah Johnson

co-ordinatorChiswick and Hammersmith Home Birth Group

We meet approx every six weeks to discuss and support home birthing parents locally. contact tel 0870 4239260

Saturday, 26 April 2008

Read this from the Guardian, Friday 25 April 2008,,2276237,00.html
Birth of a revolution
The home birth rate is currently low, but inspired by Ricki Lake's new documentary and their own experiences of labour, campaigners are fighting to give women more choice. Joanna Moorhead reportsJoanna MoorheadFriday April 25, 2008
GuardianOver the next few weeks, hundreds of people will crowd into halls across Britain to see a film that has been grabbing the headlines in the US. Called The Business of Being Born, it's a documentary by chatshow host Ricki Lake, about birth and specifically why pregnant women need to reclaim the right to give birth without unnecessary intervention. In the US, birth rights are pitiful, with home birth banned in 10 states and the caesarean section rate standing at one in three. Only 8% of women are able to use midwives, who specialise in natural birth, and instead have to see obstetricians, whose metier is highly interventionist hospital delivery.
The Lake film has led to a campaign in America called The Big Push for Midwives, and the ambition is to enable more women to use the services of a midwife and to overturn a culture in which intervention is overwhelmingly the norm.
Over here, the film's effect could be equally significant. It is being screened at venues across the country by the Independent Midwives Association (IMA), and when the lights go up the audience will be urged to bombard the chief executives of their primary care trusts with letters and emails asking for better facilities for home birth.
"We're at the tipping point," says midwife Annie Francis of the IMA. "We've been fighting for decades for home birth to be available in Britain again and now our moment has come. Home birth is already on the increase - up from around 1% 15 years ago to around 3% today. And last year a government report, Maternity Matters, said women who want a home birth should be able to get one. The tide really is turning." The campaigners' main aim is to ensure that the government sticks to its promises.
It is a big turnaround when you consider that for many years it was government policy that all births should happen in hospital. The Peel Report of 1970 made that its central ambition. Maternity Matters, in contrast, promises mothers-to-be a "full range of birthing choices": a home birth, birth with midwife care or birth in the care of a consultant. And there's plenty of evidence that where home birth is well supported, it's popular: areas such as West Somerset and Mid Suffolk, for instance, boast well above average rates (14.2% and 11.6% respectively).
All of which is great news for the grassroots activists who have been fighting for years for a woman's right to labour upright, without unnecessary machines, in her own home. Ricki Lake exemplifies such women, having been inspired to speak out by her own experiences. In her film, she describes how disempowered she felt as a result of the hi-tech arrival of her first child, and how fired up she was after the birth of her second child at home. Spreading the gospel that birth could be low-tech and without drugs or machines became what she calls her "passion project".
Other campaigners have been more modest but equally effective. Civil servant Michelle Barnes, who organised a conference on this subject last month in her home town of Sheffield, says: "Things changed for me after I had a home birth two years ago. My first child had been born in hospital after a heavily medicalised labour that led to a caesarean. I might have had a home birth the first time round if I'd known anything about it, but I didn't. After I had a home birth, I wanted to inspire and encourage others who might be interested." Her conference brought together 170 people. "Home birth is already above average here in Sheffield, at around 4%, and now we've got a head of steam it's going to go up and up," she says.
After her first experience of home birth 10 years ago, Angela Horn set up to debunk the myths about how unsafe home birth was. The research she summarises on her website includes the 1997 National Birthday Trust report, probably the most comprehensive study of UK home birth to date, which found that it halves the chance of needing an assisted or caesarean delivery and that babies born at home are less likely to need resuscitation. Another British report found that the perinatal mortality rate in planned home birth was less than half the average for all births.
"In my first pregnancy I started reading the medical research," says Horn, "expecting to find that home birth provided a more pleasant experience but had a pay-off in terms of higher mortality rates - only to find that there was a growing body of evidence showing that home birth for healthy women was remarkably safe. After I had my first baby, I felt 10ft high. It's incredible how a good birth can change a woman. You've brought new life into the world, and you've done it yourself rather than, as happens to so many women, finding yourself at the heart of a crisis that you need to be rescued from."
Horn realised that women who might be interested in a home delivery were often put off by the lack of unbiased research that challenged the status quo - in other words, no one was publicising the studies that challenged the assumption that hospital birth was safest. "Sure, there will be babies who die at home who wouldn't have died in hospital," says Horn, "but the other side of that is there are babies who die in hospital who wouldn't have died at home - the ones who get MRSA among them. It's very difficult to say in absolute terms whether home or hospital is less likely to end with a death, because, thankfully, birth is in general very, very safe in the UK. But what's clear is that there's no big difference between the two."
Some women have gone into midwifery after becoming passionate about home birth as a result of their own experience. Annie Francis says her life was changed when she had a hands-off delivery with a breech baby - her first - after being told a caesarean section or assisted delivery were her only options. "Three babies on, aged 40, I retrained as a midwife," she says. "I thought I could provide one-to-one care through a career with the NHS - but I found that wasn't possible because of the way the maternity services are organised, so I became an independent midwife working outside the health service.
"I feel I've been able to pioneer a model of care that's truly women-centred, and the exciting thing is that the government is now beginning to recognise that. The new health and social care bill contains a clause to allow primary care trusts to contract independent midwifery services in, which means that instead of paying £2,000 or so for the sort of individual, tailored service I provide, in the future women will be able to get my services on the NHS."
Other campaigners have been fired into action not by a happy childbirth experience, but by a terrible one. Mary Newburn, head of policy research at the National Childbirth Trust, decided that conditions for women had to be improved after the hospital delivery of her first baby when she was 18, three decades ago. "What happened to me was brutal," she says. "I was left all alone, lying on a bed with an oxytocin drip in my arm, which made an already painful labour sheer agony. I thought I was going to die there; the horror of it, and the horror that any woman in labour could ever be treated that way, has never left me." Afterwards, Newburn dedicated herself to researching childbirth. She went on to have three happier births, two at home, but it is the fear and isolation she felt during her first delivery that has spurred her on.
For many women who are interested in home birth, the biggest stumbling block up until now has been the absence of someone to talk to who has experienced it. As the culture shifts hopefully all that will change.

