Wednesday, 21 May 2008

"Home Truths" - in the Sunday Times

An article about home birth in the Sunday Times on 18/5/08. Thanks Innogen for pointing this out.

The home truth about homebirths
Homebirths are becoming increasingly fashionable, but are they really a safe alternative to the hospital delivery suite?

Sally Brown

There is a quiet revolution going on among pregnant women. Giving birth at home is back in fashion, and not just among the “breast-feed until they start school” brigade. Although the number of homebirths is still relatively small - only 2.5% of all births in 2006 - this represents a 10% increase on the previous year.
Women whom you might have assumed would be happier having an elective caesarean at the Portland Hospital, with a mummy-tuck thrown in, are turning away from maternity wards and the risk of superbug infection in favour of a personalised experience over which they feel they have some control.
The homebirth movement has found an ambassador in the unlikely shape of the American talk-show host Ricki Lake. She has just released a campaigning documentary, The Business of Being Born, which has attracted a cult following among mums’ support groups in this country since it was released last month. The film contrasts her own vastly different experiences of home and hospital birth.
“During the hospital birth of my first son, Milo, now 10, I felt like stuff went on that was out of my hands,” she says. “The second time, I found a midwife who was comfortable with me giving birth in water at home. Everyone told me I was crazy - in America, less than 1% give birth outside hospital - but my first birth took 36 hours and my second took nine hours from start to finish. It was hard, and I was in a lot of pain, but it was an amazing and empowering experience.”
Angela Horn runs the online support group and has had five children at home. “It hasn’t all been wonderful, and I won’t deny it hurt at times. My last birth was lovely – it took one hour 20 minutes, of which only the last 20 minutes were painful - but the first one took nine hours, and I lost a litre of blood,” she says. “I don’t think doctors are the enemy, and some women are better off in hospital, but I do believe we’re naturally meant to give birth in a home environment.”
The big problem with homebirths is that it is impossible to predict what complications might arise. All too often, painstakingly created birth plans go out of the window. “I planned a homebirth with my first baby,” says Sarah Ockwell-Smith, 32. “Looking back, I was underprepared and quite frightened. I laboured for 10 hours at home, but I was dilating for only three of them. I was in a lot of pain and my pulse rate went right up, so, when my midwife suggested transferring to hospital, I didn’t argue. They gave me an epidural and I slept for two hours before pushing the baby out – he was 10lb, and I’m only 5ft 1in, which may be why it had been difficult. I went on to have another baby in hospital, then my last two at home, with quick, pain-free labours.”
Actually guaranteeing that you get a home delivery in the first place is something of a lottery. “In places where there is a shortage of midwives, it is the homebirth facility that is pulled first,” says Helen Rogers, of the Royal College of Midwives (RCM). “Some women are told that staffing levels mean they can’t be guaranteed the midwives on the day.” (NHS guidelines stipulate that two midwives must be present for a home delivery.) “In practice, if there are staff shortages, community midwives are diverted onto hospital wards and women who had planned a homebirth will be told to come into hospital.”
The safety of homebirths remains a contentious issue. The RCM’s line is that a planned, midwife-monitored homebirth in a normal pregnancy is as safe as a hospital birth. “Women used to routinely die in childbirth, but we are healthier now,” says Mervi Jokinen, practice and standard development adviser at the RCM. “We’re not giving birth year after year and we have drugs that can stop bleeding.” A British Medical Journal report on four studies published in 1996 concluded that planned homebirth was as safe as hospital birth, and that women who gave birth at home required significantly less medication and fewer interventions.
Last month, a report in the British Journal of Obstetrics and Gynaecology found that planned homebirth babies are 39% less likely to die than hospital-born babies if - and it’s a big if - nothing goes wrong. If complications occur and the mother is transferred to hospital – which the researchers say happens in one in seven homebirths - the risk of the baby dying shoots up to roughlt eight times more than the average for all births (though it’s still less than 1%).
“What makes this a difficult issue is that it’s perhaps easy to point to a case where a homebirth baby died and say, ‘That baby might have lived in hospital,’ ” says Horn, who believes that women at home are more likely to give birth without interventions such as oxytocin (to speed up contractions), forceps or ventouse because they are allowed to labour at their own pace. “People also need to consider cases where a baby died after a hospital birth, from hospital-acquired infection, or due to complications after a speeded-up delivery.”
It is not simply lack of funding, however, that is stopping women giving birth at home. For many, the idea of a natural birth is about as appealing as having their appendix out on the kitchen table. “Part of the reason women are scared of childbirth is that it is not normalised,” Jokinen explains. “In cultures where birth takes place in the community, young and old women are present at the labour - the older women to give advice from the benefit of their experience, the young women so they know what to expect. Now, women go into labour with no idea of what happens.” Time will tell whether the next decade finds Mrs Average comfortable with the idea of giving birth on the living-room floor, but the signs are that the tide is turning. As the natural-birth guru Gowri Motha puts it: “Women are starting to believe in their bodies again.”
For a screening of The Business of Being Born near you, visit

- You don’t need your GP’s permission for a homebirth; you can book direct with the supervisor of midwives at your local hospital. Talk to your midwife as early as possible in your pregnancy about your interest in having a homebirth. She can assess your suitability and monitor your progress.
- A water birth isn’t obligatory, but hiring a birthing pool is popular, as the water supports the body and helps you to move around, which in turn assists pain management.
- Don’t be a hero. You can have gas and air, along with pethidine pain relief.
- Don’t get hung up about the mess. “There’s a lot less than people imagine,” says Helen Rogers, a midwife. “But midwives should provide plastic sheets to protect carpets and soft furnishings.”
- Homebirth is not advisable for multiple pregnancies or where there are complications such as placenta praevia, pre-eclampsia or obstetric cholestasis. “It is possible to have a homebirth after a previous C-section, as long as you agree to a hospital transfer at the first sign of trouble,” Rogers says.

Thursday, 15 May 2008

Home Birth death

There are some very worrying facts about the reporting of this story.
The coroner specifically blames the midwife's hesitation for Joanna Whale's death. Yet the evidence as reported suggests that this hesitation was only part of the cause: a significant error was the breakdown of communication between medical staff at the hospital which lead to doctors assuming - rather rashly, I would have thought - that Joanna had a retained placenta.
Better communications in the hospital might have saved Joanna's life yet the coroner blames the home birth for her death. If the midwife had had more experience in home birth management, this too might have helped save Joanna's life. The coroner does not seem to see this and instead simply assumes that the home birth situation is at fault.
The story is reported next to another court story about another young mother who died in childbirth, after a routine C-section because of placenta praevia, in hospital. Why didn't the coroner warn of the dangers of C-sections in hospital as a result?
The Joanna Whale story smacks of witch-hunting.

Angela Horn, owner of the Homebirth UK website, writes:

"This is the first maternal death after planned home birth that I'm aware of in the UK, in the past 30 years or so. This is despite theUK having around 15,000 planned home births a year, IIRC. The UK's average maternal death rate is 1 in 10,000, of which many are women who had caesareans. As planning a homebirth roughly halves the numbero f women who end up with caesareans, it would be interesting to calculate the number of women's lives which have been saved by planning homebirth over the years..."

June meeting - date changed!

We have had to change the date of our June meeting because the earlier choice clashed with another NCT event.
We will now be meeting on:

Wednesday 4 June
at 8pm
at 42 Flanders Mansions, Flanders Road, W4 (Christine's)



Friday, 2 May 2008

High risk....

A sketch from a US book about homebirth which gives an interesting perspective on hospital birth....