a musing - about homebirth - and moving on!

Most of the stats seem to point at homebirth being safest for low risk
women, that careful screening in advance and good care in labour picks out
problems in good time, there is even some research that suggests high risk
women also do better at home, I suppose there are two types of high risk,
high risk that needs help or intervention, or high risk that could still
labour normally, such as someone going for a vbac.

I'm wondering whether if you provided the exact same care at hospital as you
did at home, then you'd make it even safer, the doctors would be safely
tucked away in the background, but available if one of the rare occurances
of a crash section that wouldn't have allowed time to transfer was needed,
but I see several reasons why this may not be the case, midwives, in
whatever system they are part of, or not as the case may be are essentially
on there own (or in a pair) at a homebirth, they have autonomy, as the group
gets larger, they loose autonomy, they start acting as a group, the group
does things this way or that, not making decisions on a women by women basis
and I'm not convinced this can be avoided, I think this may be just the way
that groups made of humans behave and that's even before you add in
considerations of numbers, if two women are in homes miles apart they plain
cannot be cared for by the same midwife, in adjacent rooms, if things are
going smoothly, there will always be that temptation.

All of this ignores the women and how they react, but if hospitals were
perfect, would we react in the same way? Maybe one of the reasons why
homebirth works is because women are in there own environment, so their
behaviour can be monitored as well as the babies, that abnormalities of
their behaviour would be picked up sooner, rather than dismissed as reaction
to a strange environment. Because events other than birth happen in
hospital, I don't think we can get away from the variation of reactions that
occur in hospital.

Where do midwife led birth centres fit into this, they cannot usually offer
any more medical care than at home, they are staffed by midwives, they are
usually several minutes ambulance transfer from a hospital site, though they
should be familiar to ambulance crews which could speed up transfer times
and for women who's homes are a long way from hospital, this could also be
an advantage. Do some women actually find the idea of home inhibiting, so
the birth centre which is really no different offers them a safe place away
from home to go and have their baby, like some animals who go to specific
places away from the main group to birth? So that a birth centre becomes a
safe retreat, a clean place, set up to be advantageous for birth, with pools
at the ready, not needing to be hired/bought and set up by the father to be.

The truth is, some, even many births are going to happen in hospital, so how
do we make that safer, as many women and babies are coming away from birth
mentally, emotionally and physically scarred. It seems to me that the
ultimate responsibilty for the vast majority of women has to fall with a
midwife, not a doctor, that the midwife calls the doctor in as needed, the
doctor doesn't dictate when the midwife is to call them, or what
interventions they should do, but for them to remain responsible for there
own practice - but society as a whole still sees doctors as responsible, as
better, safer practioners, if there is a doctor on the premises and
something goes wrong under the care of a midwife, there is always going to
be someone saying, the doctor should have been called sooner, which leads to
rules, in the guise of guidelines, when a doctor has to be called when x
happens and we've come full circle, loss of autonomy, loss of responsibility
for practice and we have the same problem, where birth has relatively low
mortality rate, but a ridiculous morbidity rate.

Which rather leaves a conundrum - so it does seem to me that the more people
that are out of the hospital conundrum the better, I'm just not convinced
that they can match up to either homes or birth centres.

Anne

"Anne Rogers" wrote in message
. ..
Most of the stats seem to point at homebirth being safest for low risk
women, that careful screening in advance and good care in labour picks out
problems in good time, there is even some research that suggests high risk
women also do better at home, I suppose there are two types of high risk,
high risk that needs help or intervention, or high risk that could still
labour normally, such as someone going for a vbac.

I'm wondering whether if you provided the exact same care at hospital as
you did at home, then you'd make it even safer, the doctors would be
safely tucked away in the background, but available if one of the rare
occurances of a crash section that wouldn't have allowed time to transfer
was needed, but I see several reasons why this may not be the case,
midwives, in whatever system they are part of, or not as the case may be
are essentially on there own (or in a pair) at a homebirth, they have
autonomy, as the group gets larger, they loose autonomy, they start acting
as a group, the group does things this way or that, not making decisions
on a women by women basis and I'm not convinced this can be avoided, I
think this may be just the way that groups made of humans behave and
that's even before you add in considerations of numbers, if two women are
in homes miles apart they plain cannot be cared for by the same midwife,
in adjacent rooms, if things are going smoothly, there will always be that
temptation.

