Many Women and Providers Are Unprepared for an Evidence-Based, Educated Conversation

So true, and so frustrating. Withholding truthful information for fear of "making" people feel guilty or uncomfortable is unethical. Caregivers, advertisers, health boards etc. should be providing full disclosure so mothers can make their own informed choices. The very fear of taking choice away from mothers is doing just that, taking their choices away because they don't know what their choices are. Not right.
 
Such a scary study, but it is spot on. In Australia there has been lot of debate around home birth (as it is pretty much becoming impossible due to changes to legislation) and it is astounding that the general view of the majority women is that you are a negligent mother if you want a homebirth because it is so dangerous (not born out by the evidence but so many people say 'the statistics show it is more dangerous' based on simply wrong facts) and the mother is putting her 'preferences' before the health of their baby. I know homebirth may be considered extreme by some, but the reason most people choose it is because they ARE informed about factually based risks of intervention and the restrictions hospitals put on birth practices. And birthing centres are very few (only in major cities generally) and very hard to get into as there is such a demand.

But in the UK for example, the first thing my pregnant sister in law was asked was whether she wanted a home birth (she didn't but at least she had the choice, supported by the medical system). It is a midwife based system there, not led by obstreticians as here in Hong Kong and in Australia, US and Canada...
 
http://www.cmaj.ca/content/166/3/315.full

In some cases, the problems that being in a hospital 'solves' are problems created there in the first place, such as the lithotomy position, overuse of oxytocic drugs, being tethered to a machine and therefore unable to move around etc.

For those who think home birth is child abuse, show me the statistics to support that and I'll change my mind.
Not the 'Wax' study, which has been widely panned by both supporters and critics of home birth, as they included in the study accidental home births, unattended home births, births in the car on the way etc.
 
I know quite a few women who have chosen home births. I know women who have given birth successfully multiple times at home. I even lived in the basement apartment of a couple while in university and they gave birth at home upstairs while we were home and we didn't hear anything. One of my husband's close university friends in Australia had an awful experience during birth in a hospital with her first child so with her second she and her husband did a "free birth" at home--there was a doula who attended but actually the doula wasn't even there for the birth--they did it all by themselves and had a great experience. Her son was over 10 pounds at birth and she gave birth very quickly (I think like three hours or something start to finish) and didn't have any tearing at all. She loved her experience. I have a close friend from secondary school who gave birth at home with a midwife in the States a couple of weeks ago--her first child and her husband and mother were there and from what they've told me it was an amazing experience.

Basically, I agree with TNT that the women and their partners who choose home birth are probably the most aware, educated and up-to-date individuals out there--they are the super proactive ones. It's kind of a sad irony that they get pinned with this "irresponsible" label by society as the ones I see as really irresponsible are the ones who don't educate themselves about birth and walk into a hospital and labor, figuratively throw their hands up in the air and basically say to the staff and doctors, "Do whatever because I waive not only my involvement in this process but also the my rights and the rights of my child." There is such an attitude of waiting for the doctor, midwife or staff to come riding in on horseback as your "knight in shining armour" and rescue you, "the damsel in distress." I find that irresponsible and immature. Reminds me of this bit of writing I read recently. But the truth is, those are the women celebrated on the reality TV shows about birth--they're the ones who get the pat on the back for "doing the right thing".

No, make no mistake, the people who choose homebirth are doing so because they know what's really going on in the hospital and have realized there is a different way. Many of these women could teach a university-level course on childbirth they're so educated on the subject. Every choice has consequences and it's totally false to assume that a hospital birth carries no risk or that those risks are lower than home birth or birth center birth.

When I gave birth for the first time in the States, I walked into my midwife's office for the first appointment when I was seven months pregnant (as I was in HK for the previous six). I timidly explained to her how I was prepared for a natural birth without any augmentation, interference or interventions and that my husband and I were really serious about it and had been training for such a birth for three months. I was hoping that she wouldn't start arguing with me or laugh me off like, "Yeah, that's nice but it probably won't work out..." Instead, the midwife gave me a hug and said that she was so glad to meet women like me. She said it was like a breath of fresh air.

