PowerSwitch

As I mentioned in another thread, we are expecting our first child next month and are planning to have the baby at home (barring premature, late or breach birth).

It has been interesting learning about the issue of how we give birth. In the UK, 98% or more births happen in hospital. In the Netherlands about a third of babies are born at home. At the other end of the scale, in the US, home birthing is virtually unknown and the American Medical Association are trying to get it banned. Here in the UK, the government wants to ban midwives from practising without professional indemnity insurance, which I believe is harder to get for home births. At the same time, the NHS, at least in our area, has apparently "discovered" home birthing as is trying to encourage it.

Once you end up in hospital, women are bullied into giving birth the way that the hospital staff want them to. That sounds reasonable until you discover that the medics' decisions and choices are often not evidence-based. Women are strongly encouraged to give birth lying on their backs, which is about as sensible as trying to go to the loo lying on your back. Because the horizontal position women end up adopting is so bad for giving birth naturally and because hospitals are under pressure to achieve maternity "throughput" targets, if the women don't perform, they are strongly encouraged to accept various interventions which are mostly unnecessary and add to the stress and pain. These interventions tend to cascade to the point where caesarian sections are performed. In the US, from memory, 46% of births are by caesarian. In Brazil, apparently it's 80%!

So, what has all of this got to do with peak oil? Well, of course, as our energy supply contracts, it will get harder and harder to maintain routine hospital based birthing. As has been discussed before, healthcare systems will be subject to the same imperative to power down as the rest of society. At the same time, birthing is something that we will have to carry on doing into the future for obvious reasons. One of the many peak oil preparations our society needs to be making is the maintaining and rebuilding of our midwifery skills.

Last Sunday I saw an incredible film about this called "The business of being born", which is really worth seeing. It is about the situation in the US but needless to say, the way the US handles birth is about as dysfunctional as the way they have handled their energy policy.

http://www.thebusinessofbeingborn.com/trailer.htm

It is not available on DVD but is being shown around the UK:

http://www.saveindependentmidwifery.org ... ew/225/55/

Adam, I was really excited to read your post, and I agree with all you say. I was thinking 'intervention cascade' to myself - and then you mentioned that too. If your partner is equally clued-up and informed about the process, then it bodes very well for the coming birth, and I wish all of you the very very best.

I had a home birth with my second and it was just wonderful. If your partner fancies chatting homebirth with anyone, btw, do pm me and I'd be happy to oblige!

I'm all for choice, and it's true that as things stand, many women have not grown up into the mental and emotional resources that they need for a non-assisted birth. That's not to did my gender, but to say that we may have a generation of changes until women grow up believing in the strength of their bodies, and seeing birth as a natural process - indeed, assisting in and witnessing it.

That's not to say of course that there aren't good reasons for medical intervention. Certainly there are, because sometimes it isn't straightforward, and sometimes intervention is required. But let's at least remove the unnecessary interventions and teach our daughters that this is a natural thing, a human thing, and a thing we're designed to do.

I'm not superwoman, I'm not sporty, I've never done extreme stuff with surfboards or skis or anything. I'm a bit over optimum weight and I was 35 at the time my second was born, but it was beautiful. Also the hardest work I ever did, and still beautiful. There was singing and dancing and I nearly won at Trivial Pursuit between contractions. The midwife said it was the calmest birthing she'd ever attended.

Hoping for a really fine birth and a healthy babe, Adam. Salute your partner for me.

I am an independent soul and like to be able to do or try most things by myself. I have four beautiful children (actually 2 are now adults!) and I had all of them in hospital.

I know this is different to the ethos of this thread, but I'll say it anyway - because sometimes it's good to hear all views.

The concept of home birth sounds wonderful - idyllic even, but for me when it came to it I decided that I wanted to be in the right place should anything not go according to plan. As it happened I would have been an ideal candidate for home birth having had four straight forward deliveries with no intervention and minimal pain relief. Were I suddenly to find myself pregnant again (biologically unlikely now!) I would once again choose a hospital birth.

Perhaps I was lucky. I was treated with great respect. Not asked to deliver on my back. Allowed to have the baby delivered straight to my tummy and allowed to breast feed at once. (And no debate about it - everything was straightforward.) I stayed in hospital each time for 48 hours (slightly longer with my first) and recieved enormous support from the resident midwives and other mothers.