All of this ignores the women and how they react, but if hospitals were
perfect, would we react in the same way? Maybe one of the reasons why
homebirth works is because women are in there own environment, so their
behaviour can be monitored as well as the babies, that abnormalities of
their behaviour would be picked up sooner, rather than dismissed as
reaction to a strange environment. Because events other than birth happen
in hospital, I don't think we can get away from the variation of reactions
that occur in hospital.

Where do midwife led birth centres fit into this, they cannot usually
offer any more medical care than at home, they are staffed by midwives,
they are usually several minutes ambulance transfer from a hospital site,
though they should be familiar to ambulance crews which could speed up
transfer times and for women who's homes are a long way from hospital,
this could also be an advantage. Do some women actually find the idea of
home inhibiting, so the birth centre which is really no different offers
them a safe place away from home to go and have their baby, like some
animals who go to specific places away from the main group to birth? So
that a birth centre becomes a safe retreat, a clean place, set up to be
advantageous for birth, with pools at the ready, not needing to be
hired/bought and set up by the father to be.

The truth is, some, even many births are going to happen in hospital, so
how do we make that safer, as many women and babies are coming away from
birth mentally, emotionally and physically scarred. It seems to me that
the ultimate responsibilty for the vast majority of women has to fall with
a midwife, not a doctor, that the midwife calls the doctor in as needed,
the doctor doesn't dictate when the midwife is to call them, or what
interventions they should do, but for them to remain responsible for there
own practice - but society as a whole still sees doctors as responsible,
as better, safer practioners, if there is a doctor on the premises and
something goes wrong under the care of a midwife, there is always going to
be someone saying, the doctor should have been called sooner, which leads
to rules, in the guise of guidelines, when a doctor has to be called when
x happens and we've come full circle, loss of autonomy, loss of
responsibility for practice and we have the same problem, where birth has
relatively low mortality rate, but a ridiculous morbidity rate.

Which rather leaves a conundrum - so it does seem to me that the more
people that are out of the hospital conundrum the better, I'm just not
convinced that they can match up to either homes or birth centres.

Anne
I read your thoughts with great interst, but am quite tired and unable to
comment in full... However, although I've only had one birth (hospital) and
I started by wanting a homebirth, I enjoyed my labour, and I only want
hospital births from now on. I liked going there, knowing she was going to
be born, and that that made it seem more real (I had issues with believing I
was pg, even during scans and induction, mainly due to so many prior
losses). I liked that there were all kinds of people there who knew what
they were doing when I didn't. I liked that when I was done, I could come
home to my house exactly as I'd left it, without feeling like I'd been
bomabarded by midwives (something I resented after I came home was all the
post-natal visits). I liked knowing that I was in the hospital, so if
something went wrong I wouldn't be transferred. Being induced, I also liked
that everything felt so calm and organised. There were (thankfully) no
surprises. No one phoned in the middle of it. Because I had a short active
labour, I only had one midwife throughout, and so I felt comfortable with
her and that she was monitoring me throughout - not with machines, but just
being there. I also saw the senior midwife, but that was primarily because
my labout was so fast, and because of my hips, but at no point did she seem
to interfere and my midwife remained in control.

I don't think I'd bother with a midwife unit. If I'm going to give birth
away from home, I'll just go to the hospital. You couldn't pay me to have a
homebirth. They're great for some people, but it's just not for me.
Personally, I think hospitals get a bad press. Granted, in some cases they
deserve it, but all I can say is Yay for Maidstone General!