She had been attending births in homes, at birth centers and in hospitals for 20+ years and she said at the current hospital most of the women she said that she encountered had "checked out" of the birth--they weren't active participants and she said in those circumstances the best she could do was try to minimize the damage.
 
my cousin, 36, just had a home birth in december in canada. after the birth, she started to bleed. she had to be rushed to the hospital in an ambulance, while her new husband followed behind with the newborn in the car. she needed 2 or 3 (can't remember) blood transfusions (she turned down more, even though she needed it). she almost died.... what was she worried about? she didn't have the perfect birth that she'd wanted and therefore was going to be a horrible mother.

now, i realise, her hormones were doing terrible things to her. but her midwife should have seen the signs. she was 36 having her first. she's a redhead (redheads tend to bleed more)...she should not have been having a home birth. i feel like she was bullied by those around her to feel inadequate if it didn't all work out "perfectly".

i have no problems with having a home birth and i think women should be given all of the information so that they can make a choice, but i also think there comes a time when someone needs to step up to the plate and also give the possible consequences of those choices, not to frighten but to inform. you cannot consider yourself informed unless you have ALL of the information, including the possible bad stuff.
 
I had a homebirth in London with my first. It was wonderful. Part of my decision was based on the knowledge that I could get to a choice of 2 different hospitals within 10mins if need be. The midwives in the uk have a direct number to call ambulance services rather than the standard emergency services number. And this gave me sufficient comfort given that most of the time things don't go wrong. We were prepared in case they did.
At one point towards the end of labour my midwife was having difficulty hearing finding bubs heartbeat and it was being mistaken for my much slower one! She very calmly said " I'll try this for another minute but if I can't find it we need to transfer straight away".
Heartbeat found, crisis averted but great to see how quick she was to act.
I've since had two hospital births on HK and I would take homebirth over hospital any day EXCEPT there are no hospitals close enough to my home here in HK and I do not trust that roads won't be blocked due to an accident or roadwork etc. It's not worth the risk for me here. Shame though as I am a big supporter of birth in the home.
 
carang said:
my cousin, 36, just had a home birth in december in canada. after the birth, she started to bleed. she had to be rushed to the hospital in an ambulance, while her new husband followed behind with the newborn in the car. she needed 2 or 3 (can't remember) blood transfusions (she turned down more, even though she needed it). she almost died.... what was she worried about? she didn't have the perfect birth that she'd wanted and therefore was going to be a horrible mother.

now, i realise, her hormones were doing terrible things to her. but her midwife should have seen the signs. she was 36 having her first. she's a redhead (redheads tend to bleed more)...she should not have been having a home birth. i feel like she was bullied by those around her to feel inadequate if it didn't all work out "perfectly".

i have no problems with having a home birth and i think women should be given all of the information so that they can make a choice, but i also think there comes a time when someone needs to step up to the plate and also give the possible consequences of those choices, not to frighten but to inform. you cannot consider yourself informed unless you have ALL of the information, including the possible bad stuff.
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I think that most women who give birth at home with a decent midwife have a better "escape plan" than what your cousin seemed to have had. Things do go wrong. Women bleed. Women also bleed in the hospital. It shouldn't really ever get to the point of transfusion. In my opinion, if it gets to that point whoever was on duty--be it a doctor or a midwife--at home or in a hospital--that person was not on their game. The first line of defense against hemorrhage is pitocin and your well-prepared midwife who is attending a homebirth will have a pitocin drip on hand ready to go. I got a shot of that and another blood clotting medication in both of my legs as soon as I had any sign of too much bleeding and then I was put on a steady drip of the stuff for about 12 hours (after the birth). Meanwhile that midwife should have been on top of your cousin's uterus with her fist in it trying to stop the bleeding. How far away was the hospital? Personally, I would never choose to give birth outside of a hospital if I didn't know a hospital was within 10 minutes away--in my home city all the hospitals are within 10 minutes from where my mom lives. The people I know of who have needed transfusions after childbirth usually had the situation of the doctor not watching close enough--leaving for long periods of time and not monitoring the situation properly.

I'm sorry that your cousin suffered but it seems she and her midwife were not as prepared as they could have been. It's not like, "Oh, just don't worry about it, nothing will probably happen. Think happy thoughts..." when it comes to birth outside a hospital. No, it means that you prepare for the worst and focus on the best.

Edited to add: Not all midwives are of the same calibre and quality either.
 
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My mum is a classic redhead and gave birth to both of her children, myself included, at home with no complications. She had the assistance of very experienced midwives, with the hospital less than ten minutes drive away. I'm not saying everyone should give birth at home, but for those mothers who wish to and have had uncomplicated pregnancies, they should have the option and support. Midwives are specialists in natural birth, obstetricians are specialists in complicated birth. I do often feel that some of the complications seen in hospitals are as a result of being in the hospital in the first place, by being tethered to machines, flat on the back, anxiety, unnecessary interruptions and prodding, time limits, oxytocic drugs, infection etc. Everyone has a story of "but my friend gave birth at home and this happened" or "my friend gave birth in hospital and this happened"... There are situations where a birthing mother is better off in hospital, but there are an equal number of situations where a birthing mother is better off in her own home environment. The well controlled Canadian study posted above speaks miles - in low risk mothers with uncomplicated pregnancies, outcomes at home vs. hospital were essentially the same..
 
please don't get me wrong, i agree, if it is your choice, and the midwives/doctors agree, go for it.

