Homebirth General Discussion #1

[Schmickers]

...Sorry, I apologise. I was making a joke, but it's been a difficult week for our practice here - Victoria has been copping a lot of flack over a baby that was born recently, so I guess I was in a sarcastic mood.

So once more, I apologise.

Homebirth midwives in Australia have strict admission criteria so women who are living in areas where access to emergency care are limited are not offered homebirth as an option. And I'll concede your point about the cost of homebirth being higher here than in the UK. I just don't know whether I'd go so far as to say I wouldn't recommend them based on cost, when the research is so overwhelmingly in favour of them as a safe(r) alternative to giving birth in hospital.

As far as family or friends being unsupportive, somewhere on my todo list for setting up our practice here in Port Macquarie, is putting together an introductory package that contains a few research studies and their accompanying "normal language" press releases as a kind of an introductory package for people who are unsure about the safety of homebirth.

I think it's item #237...

Anyway, once more Babylove, please accept my apologies for making a sarcastic comment, and please excuse me for almost derailing this thread into a debate.

[paradise lost]

It would be good if Aus provided homebirth as a normal option but then from reading your comments it'd be nice if the UK was doing what you all think it is!

About 1% of UK babies are born at home. Yes, it's paid for, but you've no idea the hassle it can be. I am one of about 4 women i know who only suffered minimal stress about it - that's seeing the midwfe and having them cluck and tut at your blood pressure, exclaim "a homebirth!? You're mad! What about the mess!", the Ob tell you you'll need inducing and won't get your homebirth afterall etc. etc. THat's MINIMUM stress. I know lots and LOTS of women who were booked for homebirth and told in their 38th week that "there aren't going to be midwives available, your HB is cancelled" - this is especially common in England. Also to get the homebirth you would get, with your own, known midwife, i would need to pay about $6000 (private midwives are more expensive here) since in the NHS model you get who they send on the day, the same as if you go into hospital. I had met one of my midwives once, when arranging my homebirth at 22wks, the other, who arrived frst and caught DD, was a stranger to me. In addition the majority of society still thinks a c-section is the safest option and you suffer the same comments from friends and family about how unsafe it is.

The UK government theoretically fund homebirth but they theoretically fund breast augmentation too - after 9 years of anxiety and depression and 12 years after initially visiting the doctor with her flat chest (literally, PCOS, no breast tissue development) my friend just got her implants put in. So even though i got my homebirth and it was paid for i still demand more! LOL.

Bec

[SamanthaP]

See, this is the thing. In Aus, I hear the UK NHS homebirth scenario touted as a model for Australia. But the thing is, as Hoobley mentioned, there is not necessarily continuity of carer there. It is essentially a stranger coming to your house while you birth. I don't think this is an ideal scenario at all. The best outcomes are when you have a known carer, not just birthing in your own home. I think in Australia, consumers should be pushing for medicare rebates and insurance for homebirth midwives, as well as continuity of care models such as caseload practice. We need to create a level playing field and until these two basic elements are addressed (medicare and insurance), then homebirth in Australia will stay a minority option.

[Cricket]

So what you all really need then, is to follow the CANADIAN system.
My homebirth is completely covered, with my own personal midwife, and a secondary midwife (whom I have met) also present to care for the baby when it arrives. I will also have a student midwife there, since our local practice is training someone new, so I'll have caregivers coming out of my ears. (Or, maybe, since it is a birth, not my ears, but elsewhere..... ) If by some chance, my midwife is already attending a birth when I go into labour, I will have my secondary midwife, and some one else. (who I wouldn't know.) But I figure those are pretty good chances, and I'm quite comfortable with that.
I have the choice to have a birth in the hospital with an OB or a family doctor, or a midwife, or to use a birthing centre, (there isn't one close here though) or to give birth at home. The government has realized that it takes quite a burden off of the health care system to have women birth with a midwife, especially if they do so at home. Way cheaper for them, and good outcomes for the mum and baby.
As far as getting flak for my decision I have gotten some. But that was just from my nurse practitioner, who works at my family doctor's office. She thought I was crazy and putting my baby at risk for a "warm, fuzzy, hippy birth." I was pretty ticked. I had gone there for my first pregnancy appointment, because I didn't know if I needed a referral to the midwife. Turns out I didn't - I can just book in with the midwife right away next time. Anyways, that was the only trouble I've had. The midwives themselves are very supportive of homebirth. Mine said they would like to have about 20% homebirths in their practice, and they are having trouble getting that percentage, so they are always thrilled with a healthy mum and bub interested in trying it. (BTW - I had already made up my mind to try it, she wasn't talking me into it, or anything.)

So do some research on the Canadian model of health care, and start writing letters.

BTW - Schmickers, at least you got some discussion going! It was pretty quiet in here before that. Hope all is well in your practice and that you're having a better week this week. to you and your wife.