Lucy x

I read your thoughts with great interst, but am quite tired and unable to
comment in full... However, although I've only had one birth (hospital)
and I started by wanting a homebirth, I enjoyed my labour, and I only want
hospital births from now on. I liked going there, knowing she was going to
be born, and that that made it seem more real (I had issues with believing
I was pg, even during scans and induction, mainly due to so many prior
losses). I liked that there were all kinds of people there who knew what
they were doing when I didn't. I liked that when I was done, I could come
home to my house exactly as I'd left it, without feeling like I'd been
bomabarded by midwives (something I resented after I came home was all the
post-natal visits). I liked knowing that I was in the hospital, so if
something went wrong I wouldn't be transferred. Being induced, I also
liked that everything felt so calm and organised. There were (thankfully)
no surprises. No one phoned in the middle of it. Because I had a short
active labour, I only had one midwife throughout, and so I felt
comfortable with her and that she was monitoring me throughout - not with
machines, but just being there. I also saw the senior midwife, but that
was primarily because my labout was so fast, and because of my hips, but
at no point did she seem to interfere and my midwife remained in control.

I don't think I'd bother with a midwife unit. If I'm going to give birth
away from home, I'll just go to the hospital. You couldn't pay me to have
a homebirth. They're great for some people, but it's just not for me.
Personally, I think hospitals get a bad press. Granted, in some cases they
deserve it, but all I can say is Yay for Maidstone General!

Hang on Lucy, wasn't it you that asked about induction at home?

I'm hearing what you say though and it's a thought I did include, that for
some people they actually need to get away from home, because home is too
private to let other people into and you don't want to have the phone ring
etc. and I think this is the main reason why birth centres can even exist,
because once they are off a main hospital site, they really are no different
from home in terms of back up, yet a reasonable percentage do use them and
it's often said it would be higher if there were more, or they were fully
staffed etc.

By British standards you do sound to have had a good hospital experience, I
know that for some people with a risk factor, something that motivates
choosing caesarean is that they can't guarantee the 1 on 1 care that you
got, I honestly don't know if I'd feel safe going for a vbac in a UK
hospital at the moment and there are many other needs where almost
guaranteed 1 on 1 care would make a difference, I remember a lady here who
had had a bad tear and one of her motivations for choosing a c-section was
the fact that no one would make any provision for anything but see what
happens on the day, with regards to midwife care, when really she needed to
have every effort made to have an experienced midwife caring for her alone.
An awful lot of places just shove the machines on you regardless, even if
it's only intended for 20mins, it can then often get left on.

Hospital birth will always happen in large numbers, but an awful lot of what
goes wrong with birth is caused by hospitals and the way they work, not
necessarily birth itself - of course that's not to negate the fact that
birth does go wrong, but there are two things going on, birth itself
sometimes being a problem and hospitals sometimes making birth be a problem
and accepting that a lot of births are going to happen in hospital, I'm
wondering how hospital birth can be better - but I can't figure it out,
because the things that I see as making homebirth work out well for certain
women can't be mapped into hospitals, one on one midwife care would be a
huge step, but a long way from the whole solution, because if you then
surround that care by doctor created rules, it's really not much better than
what we have already.

Anne

"Anne Rogers" wrote in message
...

I read your thoughts with great interst, but am quite tired and unable to
comment in full... However, although I've only had one birth (hospital)
and I started by wanting a homebirth, I enjoyed my labour, and I only
want hospital births from now on. I liked going there, knowing she was
going to be born, and that that made it seem more real (I had issues with
believing I was pg, even during scans and induction, mainly due to so
many prior losses). I liked that there were all kinds of people there who
knew what they were doing when I didn't. I liked that when I was done, I
could come home to my house exactly as I'd left it, without feeling like
I'd been bomabarded by midwives (something I resented after I came home
was all the post-natal visits). I liked knowing that I was in the
hospital, so if something went wrong I wouldn't be transferred. Being
induced, I also liked that everything felt so calm and organised. There
were (thankfully) no surprises. No one phoned in the middle of it.
Because I had a short active labour, I only had one midwife throughout,
and so I felt comfortable with her and that she was monitoring me
throughout - not with machines, but just being there. I also saw the
senior midwife, but that was primarily because my labout was so fast, and
because of my hips, but at no point did she seem to interfere and my
midwife remained in control.