BUT i think there is just as much bullying that can happen from those who are PRO as those who are ANTI....neither is ok and neither should be allowed.

women need to be given all of the facts, including possible complications, so that they can make an informed, unpressured (from all sides) decision.

for what it's worth, i hold the same opinion when it comes to breastfeeding.
 
Totally agree Carang, trouble is, mothers aren't provided with all of the facts, and society often reject facts to avoid 'making' mothers feel guilty..
 
Lali07 said:
I do often feel that some of the complications seen in hospitals are as a result of being in the hospital in the first place, by being tethered to machines, flat on the back, anxiety, unnecessary interruptions and prodding, time limits, oxytocic drugs, infection etc.
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This reminds me of something a blogger I follow wrote yesterday:

Dear TLC/A Baby Story: I *dare* you to show a normal birth. Not even natural, just one that doesn't depict women in the worst pain of their lives. One that doesn't portray women crying in pain like hurt little girls because they're not allowed to get off the bed to move around and manage the pain. One that doesn't show women with serious bleeding disorders having a f**ing cesarean, which puts them at additional risks. One that doesn't show a woman basically being pitted to distress on national tv. Get a clue already! You are brainwashing women!
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I don't think that many women are taught or realize that movement during labor (which means you can't be constantly monitored or strapped down to a bed) actually not only usually decreases the pain of labor but makes it go along faster. It also gives the women a sense of control to move with what her body is doing--to partner with her labor instead of resist it.

For me, when I was in labor this last time in HK the staff in the public hospital did their best to try to insist that I lay down, flat on my back, strapped up to the baby monitor because that is protocol. Does it mean a safer birth? No. Actually, the chances of that fetal monitor being wrong are admittedly 50%! My OBGYN told me that while I was pregnant--that if the fetal monitor shows "fetal distress", 50% of the time it's actually wrong. So, you'd be better off just flipping a coin, in my opinion.

But, the point is the hospital comes along with all these protocols which often have no legitimate justification except "this is how we do things for our own convenience." Anyway....why did I refuse to lay down and do things "by the book"? Because, I was aware and educated of what the purpose of movement in labor is and other ways to manage my pain. I wasn't looking for the staff to do it for me. I was participating in my own labor, not letting it just "happen to me." Very few women really know anything about this in any useable way, I think. It's not a standard part of the education that goes on in the hospital and some hospitals (like the ones in HK) actually actively resist it--nevermind trying to encourage it.

So, that's why women labor at home--for reasons like this--because they do know what they're doing and it's the best choice for them. I think the cases of women being "bullied" into having a home birth are probably few and far between because if you are going to have your birth at home in most circumstances you have to really, personally, actively seek out that type of experience--it's not the standard nowadays in birth. But, if you're educated and know how to stand up for yourself, the good news is that any woman can overcome any sort of "bullying"--education is the key.
 
thanka2 said:
Dear TLC/A Baby Story: I *dare* you to show a normal birth. Not even natural, just one that doesn't depict women in the worst pain of their lives. One that doesn't portray women crying in pain like hurt little girls because they're not allowed to get off the bed to move around and manage the pain. One that doesn't show women with serious bleeding disorders having a f**ing cesarean, which puts them at additional risks. One that doesn't show a woman basically being pitted to distress on national tv. Get a clue already! You are brainwashing women!
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There is a new drama series in the UK called Call the Midwife. It is about a group of young midwives and older nun midwives serving in the East End of London in the 1950s. Most of the births are home births. It seems quite accurate in the way it portrays birth.
http://www.guardian.co.uk/commentisfree/2012/jan/24/call-the-midwife
 
I think women need to take responsibility for their own health - and that means doing your research, talking to as many people as possible, and then making the choice based on science and preference.
I have seen so many women here talking about which OB they prefer, and so many people seem to want a hand holder who will make them feel all reassured and happy. Give me the straight talk, anyday. It's safer for me and the baby.

BTW - what the local hospitals practice is not 'evidence based' medicine. What they (mostly) practice is staff-convenience-based medicine. Very little of the way they manage either vaginal or CS birth has anything to do with what is best for the patient or baby - it's all about their staffing roster and the $$$.
 
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