NHS homebirth in the UK - Mothering Forums

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Old 02-05-2014, 10:21 AM - Thread Starter
 
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A few months ago, I posted on the I'm Pregnant boards about my unusual circumstances- after finding out I was pregnant back in June, my husband and I left our jobs in Shanghai (where we had been for 5 years) and went back to Canada, my home country. Unfortunately, as I'd been away for too many years, I found out I couldn't apply for universal healthcare until after 6 months. We managed to get a 20 week ultrasound done privately but it was too complicated to get regular prenatal care that way. We decided to move to his home country (England) and managed to get my spouse visa a week shy of my no-fly cut-off (28 weeks).

 

Luckily, my pregnancy has been very uncomplicated- I monitored my blood pressure and weight and blood sugar during the first 28 weeks until I was able to get a midwife upon arriving in the UK, and both the 12 and 20 week scans were excellent. I did a lot of online research while I was back in North America, so a lot of my initial decisions were informed by options and difficulties within the US system (because there is so much written about it).

 

Now, it looks like I'll be having a water/home birth. It's presented as a viable option by the midwives here- on equal footing for uncomplicated pregnancies, alongside midwife run birthing centres and the hospitals. Frankly, I was surprised and quite excited. We live in a city centre, about 5 minutes from the main hospital, so if anything goes wrong, it's not a difficult transfer. When I'm in established labour, two midwives will come to my house and stay with me for the birth and any follow-up needs. We discussed pain management options and what if any interventions I would be okay with, if needed. They were very supportive and very matter of fact about the whole thing. Apparently, in my neighbourhood, home births are very common. 

 

Now that I'm here, nearly 39 weeks and waiting, I'm reading through this forum and wondering about the actual, practical differences in risks and options between US and UK home births. My midwives are all working directly with the local health services and are fully qualified (3/4 year degrees+). They have the support of the hospitals and obstetricians. All services are provided free of charge through the national health services (except my birthing pool, which I hired privately and inexpensively- they're free if you have a hospital birth but not loaned out for home births).

 

Has anyone else had a UK home birth? How did it compare with what we read on this forum? It sounds incredibly controversial and almost subversive/illicit in the US, with mothers being chastised for putting their babies in grave danger... which I've not heard at all here. Is it the systems that make things more/less dangerous?

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Old 02-05-2014, 10:42 AM
 
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FWIW,  I don't think that you can compare HB in the UK (with seamless transfer/hospital support) vs. HB in the US (kind of underground/Hospitals are not supportive -some even hostile towards HB transfers).  You have the option to see an OB consultant at the same time following with your MW.  I also think that midwifery is much better standardized in definition in the UK and in the US it is NOT (in some states, ANY woman, off the street can call herself a MW!!). 

 

I'm not in the UK, nor have I given birth in the UK.  But, if I were in the UK I would not have ANY qualms about homebirth (and I'm planning a HB here in the US!). 

Best wishes and happy, peaceful birthing Mama!


Sierra, wife to DH , Mama to DD (2012) and DS(2014). In love with my family and hoping for inner .
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Old 02-06-2014, 01:48 AM - Thread Starter
 
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Thanks! I was just really curious, after so many months of reading dire horror stories and warnings, to find out if it's inherently home birth that is the 'problem' or if it's the support system (or lack thereof). I've heard that home birth is also very common and encouraged in the Netherlands with success rates on par with hospitals. I wonder if the US stats would change if they (in a manner of speaking) decriminalized home birthing and midwifery and gave the support necessary to make it possible for such options for uncomplicated pregnancies.

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Old 02-06-2014, 08:49 AM
 
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I had my first in the UK (in a hospital as I was high risk).

 

The entire setup is VERY different in the UK. There is some friction between OBs and midwives, but there are clearly laid out guidelines for risking upward to consultant (OB) care, guidelines, etc. However there is variation within the UK as well--different areas have different rates. Home birth is actually discouraged (subtly or overtly) in some areas as there is a midwife shortage. Home birth rates have declined in some areas in recent years and I've heard some anecdotes about midwives being late with baby born before arrival. 

 

But you really can't make the leap to saying "If the US legalized home birth...." because setups are so different. In the UK it's all one system, and the midwives are trained for birth in all settings--there is no division in training between home and hospital midwives. Many, many things would need to change in the US, at a systematic level. 

 

The Netherlands does have a high home birth rate, but it is declining and there are questions about overall mortality statistics. (This is not only due to home birth; there were questions over whether staffing in off-hours was adequate.) 


DD 01/2007, DS 09/2011

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Old 02-06-2014, 09:27 AM
 
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The type of collaboration among midwives and physicians that occur at NHS homebirths in the UK is nearly non-existent in the US.

 

This would be midwives (RMs or CNMs) who have collaborative relationships with physicians, as well as the ability to admit and manage labor in the hospital.

 

I would venture a guess that there are maybe 10 practices in the entire US like this - CNMs with OOH practices and hospital privileges. It is extremely rare.

 

This is a model that I believe is very good. But it hardly exists here. There is wide variation among midwifery practices in the US (now I'm talking about DEMs, CPMs, LMs, and CNMs). There is no standard among those who call themselves "midwives" - so in planning an OOH birth in the US with a midwife, it may not be apparent what level of care you are getting. And this is due to many different factors: professional training, personal preference, laws, certification, licensure.

 

I believe home birth is a viable choice for low-risk women experiencing normal pregnancies and labors. But what a midwife might consider "low-risk" - as least here in the US - is subject to wide variation as well. I know midwives who say they only attend "low-risk" births, but this actually includes breech, twins, VBAmC, postdates, preterm, etc.

 

To include these conditions in the definition of 'low-risk', that's just asking for trouble.

 

I hope this addresses some of your concerns without fear-mongering. I do dislike the doom and gloom. How do we present information in a cautious way without being fear-mongerers? I wish I knew the answer. I would personally feel very secure with the home birth situation you are describing. You have been screened for risk-factors, you have received appropriate antenatal care, you will be attended by licensed (registered?), professional midwives with very good collaborative relationships with medical providers if needed.

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Old 02-06-2014, 09:53 AM
 
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Quote:
Originally Posted by Noboru View Post
 

 I wonder if the US stats would change if they (in a manner of speaking) decriminalized home birthing and midwifery and gave the support necessary to make it possible for such options for uncomplicated pregnancies.

^^ I do think that this would be one step in the correct direction, but things really are quite messy here in the US in terms of OOH birthing vs hospital birthing.  Both are wraught with NON-evidence based practices, some of which encourage women to birth at home, and as you might imagine, encourages other women to ONLY want to birth in the hospital.  There continue to be many issues that divide HB and hospital birth advocates and unfortunately, I don't see either side making any concessions OR seeing eye to eye anytime soon.  It's sad really. 

 

But again, I think in your case, you've set up an excellent plan of care in a system that carefully assigns risk and collaborates MUCH better!!!


Sierra, wife to DH , Mama to DD (2012) and DS(2014). In love with my family and hoping for inner .
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Old 02-06-2014, 10:36 AM
 
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Both my kids were born at home in the UK. We had great experiences both times, the second time even with joint MW-hospital care. We were lucky enough to live in an area with a relatively high HB rate and I had a lovely community MW, who was totally relaxed, exactly what I needed.

Expat mama to my 7-year-old Halloween boy and my cheeky preschooler, who came before the midwife in January 2010... Gestating a new bean, debuting spring 2014!
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