I don't think I'd bother with a midwife unit. If I'm going to give birth
away from home, I'll just go to the hospital. You couldn't pay me to have
a homebirth. They're great for some people, but it's just not for me.
Personally, I think hospitals get a bad press. Granted, in some cases
they deserve it, but all I can say is Yay for Maidstone General!

Hang on Lucy, wasn't it you that asked about induction at home?

Yeah... It was a passing thought really. All the positives I had from a hosp
birth turned me off a home birth.

I'm hearing what you say though and it's a thought I did include, that for
some people they actually need to get away from home, because home is too
private to let other people into and you don't want to have the phone ring
etc. and I think this is the main reason why birth centres can even exist,
because once they are off a main hospital site, they really are no
different from home in terms of back up, yet a reasonable percentage do
use them and it's often said it would be higher if there were more, or
they were fully staffed etc.

I just don't really understand the difference between going to a birth
center and a delivery ward - obviously I understand there aren't the docs
etc there, but when I had Jessica, I recognised the consult on duty, one I'd
seen earlier in my pg and hated, and so refused to have him there. He didn't
interfere after that. Maybe the problem is that more women need to take
greater control and have more say in their labours. I suspect a lot that
choose to birth outside of a hospital already have this ability, and
therefore that could be a factor in their positive birth experiences?

By British standards you do sound to have had a good hospital experience,
I know that for some people with a risk factor, something that motivates
choosing caesarean is that they can't guarantee the 1 on 1 care that you
got, I honestly don't know if I'd feel safe going for a vbac in a UK
hospital at the moment and there are many other needs where almost
guaranteed 1 on 1 care would make a difference, I remember a lady here who
had had a bad tear and one of her motivations for choosing a c-section was
the fact that no one would make any provision for anything but see what
happens on the day, with regards to midwife care, when really she needed
to have every effort made to have an experienced midwife caring for her
alone. An awful lot of places just shove the machines on you regardless,
even if it's only intended for 20mins, it can then often get left on.

The thing about 1:1 care is the length of labour. If I had had a 27 hour
labour, obviously my midwife would have been replaced at the end of her
shift, probably no matter where i'd been. I'm a fairly easy going person,
and tend to adapt to new people well, but I can understand that would upset
people. My point is, that in a lot of cases, you're not going to get the
same midwife taking care of your needs, even when you're lucky enough (as I
was) to have been the only labouring mother the midwife has at the time. You
might give birth an hour after shift change, but that midwife won't have
been there all the way through, getting to know you and your needs.

My SIL hired a private midwife. It cost her £2500 to do so, because she
wanted the same midwife throughout. However, there were no guarantees that
she'd have got her midwife at the time of birth. Obviously, the midwife's
job is to be a midwife and to earn money, so she also can not just have one
mother on her books at a time. My SIL was lucky that she was able to have
her midwife there,and I guess it would have upset her if she hadn't, but
even with a homebirth and private midwifery care, nothing is guaranteed on
that front.

Hospital birth will always happen in large numbers, but an awful lot of
what goes wrong with birth is caused by hospitals and the way they work,
not necessarily birth itself - of course that's not to negate the fact
that birth does go wrong, but there are two things going on, birth itself
sometimes being a problem and hospitals sometimes making birth be a
problem and accepting that a lot of births are going to happen in
hospital, I'm wondering how hospital birth can be better - but I can't
figure it out, because the things that I see as making homebirth work out
well for certain women can't be mapped into hospitals, one on one midwife
care would be a huge step, but a long way from the whole solution, because
if you then surround that care by doctor created rules, it's really not
much better than what we have already.