[Chalalan]

Hi Smickers,

Thanks for the apology and thanks also for clarifying some of the criteria for being eligble for homebirthing in Australia. I thought there must be strict boxes to tick if midwives were to take on a client for a homebirth but I wasn't sure what they were. Do the criteria differ from state to state in Aus that you know of? Would it be possible to get a broader run down of the type of pregnancy / situation that makes a good candidate for home birth...ie what makes up a low risk mum to be?

I hope you and Victoria are feeling better and the stress is off. Victoria should be applauded for providing this service and not be copping flak.

Cheers, Jen

[SamanthaP]

Hi Jen,

It's up to the individual midwife and the individual woman as to whether or not she births at home. There is no set criteria for who can or can't birth at home. It's the woman's choice and obviously the midwife will decide if she is comfortable attending that woman. If not, the woman can just look for another care provider who is happy to attend her birth. I don't think you can just willy nilly relegate issues into "high" or "low" risk, it's never that clean cut.

[Claire]

My home birthing experience has been wonderful. I read recently about a lady describing her birthing experience as being 'joyous' and decided that I wanted that too. I got it having a homebirth.

When I visited the local hospital's labour ward at 30+ weeks pregnant, I immediately knew that my 'joyous' birth wouldn't be possible there. The anxiety I felt just visiting the place, the sheer depression I felt being shown a room with NO window, the look of horror on the faces of the other soon to be first time parents was all the evidence I needed really. I heard myself say, " I'm not birthing here" but it took a few days and a lengthy discussion with my doula to make the decision.

The out of pocket expense has been completely worth it..worth every cent.

I felt so empowered having a homebirth - there was no fear of the unknown whatsoever as I had read as much as I possibly could. I had watched videos, DVD's and followed the Pink Kit aswell as taking on board Hypnobirthing. My only worry was tearing that 4th degree scar from my first birth.

It's amazing just what the body and mind is capable of. I birthed exactly the way I needed too - very slowly with two long periods of quiet contemplation (although it was a short labour). The second stage was long and birthing my baby's head took time but I didn't tear the scar and only got a little 2nd degree tear and a small graze..

I felt incredibly well supported with my doula, midwife and husband all working together to create an atmosphere for a positive birth.

I would recommend it to anyone, I really would.

But I am finding it a little bit strange dealing with all the 'you're brave' comments. I knew I was in the safest place possible....ther was nothing brave about it. I think you have to be very brave to birth in hospital with the rate of medical intervention being so high.

[Ellibam]

clare i always say to those who make the "gee your brave" comment that i was brave to have given birth in hospital it was amazing to give birth at home!

[Chalalan]

Quick question...whats a lotus birth?

[Cricket]

As far as I know, in a lotus birth, the umbilical cord is not cut. The placenta remains attached to the baby until the cord falls off. There may be other things that are done too, but that is the one that sticks out in my mind. Mums who choose that kind of birth generally make a special bag for the placenta and fill it with lavendar and salt to keep it from smelling. I don't know if there is anyone on BB who has done a lotus birth - maybe some one else knows? Not really my thing, but obviously some find it quite appealing.

[Chalalan]

Cricket! I've been thinking about you! How did your homebirth go? Have you written up your birth story? If so, I'll have a read in the birth stories section.

Congrats on the arrival of Emily and I hope your birth experience was everything you were hoping for and more!!

PS thanks for info on lotus birth, dont think its my sort of thing...

[Schmickers]

Hi Jen,

It's up to the individual midwife and the individual woman as to whether or not she births at home. There is no set criteria for who can or can't birth at home. It's the woman's choice and obviously the midwife will decide if she is comfortable attending that woman. If not, the woman can just look for another care provider who is happy to attend her birth. I don't think you can just willy nilly relegate issues into "high" or "low" risk, it's never that clean cut.

Independently Practicing Midwives (IPMs) are not regulated in Australia, however there are some criteria for offering a homebirth that are generally accepted. The woman must be in good general health without any medical conditions that would increase the risk of complications during pregnancy and birth. They should be within reach of medical support, which tends to disqualify women in isolated rural areas; the pregnancy should be a normal single pregnancy, as having a multiple birth carries an increased risk of complications; the woman should be free of any substance abuse issues; some midwives choose not to offer homebirth to women who smoke cigarettes, as nicotine smoking can increase the risk of low birth weight babies; some midwives will not offer homebirths to women who are not willing to breastfeed from birth; and if the woman has a live-in partner, then they must also not have any substance abuse or aggression issues, and must be generally supportive of the choice.

Theres the criteria off the top of my head. The big ones are multiple births (a big no-no) and breech birth (frowned upon by the medical establishment, but the evidence against vaginal breech birth being safe is proving to be quite dubious, so many midwives are choosing to attend them now; sadly, the techniques in supporting a woman through a breech birth have been lost to our current generation of midwives and many are having to re-learn these skills).

