OcUK Dadsnet thread

[RoboCod]

They do pose a greater risk to 1st time births.

So?

 

[Simon]

Don't think the risk is different anyway, the issue is if something goes wrong you are much further from help. Unless Emergency C section at home are something midwifes do?

So risk could be the same, the impact is greater though

 

[Unseul]

Don't think the risk is different anyway, the issue is if something goes wrong you are much further from help. Unless Emergency C section at home are something midwifes do?

So risk could be the same, the impact is greater though

How they're defining the risk is important. Risk of something going wrong, or risk of negative end result.

 

[Jez]

The fact that you are further from help is what creates the additional risk. Personally i wouldn't want a home birth, for the completely inconsequential amount of time that a birth takes, i would want to be as near to the main facilities and with as much equipment around you as is possible.

As it turned out for us, a home or facility based birth would have been a ridiculous situation, as we ended up with an emergency c-section. We'd have been in an ambulance rushing to the very place where we were all along anyway, how pointless.

 

[Minstadave]

The fact that you are further from help is what creates the additional risk. Personally i wouldn't want a home birth, for the completely inconsequential amount of time that a birth takes, i would want to be as near to the main facilities and with as much equipment around you as is possible.

As it turned out for us, a home or facility based birth would have been a ridiculous situation, as we ended up with an emergency c-section. We'd have been in an ambulance rushing to the very place where we were all along anyway, how pointless.

Further from help, little or no monitoring during labour, delay in intervening when it goes wrong, no neonatal team if baby is unwell.

You have to carefully select who is appropriate for a home birth and make them aware if the risks and benefits.

 

[Minstadave]

So you agree with me that home births aren't "stupid" and don't pose any greater risk?

No one is going to agree with that there is no increased risk, it is wrong and there is ample evidence to back that up.

For specific groups the risk isn't hugely increased and it is down to the individual and how they balance the risk vs benefit.

 

[theone8181]

My Mrs went straight to the er after 1st birth due to tears, how would that have worked with a home birth? I've no issue with them, but it something does go wrong it's had, our hospital is 30 mins away so not local.

 

[Jez]

Further from help, little or no monitoring during labour, delay in intervening when it goes wrong, no neonatal team if baby is unwell.

You have to carefully select who is appropriate for a home birth and make them aware if the risks and benefits.

What benefits are there other than not having to go to a hospital with nightmare parking? (Which admittedly is crap, but come on )

You end up with the baby either way, one could in theory be a nicer experience, but for most we are talking an almost in and out visit, its inconsequential. The risk if it goes wrong however, is quite bad, and for what, to avoid going to a hospital? I dont see why anyone wouldn't want to be at their central hospital where it can be dealt with in house with all of the best possible facilities on site. As i say, we used the operating ward, it was up one elevator. That would have been a nightmare if we had been off site.

 

[Minstadave]

What benefits are there other than not having to go to a hospital with nightmare parking? (Which admittedly is crap, but come on )

You end up with the baby either way, one could in theory be a nicer experience, but for most we are talking an almost in and out visit, its inconsequential, but the risk if it goes wrong is quite bad, and for what, to avoid going to a hospital? I dont see why anyone wouldn't want to be at their central hospital where it can be dealt with in house with all of the best possible facilities on site. As i say, we used the operating ward, it was up one elevator. That would have been a nightmare if we had been off site.

There are a lot of benefits espoused for a home birth, less medical, lower chance of forceps delivery or C-section, nicer environment, family close by, no COVID restrictions etc.

I'm not supporter of home birth if I'm honest, I see the bad side of it too often in my work but to some it is important so I try to keep an open mind. What I dont like is the lack of openess and consent that the midwives employ.

 

[Minstadave]

My Mrs went straight to the er after 1st birth due to tears, how would that have worked with a home birth? I've no issue with them, but it something does go wrong it's had, our hospital is 30 mins away so not local.

They'd arrange for you to be taken to delivery suite by ambulance shortly after the birth, usually with the baby in tow.

 

[RoboCod]

Further from help, little or no monitoring during labour, delay in intervening when it goes wrong, no neonatal team if baby is unwell.

You have to carefully select who is appropriate for a home birth and make them aware if the risks and benefits.

How can having one or two midwives present at all times equate to little or no monitoring?