Friday, 18 April 2008

Home birth group meeting 17/4/08

Five of us met at my the beautiful Maya who is now 7 weeks and just gorgeous. Congratulations to Magda on the birth of her daughter.
Congratulations also to Bola who had her homebirth...I'll post up her story next unless she gets my invitation and beats me to it.
Congrats to Christine who didn't have her homebirth but like Magda made her own decisions and choices...but is now going back to the States!
Welcome to first time home birth mum Jools who is expecting her first baby and having a home birth with Elizabeth as her doula.


BJOG: Safety of Home Births
Released on 02/04/2008
Author Press Office
NCT Statement on BJOG study – Home births
A new study published in BJOG: An International Journal of Obstetrics and Gynaecology examines the safety of homebirths.
Mary Newburn, Head of Policy Research at NCT (National Childbirth Trust) said;
“In our opinion, the findings in this study are unreliable and may be seriously misleading”.
“We believe there are fundamental weaknesses in its design and also some errors and inconsistencies in the methodology.”
The design of the study is weak in a number of ways.
The study is retrospective and uses data from several different studies and databases compiled for other purposes. This may present problems of missing data, mis-coded cases and recall bias.
To assess the safety of home birth accurately, prospective data is required that is collected for the purpose of the study and follows women through their care and records outcomes for them and their baby.
Further, when comparing the safety of planned home births with planned hospital births, it is vital to have similar samples of women, and to exclude unplanned home births.[1]Methodology
In this study, Mori et al make a series of estimates about unplanned home births and intra-partum related perinatal mortality (IPPM) rates, applying estimates from previous studies to two unrelated datasets.
In particular, their estimates of unplanned home births are unreliable. Two different methods have been used to calculate unplanned home births.² This leads to inaccurate estimates of perinatal mortality rates for planned home births. ENDS
Reference: Mori R, Dougherty M, Whittle M. An estimation of intrapartum-related perinatal mortality rates for booked home births in England and Wales between 1994 and 2003. BJOG 2008; 115:554–559.
For more press information please contact Press Office, National Childbirth Trust, 0208 752 2404 or email
1. Unplanned homebirths have poorer outcomes than planned home births as women who conceal their pregnancies are often unattended in labour and have had no antenatal care.
2. One of the estimates of around 66,000 (calculation A) is three times higher than another estimate of 20,000 (category B).
A paper published in the BMJ by Murphy et al, over 20 years ago showed calculation B to be more reliable, yet Mori et al base their conclusions on calculation A. If estimates of IPPM are based on calculation B then IPPM associated with home birth is not different from rates for all births (home birth 0.74; all births 0.79).