Its interesting to note (I don't know exact figures and I am in the process of researching them) that the last midwife in Australia to be succesfully prosecuted for negligence in Australia was Maggie Leckie-Thompson; that was nearly two decades ago, and was as a result of a complaint from two obstetricians that is generally (among the midwifery community, anyway) accepted as being politically motivated. Obstetricians either sued by families, or prosecuted by the courts for negligence, much more frequently. There is little doubt, and the research evidence from countires such as the UK, the US, Europre, and Australia supports this, that homebirth is a safe option, with a much lower incidence of potentially damaging intervention, than hospital birth, for women who meet some basic criteria, such as those outlined above.

[SamanthaP]

What you say is true, Schmickers, but ultimately it is the womans choice if she chooses to birth at home, regardless of so-called risks which are medical constructs anyway.

[Chalalan]

Thanks Smickers, thats exactly what I was after. So basically if I have a normal pregnancy, I will be able to have a home birth. Excellent!

More questions apart from the midwives, doulas etc, patrners etc, what other support people at home births have people had. Were there too many, too few people around? Did you find you were able to keep people away (say a friend that doesn't take no for an answer) when its all happening in your own home? What pain relief are midwives able to offer during a home birth? Did mums find that they were more relaxed and didn't require (as much) pain relief compared to hospital births?

Thanks for playing 20 questions with me!!

[Ellibam]

you should be able to keep people away by not telling them your in labour....
i always become hermit like in the weeks before i have bubs i only answer calls i want, i dont invite people over. people that you dont want generally get the clue(eventually)
My midwife has no form of pain relief,(water and being home in a positive environment does wonders). most people dont need pain relief its only because its offered(esp in a hospital environment) and we are so use to seeing on tv,movies that we think we will need it!
Also be prepared before hand! knowing that yes it will hurt but you can get through it it!
ALL PAIN GOES WHEN YOU HAVE BUBS IN YOUR ARMS

[Claire]

My midwife did not carry any pain meds and I never asked for them. Birthing at home meant that pain relief never actually crossed my mind. She likened the birthing pool as an equivalent to the gas you'd use at hospital. I's certainly advocate it as a good form of pain relief.

[onthefly]

Hi
I don't suppose there's anyone who's birthed at home through the community midwifery program in WA? I'm keen on a HB, but haven't quite got myself to 'make the call'... would love to hear more about the ins and outs etc. One good thing about the CWP here is that it's medicare funded, so only a $120 application fee is payable. I've seen everyone's comments on money - i know it shouldn't really be a big consideration but we just couldn't afford to pay out 2000-4000 unfortunately. (our private OB is covered by insurance).

Not sure what my reluctance to call is... can someone please give me a 'prod'? Don't know how limited the program is, since it's free, but even if we can't get in this time would be good to find out more for next time.

cheers,

[Schmickers]

What you say is true, Schmickers, but ultimately it is the womans choice if she chooses to birth at home, regardless of so-called risks which are medical constructs anyway.

Hi Samantha,

You are absolutely right, it is the woman's choice to give birth wherever he or she chooses. However, in terms of retaining an independently practicing midwife, a reliable midwife will adhere to admission criteria such as those laid out above, as there is research which indicates that certain types of pregnancy carry an increased risk of complications. Twin or multiple pregnancies, for example, are a statistical rarity and certainly not a "normal" pregnancy, in that "normal" human physiology only produces one egg in order that there be only one pregnancy. So therefore, pregnancies such as these carry a greater risk of complications. My personal belief, as a nurse and as a father of two girls born at home (not as a midwife, although as part of our business I am quite familiar with the research surrounding birth at home) is that homebirth is a safer option than hospital birth for women with a normal pregnancy, "normal" being defined according to the kind of criteria I mentioned above, as long as they are supported by an appropriately trained and experienced individual. I also believe that, for women who are isolated from medical care, it is sensible to take measures to ensure that medical care is available; whether that means relocating closer to medical care, or alternatively, choosing to birth in hospital but educating yourself and bringing with you a vocal advocate to be your voice during labour and ensure your well-research wishes and desires are accepted, even if they happen to go against hospital policies, policies which often exist for the convenience of staff, not women.

My wife often poses that exact situation to me as a moral dilemma - knowing the risks inherent in medicalisation of a hospital birth, would I support her to birth twins at home? My answer is that no, I would not; but that I would pay for the services of an IPM to accompany us to the hospital as an advocate; that I would light candles in the birthing suite, burn oils, play music, and dim the lights; bring our doona from home and put it over the bed, close the cupboards and the windows; blow up our own birthing pool; bring sandwiches and food and drink; and then I would politely give the midwives and any obstetric registrar present a packet of Tim Tams and let them know that, if we needed them, we would let them know, and that until that point, the only people who we would permit into the room were one hospital midwife and our own support people, and that we were willing to sign any waiver or document that they desired us to sign to facilitate this birth experience in the safest and most natural possible way, and that we had personally chosen and employed an experienced midwife as a support person whose judgement we trusted and that if they honestly felt that complications were arising that required intervention, we would obviously accept such intervention.