If you are deemed low risk you are appropriate for home birth. Low risk this makes up the majority of births.

The NHS website states there is no increased risk for a home birth over hospital births. We've consulted several midwives, the experts in pregnancy and child birth, and they've all echoed this. Doctors are for if things go wrong, I don't believe they know better than midwives about pregnancy and child birth. Given a midwife will identify any issue early on, they'll be taken to a hospital if required. It's hardly like we live in the outback ffs!

 

[RoboCod]

What benefits are there other than not having to go to a hospital with nightmare parking? (Which admittedly is crap, but come on )

You end up with the baby either way, one could in theory be a nicer experience, but for most we are talking an almost in and out visit, its inconsequential. The risk if it goes wrong however, is quite bad, and for what, to avoid going to a hospital? I dont see why anyone wouldn't want to be at their central hospital where it can be dealt with in house with all of the best possible facilities on site. As i say, we used the operating ward, it was up one elevator. That would have been a nightmare if we had been off site.

Because like you said, it's in and out. Like a conveyor belt where the staff will be urging intervention. You are much more likely to receive intervention in hospital than at home, because the hospital is not an environment that is conducive to birthing. So intervention becomes a necessity because the birth often becomes delayed. When there is intervention, the mother is more likely to have lasting negative implications.

 

[Unseul]

Because like you said, it's in and out. Like a conveyor belt where the staff will be urging intervention. You are much more likely to receive intervention in hospital than at home, because the hospital is not an environment that is conducive to birthing. So intervention becomes a necessity because the birth often becomes delayed. When there is intervention, the mother is more likely to have lasting negative implications.

Guess that depends on the hospital. We arrived, they put in the epidural, and let my wife sleep for 6 hours whilst things proceeded. No rush, no induction, no intervention.

 

[Minstadave]

How can having one or two midwives present at all times equate to little or no monitoring?

Hospital births come allow the option of real time CTG monitoring where contractions and baby's heart rate are monitored closely for signs of foetal distress and guide intervention.

Home births involve minimal foetal monitoring, either listening in occasionally with a Pinard Stethoscope (something from the dark ages) or a sonicaid. There is often a significant delay in picking up foetal distress (or an extremely unwell baby comes out without ever being picked up).

If the midwife is only listening in every 15 minutes of so (often less frequent if a pool birth) then often far too long passes to recognise and manage a foetal bradycardia before irreversible damage is done.

 

[Jez]

Because like you said, it's in and out. Like a conveyor belt where the staff will be urging intervention. You are much more likely to receive intervention in hospital than at home, because the hospital is not an environment that is conducive to birthing. So intervention becomes a necessity because the birth often becomes delayed. When there is intervention, the mother is more likely to have lasting negative implications.

It wasnt like that at all in the JR Oxford, we had a large private room, and they left us to it for as long as we wanted and the baby was monitored the whole time via the mountains of wires and pipes and whatever else surrounded the bed. Importantly also there is every level of medical staff on site, and every facility possible within the building.

I guess i only relate to ours, but a home birth would have been a nightmare and from that perspective and because it is unpredictable, i dont see why you wouldn't want to be in the best possible place medically.

 

[Unseul]

Hospital births come allow the option of real time CTG monitoring where contractions and baby's heart rate are monitored closely for signs of foetal distress and guide intervention.

Moving away from the argument a little. The CTG monitoring was useless in our case . They monitor because when contractions start, the baby stops moving, and so you need the monitor to help gauge what's going on with them. My boy decided to go a different route though, every time my wife had a contraction, he fought back. The doctor took a look at the printout and said he'd never seen anything like it, it was completely useless, but at least we know the baby is healthy .

No surprises that when he came out he got a 10 on the apgar score.

 

[Minstadave]

Because like you said, it's in and out. Like a conveyor belt where the staff will be urging intervention. You are much more likely to receive intervention in hospital than at home, because the hospital is not an environment that is conducive to birthing. So intervention becomes a necessity because the birth often becomes delayed. When there is intervention, the mother is more likely to have lasting negative implications.

Intervention is not based on throughput - that is a complete fantasy. It's based on risk to the mother and foetus. Intervention is absolutely more likely in hospital, that is true, but it's based on a lower threshold for risk than in a home birth.

