home birth with midwives? public midwife care with doula? private ob care with doula?

[jbie]

any thoughts on which model is actually safest for baby and mother?

- home birth with 2 private midwives
- public hospital with rotating shift midwife care, with doula
- private ob care in private hospital, with doula

[Fi]

I should imagine (being the cynical old thing that I am ) that no matter the situation, you would be able to find stats that back up your argument as to which is the safest.
Some people say the incidence of problems with homebirth is very low, but then homebirths can be the lower risk pregnancy situation, so you are essentially bringing about bias in the stats before you get off the starters block!
I would say if you are looking at the above options, you should choose the one that best suits your lifestyle and your relationship with your partner.
I personally am going public with semi private midwife (a birthing clinic where it can only be one of 5 midwives on the day) but due to previous experience, I am comfortable with no doula. My partner is very supportive, the midwives are just sensational, but I tell ya - a babysitter might be useful!!!

[Schmickers]

I believe that birthing at home, with a trained midwife, is the safest option for a normal birth.

That said, the definition of a "normal birth" is the one that challenges most people. I believe a normal birth is one that occurs to a woman who has had no serious complications during her pregnancy, who is healthy and within safe child-bearing ages, who is not obese, and who enters into the birth experience with a willingness to make it her own, a woman who actively seeks education and support to empower herself during the birth of her child, and who actually desires to be ana ctive participant in the birthing process.

The research overwhelmingly states that birthing at home with a trained midwife in support is "as safe as birthing in hospital" given the criteria of a woman who has had a normal pregnancy. There are even a few studies which are willing to make the groundbreaking statement that birthing at home "might be safer" than birthing in hospital, for a woman who has had a normal pregnancy. There are few studies that are willing to definitevly state that home birth is safer, and this is partly because there usually needs to be quite astounding evidence in a research study for anyone to draw a definitve conclusion, and usually the results are "might bes" or "probablys"; partly because there are so many variables in the birth process and the change of environment between home and hospital, that it is difficult to pin-point one thing, or one group of things that make a difference; and partly (sadly) because pregnancy and birthing care is one of the most politicised aspects of the medical industry and many researchers are hesitant to try and "rock the boat" so to speak.

On the other hand, for a higher risk pregnancy, I believe the safest option is to birth within a hospital, with an obstetrician and an obstetric registrar present, and with the support of midwifery staff. Note I said an obstetrician and an obstetric registrar; I do not believe it is appropriate for women in hospital to be attended by an unsupervised registrar if their pregnancy is not considered to be low risk. If it was my wife, I would not want her attended by a junior doctor! If it was me, I would kick and shout long and hard until an obstetrician was contacted to be present, especially if surgical intervention was required. In such a situation, I believe the safety of the mther and child is increased if a trusted midwife is able to be present, one that the mother has had a chance to build a rapport with, and who is able to act as an advocate for the mother, the unborn child, and the immediate family.

Well, there are my views, controversial as they may be...

[BellyBelly]

Figures actually back up what Michael has said. I think the stats I saw were from NZ where they are tracking the stats. It's safe in either, however you have to consider the massive difference with interventions, be it a normal pregnancy or not. Also the benefit of being in the home environment where you are comfortable (if you are) and labour is often therefore faster as there is no interruption to your rhythm and you feel 'safe' and not anxious to birth. If however you dont feel safe at home, you may find it better to birth in hospital - depends where you feel you would be most comfortable so those labour hormones can do their thing.

[rascal]

I personally am going public with semi private midwife (a birthing clinic where it can only be one of 5 midwives on the day) but due to previous experience, I am comfortable with no doula. [/QUOTE]

Hi Fiona what was your problem with the doula?
Lisa

[Fi]

Lisa - no probs at all with doulas, I just know that with DP and the midwives I have, I should be fine for birthing support without a doula.
I think they are a great idea for some people - But since I had everything go wrong that could go wrong with my daughter, and received sensational support from the same midwives as this time, I'm feeling pretty good about the whole thing.
Sorry to disappoint - no nasty stories to come out of me on that front!