The problem is, when you remove the doctor created rules, people sue when
things do go wrong. They ask why weren't the rules in place, and what's
going to be done about it. Let's face it, birth is like any other business,
and they are prime targets for legal action. Society as a whole is partly to
blame - how often have people said "oooh, she wants a homebirth. I wouldn't
want that for my first, oh no". A lot of people also view labour as a
medical procedure, so it makes sense for them to go to the hospital. For
others, it's just that it's the norm. Either way, I think that hospital
birth will always be different from a home birth. Even if they give you your
own room designed to look like your own bedroom, you're always going to know
that it's not, and that alone makes a huge psychological difference. Also,
if there's a doctor there to make a decision, then the midwife will call
them - it's the same when I'm at work. I can happily make decisions when I'm
on my own. Bring the teamleader in, and I'm always after a second opinion. I
think that's human nature.

Lucy x

"lucy-lu" wrote in message
...
I just don't really understand the difference between going to a birth
center and a delivery ward - obviously I understand there aren't the docs
etc there, but when I had Jessica, I recognised the consult on duty, one
I'd seen earlier in my pg and hated, and so refused to have him there. He
didn't interfere after that. Maybe the problem is that more women need to
take greater control and have more say in their labours. I suspect a lot
that choose to birth outside of a hospital already have this ability, and
therefore that could be a factor in their positive birth experiences?

I can only say from my experience but having been in a MLBU for most of my
hospital labouring I can tell you there is a huge difference between that
and the main delivery ward.

For a start the paint colour, bizarre as it sounds, has a huge impact. The
MLBU rooms are painted a nice soft baby blue, the delivery rooms are vivid
vomit yellow and you need shades to go in there. Not conducive for relaxing
in at all. In the MLBU the beds are actually matresses on the floor
surrounded by cushions, so at a better level for bending over for
contractions and laying down on for exams. The beds in the main unit are
hard, too high and thin with one pillow if your lucky. The MLBU had nothing
in it but gas and air on the wall, a sink, a fan and a soft lit full length
lamp. The main unit was full of scary equipment, cupboards of medical stuff
and little else.
In the MLBU there were two roms and a birthing room, and there were 2 mw's -
so the ratios of patients to staff were fantastic. I don't know about my
hospital but on Panaorama last night Machester Hosptial seemed to think it
was ok to have 3 mw's for 23 women! In the MLBU there were no doctors or
consultants, by the time I gave birth there were at least 6 people in and
out - including the mw who came down with me to the MLBU because even though
she had finished her shift she wanted to be with me till I gave birth. In
the MLBU there are 3 post-birth beds to get to know your baby in peace. I
think Anne can tell you that the main ward isn't like that at all.

All in all I think I would like to have a go at a home birth but with the
anti-b's for Group Strep B I can't do that. I do know that you don't have to
have them but it's only taken the experience of one mum's baby who died
because she did'n't have it and they didn't treat the baby after for me to
know I'm not interested in taking that risk, as minimal as it may be.

Very interesting question though Anne. After watching the Panorama programme
last night on the lack of care in hosptials it seems blindingly obvious to
me that a good deal of the problems could be sorted with more mw's and
equipment. I think one of the mw's on the programme made a valid point that
deaths of babies can be swept under the carpet, it's the death of a mother
that gets the government to spend more money.

Jeni

I'm really still thinking about all this, but I wanted to add a few things:

I'm in germany. Just so we all know what we're comparing ;-)

Right now and for me I have four options:
1 unassisted homebirth
2 homebirth with midwife(s) and helper(s)
3 birthingcenter
4 hospital

Number 1 is not really a valid option for me. I don't want to do this
alone, I don't think it would be a good idea.