I'm not sure overall how you quantify what is worse? The higher risk of intervention and the effects of that vs the higher risk of brain injury/impacted delivery and transfer etc.

 

[Minstadave]

If you are deemed low risk you are appropriate for home birth. Low risk this makes up the majority of births.

Sorry wanted to pick up on a few things. Low risk births are not no risk. Yes these are Mum's more likely to have an uneventful homebirth however low risk includes first time mothers, and they have a doubled complication risk having a home birth. The criteria deciding who is low risk is very lax.

The NHS website states there is no increased risk for a home birth over hospital births. We've consulted several midwives, the experts in pregnancy and child birth, and they've all echoed this. Doctors are for if things go wrong, I don't believe they know better than midwives about pregnancy and child birth. Given a midwife will identify any issue early on, they'll be taken to a hospital if required. It's hardly like we live in the outback ffs!

I think you overestimate the skill of midwives to monitor during labour and I'd be careful about the information you receive from them and everyone else - all sources are biased in some way (including me - I'm a neonatal consultant and will be very biased). It sounds like you've been sold a very one sided view of home births and are trying to fervently defend that side, straying into confirmation bias. The truth is somewhat different from what you've been told.

Community midwives are often evangelists of homebirth and poorly explain the risks involved in my experience. Issues during labour are often recognised late, if at all, and interventions take much longer when required. The standard for an emergency C-section is within 30 minutes iirc in hospital, you're not even going to be at the hospital within 30 minutes for most home births gone wrong, let alone cannulated, consented, in theatre, anaesthetised and the choppy bit started.

I have seen hospital births and home births go wrong in my 10 years as a paediatrician. To me, the setup in hospital is decidedly more risk adverse than that of a community birth.

The community midwives have the good fortune of washing their hands of Mums and babies after a few days, I look after the families for years following complications, so that also gives a different perspective. All I would suggest is to try and keep a more open mind and try to take a balanced view.

 

[SixTwoSix]

Because like you said, it's in and out. Like a conveyor belt where the staff will be urging intervention. You are much more likely to receive intervention in hospital than at home, because the hospital is not an environment that is conducive to birthing. So intervention becomes a necessity because the birth often becomes delayed. When there is intervention, the mother is more likely to have lasting negative implications.

We were given a private room on arrival in Coventry hospital Lucina Centre, had 2/3 different midwives popping in every now and then to see how things were going along. Baby was born about 4 hours after arrival. No rushing, no emphasis to get us out as soon as possible. Once little one was born we were allowed to stay in there and relax/recover for another 8 hours before my wife was asked if she was ok to go to the ward.

Only drawback was the horrendous parking charges

 

[RoboCod]

Sorry wanted to pick up on a few things. Low risk births are not no risk. Yes these are Mum's more likely to have an uneventful homebirth however low risk includes first time mothers, and they have a doubled complication risk having a home birth. The criteria deciding who is low risk is very lax.



I think you overestimate the skill of midwives to monitor during labour and I'd be careful about the information you receive from them and everyone else - all sources are biased in some way (including me - I'm a neonatal consultant and will be very biased). It sounds like you've been sold a very one sided view of home births and are trying to fervently defend that side, straying into confirmation bias. The truth is somewhat different from what you've been told.

Community midwives are often evangelists of homebirth and poorly explain the risks involved in my experience. Issues during labour are often recognised late, if at all, and interventions take much longer when required. The standard for an emergency C-section is within 30 minutes iirc in hospital, you're not even going to be at the hospital within 30 minutes for most home births gone wrong, let alone cannulated, consented, in theatre, anaesthetised and the choppy bit started.

I have seen hospital births and home births go wrong in my 10 years as a paediatrician. To me, the setup in hospital is decidedly more risk adverse than that of a community birth.

The community midwives have the good fortune of washing their hands of Mums and babies after a few days, I look after the families for years following complications, so that also gives a different perspective. All I would suggest is to try and keep a more open mind and try to take a balanced view.

So are you claiming you know better about child birth than a midwife does?

My mind has always been open. I just champion the idea of home birth and was retorting to the closed mind statement by Rob that "home births are stupid" and that "home births increase risk" when as a matter of fact the experts in child birth (midwives) and the NHS all state contrary to that.