Perhaps things have changed in the 12 years since my youngest was born, but really a hospital birth is NOT the worst thing in the world. I'd go it alone for many things - just not for bringing one of my precious offspring into this world.

Ah well - I've said my bit. Be flexible about your dreams...... and don't be upset if for some reason plans have to change.

Best wishes for the big day wherever it happens! (Ahhhh takes me back!)

My sister gave birth to her second at home, basically because it came really quickly and she didn't even have time to get in the car to be driven to the hospital.

Her husband delivered the baby, following instructions on the telephone from a midwife at the hospital.

Both of them said it was the most amazing experience, the ambulance crew arrived but my sister's husband couldn't let them in the door because he was delivering the baby! When he finally let them in, they just did a bit of tidying up really!

My sister said it was a remarkable experience, she gave birth crouching, on her knees, and she said it felt far more natural that way as gravity was actually assisting her, rather than lying on her back having to push all the time, the baby literally wanted to 'drop' out anyway.

I'm sure they were very grateful to have the ambulance crew there immediately afterwards in any case though.

epidurals are wonderful!

Seriously:

even if you would prefer a natural birth if there are problems and you have to be induced with a drip it is very painful and hard to cope. In that case an epidural really helps to recover some feeling of control

don't have pethidine - it doesn't work and just means you can't cope naturally with the pain

Our second is due in October.
The first was in hospital, started well in a pool, midwives were variable OK to very good.
Daughter got stuck and ended up with an emergency C section.
In a 3rd world / 19th C situation - one or both dead.

There is no way either of us want the second birth to be anywhere other than in a hospital.

Don't believe all the hype - either the natural is best no pain relief (few friends who did this first time went epidural second time)
Or that hospitals just want to do a C section. Everyone is different. There is no one right answer. Works out what's best for you and don't let anyone tell you what is the "right" way to go.

I had to have an argument with the doctor who wanted to wait another hour before doing the C section. Don't forget C sections aren't cheap, and they can't chuck you out straight away.

Get clued up, accept that it is potentially very dangerous if things go wrong and sort your plan B & C now - my wife was in too much pain so I had to make the C section decision on my own, knowing she did not want one if at all possible.

We had a friend who's had 2 home births and they went really well -so good luck, but be prepared.

From a PO point of view, first cause of death in women before WW1 in the UK was childbirth. Still is in large parts of the 3rd world. In the UK, its about 45 a year in the whole country, most of whom are pretty sick to begin with. WHO state that ideally about 1 in 10 births would be C sections.

I shall show this to my wife, she'll be a PowerSwitch fan

We had our first one in hospital and it was horrible - the whole process was terrible and they didn't believe her when she said he was coming as we were only 2 hours in. She ended up getting cut terribly by a nurse (no midwife) which had infections for a long time after.

We had our second at home in a water pool - we had 2 midwives who had nothing to do other than just encourage her. They really enjoyed it and were really shocked when a 10lb 10 ounce baby popped out - she only had a small bump so everyone was expecting something smaller. In fact had they known his size she would have had to go into hospital so it was a good job.

All round it was fantastic - couldn't recommend it more highly.

We hired the birthing pool and the company even came and cleaned it out - I have to say I didn't fancy that bit of it!

Edit: random smiley somewhere it shouldn't have been!

Get that book by Sheila Kitzinger.

She compares childbirth to long-distance running (though personally I think it's more like mountaineering) in that most people don't realise how fit they are, you don't do extreme sport in a hospital but it's clever to have medics on standby just in case.

I have a medical history that's so long I shouldn't even be here. But reading that book gave me a lot of confidence, and really that's what you need: confidence that your bod will do what is needed of it. It will.

The comments about not on your back are spot on: I was upright(ish) for my two, and that really helps.

There's pain but this isn't like the pain you get with an injury, more like the type you feel when you're really doing your best for some sport.

Adam1 I wish your other 1/2 bon courage and may it be straightforward, quick and happy (like my 2)!

Shiela Kitzsinger? She's been around a while. I read a book of hers before Chris was born

Interesting range of responses: I should have done a poll when I started the thread.