Number 2 is what I want. I have a midwife who does homebirths, but is
also working at the hospital. I don't know how to explain this
propperly, she's not a normal midwife who's employed by the hospital,
she's a self employed midwife who also works for the hospital. In
germany it's called "Beleghebamme" it's like a doctor who has his own
practice but _also_ works at the hospital. I don't quite know how
exactly she does it, but she told me that 3 weeks around my EDD she
won't be working at the hospital because she'll be on standby for our
homebirth.
I can have 2 midwifes at my homebirth, but I can choose to have only
one, my call really. I think I'll be going for two simply because her
rules are three people present besides the mother. The "father" will not
be present if I can help it. I want my best friend here, but she lives a
two hour car ride away, so I'm not sure if she'll make it in time (first
birth: 5 hours from first contraction to baby). My other best friend
lives 4-5 hours trainride away, so yeah. My brother will hopefully be
able to take care of Sam (who will have the option of coming in and
being there during the birth, but if he rather play I need someone there
to watch him).
So, the pros for me a I have a midwife or two right here at home. I
know where everything is, I don't have to ask a stranger for anything
(big problem for me when I'm stressed). I don't have access to pain
medication (huge bonus for me, last time I was screaming for something
for the pain knowing full well I didn't really want it and since I got
to hospital so late they couldn't give me anything either :-) ).
If I need to be transferred I'll be taking my midwife with me. I won't
get confronted with strangers and a new environment. With Sam that
wasn't a big deal, we transferred 30 minuted before he was born, the
midwife I had at home couldn't come along (good thing, she was the only
one ot of the three I didn't get along with well and she wasn't a great
help during labour at home, especially because she didn't come in for
ages!). But I ended up with a fantastic midwife at hospital and even
though the head of gynocology was sitting next to me I only ended up
with minor abrasions, and he's known to be very skalpell happy.


Number 3. I'm not opposed to a birthing center, but for me it's not
practical. There are two in my area, but both require a car trip and I
don't have a car and I don't think my brother would be all that happy
driving a labouring woman whos waters could break at any moment in his
beloved car. And I don't think I'd be a good taxi "guest" in labour.
Also, both birthcenters are a fair way away from hospitals in case I
should need to be transferred.
What I've seen about birthcenters has been really phantastic. Nice
rooms, nice midwifes, totally positive atmosphere. I wish there was one
closer because it would probably be perfect in my situation.

Number 4. The dreaded hospital. I really really don't want to go to
hospital. The smell, the busy atmosphere, and no matter how many nice
decorative storks they put up it's still a white room with sterile
everything and everyone dressed in white and busy busy.
I also don't want to have pain medication right there. Because I know
I'll be screaming for it, but I really really don't want any. Last time
I wanted a cesarian or at least please make a cut so he can just slide
out, and give me something for that goddamned pain! Thankfully I was
unable to speak by that time.
That said, if my midwife says transfer I will. She's the boss she knows
what's going on. But if I have to go into hospital I want to go there as
late as possible.
My midwife told me that at "her" hospital, births are the midwifes
thing. Doctors generally have to talk to a midwife first before they go
and see a labouring woman. Noone just walks into a room and certainly
noone comes in and examins a woman "just to see how things are progressing".
I think hospitals are a mighty fine thing for emergencies. But just as I
wouldn't go in for mild pain in my throat I don't want to go in for
giving birth. There are people who are more qualified and environments
better fit for that.
I will not tell another woman where or how to have her baby, but when I
hear a woman proclaim "Oh, I want a c-section because I don't want to
deal with the pain of labour, besides, isn't it rather messy, and won't
sex be horrible afterwards, and what's up with not knowing when the baby
will be here?!" I want to scream at her. Thankfully I don't know many
such women ;-)

Hospital births are always more "at risk" of unnecessary interventions.
Because that's where one can intervene. How's a single midwife at home
going to offer a pda? Or internal monitoring? She just simply doesn't
have the equipment for all that. Also, shift changes, who's she going to
trade with exactly? She can't nip out for a cup of coffee or whatever
and have some one else stand in. She's usually the only "professional"
there.

The other thing I think contributes a lot is the calmness. In a hospital
there will always be some kind of hectic going on. Just because there
are a lot of people around. At home noone has to "go down to xyz to get
abc". And if they do it's one person once and not 5 different people
running in 5 different directions. The noise level at home is most
likely lower than at hospital (and I'm saying this knowing full well
that we'll have a construction site right next door this summer). And
the sounds are more familiar.