Women who transfer to hospital
The Mori et al paper quotes an increased estimated IPPM rate for women who plan a home birth but transfer to hospital. There are three key problems with this:
These are very rough and inaccurate estimates. The paper does not make it clear that the calculation of 6 baby deaths per 1000 women transferred is a rough estimate, not a precise number. The range using two different calculations was anything from 0.78 to 8.37 deaths per 1000 births. To put this in context, the rate for all births was 0.79 per 1000 births.
Over half of the women from the three research studies used by Mori et al to calculate the estimate rate of baby deaths transferred before the start of labour, so they had all their labour care in hospital.
A higher complication rate would be expected for women whose pregnancy is not straightforward, but there is no means of comparing the women planning a home birth (who, for example, might develop pre-eclampsia, or have twins, or have a breech baby) with similar women planning a hospital birth. Women booked for hospital care with these kinds of risk factors will also have a higher complication rate than other women (though no data is provided by Mori et al to allow comparison).

The Birthplace study is underway to address these issues (

A typical headline to report this study: "Home-Birth babies at greater risk of dying" - Daily Telegraph.

BBC report:
Home birth to ward increases risk
There may be serious risks for the baby when mothers who chose a home birth are transferred to hospital, a study says.
Researchers writing in the journal BJOG examined all home births over a decade.
While the death rate for births at home was low, if the mother transferred to hospital the risk of losing the baby soared to eight times above average.
Home birth advocates say the study does not consider women who develop problems in hospital. And the deaths of babies numbered just 65, from 10,752 cases.
Less than 2% of women currently opt for a home birth, but the government has promised all prospective mothers the choice by 2009.
Self-selecting group
A team at the National Collaborating Centre for Women's and Children's Health looked at data on all home births in England and Wales between 1994 and 2003.
Essentially women who opt for a home birth face either a very successful, satisfying outcome, or a potentially disastrous one - there isn't the greyer area that you see with hospital births Professor Philip Steer Editor, BJOG
There were broken down into three sub-sections: planned home births, unplanned home births - when a mother intended to go to hospital but was caught unawares, and a "transferred group" - when women who had planned a homebirth ended up giving birth in hospital.
The death rate among babies whose mothers planned - and did - give birth at home was lower than the average for all births taken together - including those in a hospital, midwife-led unit, as well as at home.
This, the study's authors suggest, was not surprising, given that on the whole only women with few risk factors are likely to be able to book a homebirth and they were thus a self-selecting group.
But when complications did arise for women in this group and she needed to be transferred to hospital, her risk of losing her baby was nearly eight times higher than the national average - and 12 times higher than had she given birth at home.
On average, around 15% of women who have chosen a home birth will be transferred - although the figure is significantly higher for first-time mothers and significantly lower for those who have already had children.
"Essentially women who opt for a home birth face either a very successful, satisfying outcome, or a potentially disastrous one - there isn't the greyer area that you see with hospital births," says Professor Philip Steer, the editor of the BJOG.
"Women's decisions about where and how they give birth must be respected, but it is very important that they are not misled about the risks and are in a position to make an informed choice."
However, the authors conceded that the actual data about transfers was taken from a multitude of studies and was inevitably inconsistent.
"Transfers" did not refer exclusively to women who were rushed to hospital in labour, but included any woman who, having initially chosen a home birth at 12 weeks, ended up giving birth in hospital.
You're not comparing like with like - the study is seriously flawed Mary Newburn NCT
The reasons were also unknown, potentially varying from a change of heart or the desire for more effective pain relief to a major complication.
And the actual numbers are small. In the 11-year period studied, sixty-five babies died after their mothers were transferred to hospital out of a total of 10,752. Childbirth in the UK, experts stress, remains very safe.
The National Childbirth Trust, which wants all women to have the choice of a home birth, says the study should have looked at the number of babies who died in hospital after their mothers developed complications.
"You're not comparing like with like," says Mary Newburn, head of policy at the charity. "The study is seriously flawed."
The Royal College of Midwives said such the research was "welcome but inconclusive".
"The nature of transfer means that complications are anticipated or evident. This principle applies irrespective of place of birth, whether this is at home, in a birth centre or in hospital," said Dame Karlene Davis.
A spokesperson for the Department of Health said: "The department welcomes this article, whose findings will add to the much larger and more detailed study we have already commissioned on safety of place of birth."