This is what Henci Goer said in 1995 on home birthing (quoted in one of the books we have been reading):

"Ultimately the issue of the safety of home birth cannot be settled by research...It comes down to a matter of individual choice. The real question about safety is not, "Do you want a pleasant birth at home or a safe birth in the hospital?" It is, "Do you want to give birth at home and run the minuscule risk of an emergency that might (but not necessarily would) be handled better in the hospital, or do you want to give birth in the hospital and run the considerably increased risk of infection, the certainty of additional stress, and the near certainty of having unnecessary (and potentially risky) interventions?"

Of course that quote is slanted in a certain direction!

I'm sure someone who wanted to push (sorry for pun ) a hospital birth onto a prospective mother could write a very similar but otherway-slanted statement.

I'm not going to do it because I'm not at all adament about my view. There are pros and cons to both ideas. But nothing is as black or white as that quote suggests!

It is a very emotive subject, and of course all experiences are different, but I am inclined to agree with the above quote.

I think the best of all worlds would be for home birth to be a better-supported option and for women approaching childbirth to be well-informed and confident... no, I don't know how to achieve that, either, but it's a debate that deserves airing.

It is an emotive subject and it is complex (like so many) but the conclusion we have come to as a couple is that:

1) it is a natural process that has been refined by natural selection over the 250,000 generations that humans have been around as a distinct species;

2) hospitals do have a habit of pushing women to give birth to suit the convenience and non-clinical priorities of the hospital staff.

3) birth can be painful, indeed very painful, but so much depends on how psychologically comfortable and relaxed the woman is and on how confident they are in their own ability to give birth; the epidural eliminates the pain but at the cost of loss of control of the birth process and (statistically) increased risk of further medical intervention.

4) hospitals are great when there is a genuine need for them; if either party (mother or baby) have a significant condition that adds real risk to the process, then, yes, bring on the medical technology. If not, then it's best to do it the natural way assisted by a trained, skilled midwife who can identify and (in most cases) help the women to overcome problems and when not get them to hospital.

The reason why I started this thread was to flag up something that has recently occurred to me, which is that, as with so many other aspects of life, we will have to make other arrangements for birthing in the future. Contrary to what some may think, this does not mean that we have to have the high-perinatal death rates experienced in our past or in poorer parts of the world today. It is possible to be very safe and manage the pain without all the fossil-fuel driven inputs of today's medicalised birthing. As with many of our other choices as go into energy decline, if we do nothing to prepare, the outcome will be a lot more death and suffering. If we don't embrace modern, hygienic but low-tech birthing, we will not be able to sustain the medicalised model and we will end up with the high mortality rates we would all want to avoid.

Bravo, go for it adam. My wife decided on a home birth for our fourth after (ahem) rather mixed experiences during three hospital births. She did face some pressure from local midwives but stood fast. And we were concerned not to have to travel due to previous rapid deliveries! It all went pretty well and we are both glad about having at least one of our kiddies born at home.

Too right we'll see more home births PPO, and a good thing too! The key issue I suppose is helping folk to realise that birth is a quite natural thing and that women can generally handle it without all this technology. There has been a loss of this natural instinctive knowledge and confidence, which hopefully will be restored quickly.

Its fair to say that advanced medicine is useful for emergencies, and that's worth having while we still have it. If anyone is critical about your choice of home birth in that respect, it might be helpful to mention that for most people in most places, it takes no longer to get to hospital than it does take time to get a team ready for an emergency caesarean (e.g. 30 mins), so you are no worse off that if you were deciding to be in hospital.

Best of luck with everything!

Got to say I don't agree. Humans have evolved with the maximum head size that can get through the pelvis. One reasons human babies are so helpless for so long is that they should be in the womb longer, (we are way off where we should be if you plot mammal size against gestation period) but can't as the baby's head is too big. The trade off for our big brain is that unlike most mammals humans have a higher mortality rate during birth. This is perfectly consistent with evolution - there are many non-mammal species where reproduction equals death for females. The advantages of the large brain outwiegh the disadvantages for the species / selfish genes involved. The human situation is not as stark, but the idea post peak without modern medical intervention we will not return to the something like the death in childbirth rates we had historically is wishful thinking. Same goes for death in prematurity and similar problems. Hospitals have their problems - I think the American situation is more to do the lawyers and risk of being sued than purely medical. After all they are the ones who carry the can for dead babies and mothers. And that does still happen.