Ok, that's it for now.

take care!
Nicole

"Anne Rogers" wrote in message
. ..
Most of the stats seem to point at homebirth being safest for low risk
women, that careful screening in advance and good care in labour picks out
problems in good time, there is even some research that suggests high risk
women also do better at home, I suppose there are two types of high risk,
high risk that needs help or intervention, or high risk that could still
labour normally, such as someone going for a vbac.

I'm wondering whether if you provided the exact same care at hospital as
you did at home, then you'd make it even safer, the doctors would be
safely tucked away in the background, but available if one of the rare
occurances of a crash section that wouldn't have allowed time to transfer
was needed,
The only times I saw a doctor for either of my births was for #1 putting the
epidural in, and for both the well baby check. I thought doctors did
generally stay in the background. Certainly for #2 I was down as high risk,
and consultant led, but still was entirely left with the midwife
Debbie

lucy-lu wrote:

I don't think I'd bother with a midwife unit. If I'm going to give birth
away from home, I'll just go to the hospital. You couldn't pay me to have a
homebirth. They're great for some people, but it's just not for me.

I think that women should definitely go where they feel
most comfortable, and if that's a hospital for you, then that's
great. However, I think that you likely did have an experience
that was among the least likely to highlight some of the potential
downsides of hospital care. But that's sort of one of the problems
all around with tackling this issue. Birth is an intensely personal
experience, but few of us have so many births as to be able to make
a personal comparison that covers any reasonable variation in
the relevant variables. So, we all have these idiosyncratic
experiences that for us don't add up to much of a big picture
(except for those few who've had enough babies and run the gamut
of experiences--and even then it's only a small portion of
possible experiences). And we all have likely untrue perceptions
of what would happen in scenarios we didn't experience, plus
home, center, and hospital births vary considerably not only
from country to country but also provider to provider.
So, it's fairly blindingly obvious that individuals
are going to have different preferences, but on top of that,
with the rather large variation from provider to provider, even
a given individual might have made the same choices in a
different location and had a different result. Obviously,
there are trends that can guide one's decision making, but
as we all know, statistics don't say much about one individual's
experience, just as one individual's experience doesn't provide
much of a basis from which to generalize.

Best wishes,
Ericka

lucy-lu wrote:
"Anne Rogers" wrote in message
...

Yeah... It was a passing thought really. All the positives I had from a hosp
birth turned me off a home birth.

I think that's an odd way to phrase it ;-) I can see why
a positive hospital birth would turn you *on* to a hospital birth,
but not sure why it would change your perception of a home birth.

I just don't really understand the difference between going to a birth
center and a delivery ward - obviously I understand there aren't the docs
etc there, but when I had Jessica, I recognised the consult on duty, one I'd
seen earlier in my pg and hated, and so refused to have him there. He didn't
interfere after that. Maybe the problem is that more women need to take
greater control and have more say in their labours. I suspect a lot that
choose to birth outside of a hospital already have this ability, and
therefore that could be a factor in their positive birth experiences?

I'm not sure that's true. There is a very different power
structure in one's home versus in a hospital. Someone who can speak
out in an environment where they are in charge is not necessarily
going to speak out in an environment where they're not running the
show. I think many people choose homebirth so they won't *have*
to fight because they know they're not good at that. In addition,
while you spoke up and had your wishes respected, that's not always
the result of speaking up. I think that's the fallacy of the argument
that hospital birth wouldn't have these problems if women would just
get educated and speak up for themselves. The power dynamic inherent
in the situation works against that. It's certainly true that the
woman who is educated and speaks up has a much, much better chance
of getting what she wants in a hospital setting, but there are many
factors operating against her speaking up and against her getting
what she wants even if she does speak up. This, of course, varies
from provider to provider and hospital to hospital.

The thing about 1:1 care is the length of labour. If I had had a 27 hour
labour, obviously my midwife would have been replaced at the end of her
shift, probably no matter where i'd been. I'm a fairly easy going person,
and tend to adapt to new people well, but I can understand that would upset
people.

It's not just that it upsets people. It disrupts continuity
of care, which creates more of a potential for information to be
lost and lead to mistakes.

