Originally Posted by Buzzbuzz
Out of curiosity, since you are a UK homebirther -- the impression I got of the Birthplace study was that the criteria for being included in the study as a homebirth mother were actually *stricter* than the criteria actually used to homebirth in the UK. With the result being that the study results were not actually representative of what is going down "on the ground" currently in the UK?
Also, isn't it also accurate to describe the increase you are talking about as a "doubling" of risk? While double of a tiny number is still a tiny number, it isn't so small to those who fall within the percentage of the increase, right?
Homebirth in the UK is the mother's right. So while they can say "we strongly advise you that a homebirth would be dangerous" they cannot refuse to attend you (if they really feel you're high risk they can however show up and immediately call an ambulance). Thus the study was made "stricter" because although it is not officially "allowed" there ARE women who are VBAC, VBA2C, carrying twins, high-BMI, "old" etc. having homebirths. Equally there are absolutely women who are young, healthy and having a normal pregnancy being risked out for ridiculous reasons - it's just that they cannot DROP care, so if you know you can refuse to go in then you can still attempt a homebirth. Does that make sense? Truly there IS no "criteria" for a homebirth here, but depending on your care you might have a serious uphill fight to have one even if there's no actual medical reason not to - when i was having #1 i had NHS midwives and while they were very good they were stuck with all the hospital protocols and it made my care patchy and unsatisfactory. For example i was told that i had an "untried pelvis" (something which was relevant in the times of rickets and polio in the UK but which is medically irrelevant for 99.99% of modern UK women) when i booked and should not homebirth because of it. And then told by a registrar that at 10 days past 40 weeks homebirth was far too dangerous an option (stillbirth risk increasing being her reason for saying this) and she then went on to tell me i must instead be induced in the hospital - when they fetched the ward book the next induction spot was when i was 40+15 and she solemnly wrote me in for it! Needless to say when labour began at 40+11 i didn't rush in. They did a GTT when i was 41+2 AGAINST my consent in another attempt to find a reason to discourage homebirth. They basically get twitchy as soon as ANYTHING happens that isn't textbook "normal" - with DD2 i had an independent midwife, of which there are very few remaining (they are the only way to get assured one to one care now) but booked with a hospital too, in case i should need to be transferred, and the midwife there told me i couldn't have a homebirth with my hypothyroidism, despite it being very well controlled - they failed to even diagnose it with DD1 when it was truly dangerous (as it was uncontrolled)!
Fear is rife still - i know many women who have successfully homebirthed and many many more who have transferred for long labour (after 5 hours of contractions in one case!), slow progress (2 of the 3 i knew who transferred for that gave birth in the ambulance), "non reassuring foetal heart tones" (in one case baby was distressed, in the other 3 the drop in rate was caused by the head passing the ischial spines (which causes a vasovagal response), all those babies came in the ambulance or the triage room), "tired mother" (they refused to let her go to bed but transferred her and then gave her diamorphine, her baby was born 40mins later, drugged, and went to NICU until his breathing normalised) . I know dozens of women who've expressed an interest in homebirth and been shut down at their first appointment with either spurious reasons or just a "no, i don't think so" from their Ob.
It is true you could say the complication rate doubled. But i myself fell into that group BOTH TIMES, as you read above (in fact my births would have been included in the study but for the fact that i live in Scotland). DD1 needed suctioning and oxygen, DD2 (for whom hospital would NOT reduce the risk, given she was a second baby) had a true knot and a velamentous cord insertion. Both of my babies would, in my local hospital, have spent their first 24 hours in the nursery for observation, on a drip, repeatedly stabbed for glucose levels and away from me. Neither of them NEEDED that, it would not have improved anything for them, and could only have been traumatic for them. I have nothing against intervention, i am only against UNNECESSARY intervention.
For me that doubled risk is absolutely worth it, because the numbers ARE so tiny, that even if you, like me, end up in the "complications" group, the risk of serious complications is even tinier - yes bigger than in hospital, but in absolute terms still such a tiny increase that you could still know you'd been very very unlucky indeed to have suffered that serious complication. For other women - well it's everyone's right to make that choice. There is truly NOTHING wrong with choosing to give birth in a hospital if that choice is able to be made with facts (or at least COULD be made with facts - obviously some women want to make their decisions in other ways and that too is fine, so long as they had access to facts if they wanted them).
My DD1 was able to be born without drugs in her system, handled by very few people (most of whom she would be recognising the voices of from prenatal times), fed only my own milk from my own breast, subjected to NO unnecessary interventions and treated at all times with gentleness and respect borne of being "the baby" rather than "a baby" as in the hospital with 30 other babies born that day. I can say honestly that weighing ALL of that against the fact that she needed some suctioning (with a bulb syringe) and a little oxygen for about 50seconds after her birth i have no regrets whatsoever.