Tuesday, 30 March 2010

Why your first is the best one to have at home

Women are often recommended (ie told) not to have their first baby at home – because you don’t know what will happen. However it is precisely because of this that planning to have your first baby at home is eminently sensible. The great thing about being booked for a home birth is that you can go to hospital at any time you choose – it is much harder to transfer out of hospital to home! On top of that first labours tend to be longer. Being at home is less tiring and more comfortable for the long haul.

Most importantly, you are more likely to have a positive birth experience at home. Things are actually less likely to ‘go wrong’ at home. Studies have shown women who have planned home births need less pain relief, less likely to tear/have episiotomy, less likely to haemorrhage, and 50% less likely to have a caesarean or assisted birth even if you transfer to hospital. The baby is less likely to need oxygen, more likely to be in a good condition at birth. All of these benefits were shown in scientific research in which women booked for a hb were matched to women with similar risk factors booked for hospital births.* In fact a government body (NICE) looking into reducing the caesarean rate recommended that all women with straightforward pregnancy should be offered a home birth.

The deputy general of the Nursing and Midwifery Council said “The vast majority of women, well in excess of 60-70%, will not have started to have complications and these women do much worse in hospital, where they are at risk of interventions.” (June 23, 2006, The Guardian)

Why are the outcomes so good at home?
Going into hospital interferes with the flow oxytocin (the hormone that keeps labour moving on) – which is why women often report labour slowing down or stopping on arriving at hospital. It’s the flow of adrenaline (caused by stress/anxiety) that affects oxytocin and also inhibits the production of endorphin (the body’s own painkiller). So being as relaxed as possible is important, and for many that means being at home.

Other aspects of being at home that positively affect the birth are being upright and being able to move around freely with many different surfaces to lean on, access to a bath for pain relief, privacy, distractions from the pain, being able to eat/drink.

What about the equipment?
At home you have the most vital piece of equipment – a midwife. Midwives at home still do all the same checks and monitoring they would do in hospital. They carry equipment to deal with emergencies. At home, however, as they are solely looking after you, they also use their higher level observation skills – noticing how you are coping, your body movements, sign of labour progressing, or not. They are able to spot problems coming and make remedies or call an ambulance. (Did you know - mws can tell that a woman is getting near pushing by the way she curls her toes!)

Of course you may need or want to be transferred to hospital care, either before, during or after labour, though this is very rarely a major emergency. The vast majority of times it is due to a risk factor arising in the final week, labour not moving on, the woman wanting more pain relief, or the midwives wanting to have the baby more closely monitored. Most of those are transferred to hospital care before labour begins. More first time women do than second timers (up to 40% though rates vary tremendously). That means 60% (or more) of first time women booked for a homebirth have a straightforward birth. This contrasts greatly to hospital.

My local hospital has a higher than national average of normal births (54% in 2005). The figure will be lower for first timers as subsequent births are likely to be easier, more straightforward and quicker. Some months the the hospital has had a c.s. rate approaching 30%, and last year’s average was 25%. Again this will be higher for first timers. Other hospitals have similar outcomes. (go to www.birthchoiceuk.com )

Women in hospital use more pain relief, including epidural, which is linked to longer labours and a higher risk of assisted birth. In hospital you are less likely to have one-to-one care from a midwife.

I hope I have given you some food for thought. If you are looking forward to your first, or subsequent birth, you might like to explore the option of home birth, particularly to talk to women who have had/ booked home births. You can also look at the information detailed below.

*If this all sounds too good to be true then check out www.homebirth.org.uk or look at ‘Safety in childbirth’ by M Tew, an obstetrician who set out to prove that homebirths were unsafe and found the opposite. Women have been kept in the dark.

Further info:
From NCT maternity sales (www.nctsales.co.uk)
NCT booklets (£2.50): home birth, using water in labour
NCT information sheets (£1): home birth, straightforward birth, using water for labour and birth
Birth your Way by Sheila Kitzinger
NCT My birth year

From Association for the Improvement of Maternity Services (www.aims.org.uk)
(Shane Ridley, Manor Barn, Thurloxton, Taunton, Somerset TA2 8RH
Books: Choosing a home birth, Safety in childbirth, Choosing a water birth, Birthing your baby


The NCT moderates an e-group for women and men to discuss issues related to homebirths – go to www.health.groups.yahoo.com/group/homebirthUK

1 comment:

bridebug said...

This is facinating Cathy - I will be coming back here to read again when I plan to have babies :-)