My SIL hired a private midwife. It cost her £2500 to do so, because she
wanted the same midwife throughout. However, there were no guarantees that
she'd have got her midwife at the time of birth. Obviously, the midwife's
job is to be a midwife and to earn money, so she also can not just have one
mother on her books at a time. My SIL was lucky that she was able to have
her midwife there,and I guess it would have upset her if she hadn't, but
even with a homebirth and private midwifery care, nothing is guaranteed on
that front.

No, there's no perfect solution to this problem. However,
there are substantial differences in the odds for different types
of care. Of course, you can always look for the outliers.

The problem is, when you remove the doctor created rules, people sue when
things do go wrong.

?? I don't know about the situation in other countries,
but in the US, midwives get sued at a *dramatically* lower rate
than obstetricians. Not even in the same ballpark. There are
lots of reasons for that, but I'm not sure this argument holds
water in the US.

They ask why weren't the rules in place, and what's
going to be done about it. Let's face it, birth is like any other business,
and they are prime targets for legal action. Society as a whole is partly to
blame - how often have people said "oooh, she wants a homebirth. I wouldn't
want that for my first, oh no". A lot of people also view labour as a
medical procedure, so it makes sense for them to go to the hospital. For
others, it's just that it's the norm. Either way, I think that hospital
birth will always be different from a home birth. Even if they give you your
own room designed to look like your own bedroom, you're always going to know
that it's not, and that alone makes a huge psychological difference. Also,
if there's a doctor there to make a decision, then the midwife will call
them - it's the same when I'm at work. I can happily make decisions when I'm
on my own. Bring the teamleader in, and I'm always after a second opinion. I
think that's human nature.

I think this is true, and there are other factors as well.
There have been studies looking at 'home like' environments within
hospitals. They haven't always been well done studies, and they
are often comparing home-like hospital rooms with regular hospital
rooms, rather than home-like hospital rooms with home, but looking
across the studies it still appears that a home-like environment
in the hospital is not the same as at home. That makes a certain
amount of sense to me. Even with a home-like hospital birth, there's
no getting around that the whole decision making process at the
start of labor is different there's a transfer of location. Those
are two big factors that are different right off the bat.

Best wishes,
Ericka

"Ericka Kammerer" wrote in message
. ..
lucy-lu wrote:
"Anne Rogers" wrote in message
...

Yeah... It was a passing thought really. All the positives I had from a
hosp birth turned me off a home birth.

I think that's an odd way to phrase it ;-) I can see why
a positive hospital birth would turn you *on* to a hospital birth,
but not sure why it would change your perception of a home birth.

I just don't really understand the difference between going to a birth
center and a delivery ward - obviously I understand there aren't the docs
etc there, but when I had Jessica, I recognised the consult on duty, one
I'd seen earlier in my pg and hated, and so refused to have him there. He
didn't interfere after that. Maybe the problem is that more women need to
take greater control and have more say in their labours. I suspect a lot
that choose to birth outside of a hospital already have this ability, and
therefore that could be a factor in their positive birth experiences?

I'm not sure that's true. There is a very different power
structure in one's home versus in a hospital. Someone who can speak
out in an environment where they are in charge is not necessarily
going to speak out in an environment where they're not running the
show. I think many people choose homebirth so they won't *have*
to fight because they know they're not good at that.
I think what Lucy is saying is that here (the UK) it is generally assumed
that you will go to hospital to have the baby (not so much by the medical
profession, but by general opinion). Someone who decides to have a home
birth will often have a lot of "do you think it's wise" sort of comments. So
(I think) what Lucy is saying is that someone who stays firm and gets a home
birth (particularly for the first birth which is harder to get) is more
likely to stand up generally for themselves wherever they labour.
Correct me if I'm wrong :-)
This reluctance for first home births here, does also mean that you get a
number of people who will tell you that they had a dreadful first birth in
hospital and a lovely second birth at home and put it down to being at home
rather than second births being easier (vast generalisation here) which can
mean that a for lot of home v hospital birth stories people (particularly
the older generation)can be very skeptical, and make comments accordingly.
Debbie