S2E5 - The Biggest Intervention? Leaving your Home to Birth Your Baby - Risks of different birth settings

Hello and welcome to the birth until the podcast. I'm Shelley, a long time do-la, advocate and former university lecturer. And I'm Kemi, a badass per paper, formerly a UK registered midwife. Just a couple of rebels with decades have combined experience in pregnancy, birth and beyond, getting together to share wisdom. We exist to equip birth workers, families and seekers of truth with informed choice, not fear. Come as you are, learn what they don't teach. This is the birth revolution and you're all affected. Hello everybody, welcome, welcome to this episode. We've made so many wonderful pastures thing. I think it's episode five. I think so because we had a double with tests and then we had a double with going through all of those things on offer to you. Oh, it's a bunch of numbers. We felt like we've been through pregnancy and we needed all the snacks at the end of those. Oh, all of the snacks. So this is episode five. Welcome. We are having fun. So we have just come off our lovely monthly call with our untethered rebels, which was so nice. Honestly, yeah, honestly, really good. It had a lot of us in there with our experiences and that kind of chat that you can only have around the fire or in a circle. That's the kind of chat we have. It's really important that we get to share our stories and it's an essential part of learning. So for dolers and nerds, birth nerds, dolers, midwives in there, a lot of learning. Obviously, we could say obstetricians do. But actually obstetricians, you do what it says on the tin, kind of observed, is that the word that they're supposed to be observing. That's what obstetricians supposed to be observing and only waiting in if they're needed. And so I'm happy for you to stay out there on the fringes of medicine. But for us, midwives, dolers and nerds, we need to get down to the nitty gritty of what untethered birth really looks like undisturbed birth. Yeah, and coming together in community like that is just so fulfilling. It feels like my cup. So if you're not already an untethered people, and supporting the podcast and coming to a monthly get together with me and Kevin, which is lush, why not? Come join us. Okay. So now let's dive into what we're doing today. We're going to talk about the place of birth. We're going to discuss the big, the massive outcome altering intervention of leaving your home to birth. You're pregnant. Why? I see. And today, after today, you'll be wondering why you do it. Okay. So, and that's absolutely necessary. I'm not saying that there aren't times when obviously it is necessary. But you know, we're not all absolutes. This is something that I'd really find grand smuggies actually to go off topic already. The whole black and white thing that people seem to have when you present an option, you know, people come in, usually traumatised people who have done the thing that they didn't really want to do, but they did it because they were told they had to. That kind of age-old, former cycle happens. But this kind of black and white attitude of things, and it's funny. It happens with birth, happens with breastfeeding. So things aren't black and white. You can want something, and then at some point need something else. It doesn't mean that you wanted that thing in the first place. It doesn't mean that you're judging somebody who wanted that thing in the first place. We're all different. We've all got different things that we want and we need and feels good for us, and that's okay. Let's need to celebrate the difference if we all are saying life will be very boring. Okay. Let's carry on. So in the spirit of this podcast and celebrating women in art and science and gloriousness of birth, I wanted to cycle back as we did a lot in the first season to somebody that Kami mentioned in a previous episode, Marjory Chiu, who was a British medical statistician and she was based at Nottingham University actually in the 1970s and 80s. And she decided that she would take a look at the national maternity data, the same data that was used to justify hospital birth as the safest option I'm doing a better come as safe people. And she just decided to analyse that data as not a white man who wanted to make money out of. How about that? How about that? I wish he found was very uncomfortable for the institutional patriarchy, but I'm sure Kami was no surprise to her physical birth supporters. And she found that the dramatic fall in perinatal mortality in the post-war period was not cosensingly attributable to hospital birth. No! And much like Tess said in the previous episode and Kami and I have said in previous episodes, but it's just so important that we need to keep shouting it out. Did you hear that people? Birth in hospital did not has never been the reason childbirth became safer. You pretty much have always been being lied to when people tell you it's safer to birth in hospital. Mortality at the time was already falling before hospitalisation became routine because of, as Tess said, improvements in nutrition, sanitation, antibiotics, overall health. And that explained the majority of the decline. Not doctors, not obstetrics, not birthing in hospital. You've all been lied to, you've all been suckered, like properly suckered, and I know it feels horrible to be suckered. I've had that with people. I think the things that have rocked my world the most in my life of when I thought that somebody is something that they're not or they've turned out to be something that I didn't think they were. And it rocks your world, doesn't it? But you know, seriously, rock your world because the data, it's very clear and has always been very clear. And Marjorie first published her in her book, where she wrote about these statistics. It was called "Safe a Childbirth" with a question mark, which I just love that title. Just using wondering once you do read it. It was first published in 1990 and it challenged the central and very loudly dominant and grossly mistaken assumption that hospital birth was inherently safer for all women. He doesn't, and it never has been. Okay, just shouting that louder. You're at the back thinking that hospital is still a better place to birth your baby. She identified the critical statistical problems of, you know, the data at the time where everything was lumped together all out of hospital births, including births in prisons, which, you know, are not completely safe, including concealed pregnancies, including unparamed births. And then, you know, compared that to the mixed group to planned hospital births. And when she separated out the planned home births from the data, it's what? The outcomes were comparable. It was as safe at home as it was in hospital for the vast majority of pregnancies. And much like we don't argue, she did not argue that all births should happen at home. She argued that blanket hospitalization was not evidence-based. Risk needs proper stratification and individualization. Women deserve informed choice. And here we are. The case later still debating the same question with the vast majority of people, believing the bullshit they were sold back then, but hospital is safer than home when it is not for the vast majority of people. It wasn't then, it definitely isn't now. And we're going to have a talk through some of the very large and very robust studies, some physiology and whatever other shenanigans we get up to as usual over recording conversations. Because, you know, we can't stay on topic. We have to have a few rants here and there. Come on. So, if we first discuss home birth safety, fear and the incredibly damaging media narrative, because I think that's really important. You know, as I've had a few people recently who've read things in the paper and it started to make them worry and doubt the decision about home birth. And why people worry about home birth? It's not a new thing. You know, we've got research from people like Newburn and Guide in McFarlin in 2011 who showed that strong critiques of home birth in medical journals are not purely about evidence. And they reflect this deeper cultural assumption in medicine. And when clinical authority feels challenged, they don't like it, especially by normal physiological birth settings like home. And the response is often defensive and alarmist rather than evidence-based. You know what, this feels a bit like the whole induction argument as well. Rather than just having a weight and then having a baby, doesn't it? You know, these patterns repeat. But it's psychology is so important, isn't it? psychological patterns are so important things. And you know that criticism of hope birth often has more to do with institutional anxiety and professional boundary concerns than actual safety data. Now because if everyone's happily having their babies at home without complications which the vast majority people would do then what are the obstetricians going to do? They don't have 50% of the proclamation to cut into, they get bored. Yeah, that's true. And that's sad isn't it but that's exactly what it is and because- That's exactly what it's come to. Because we hold people with medical degrees up on this pedestal like they are gods and I know a lot of them have gone complexes. We think well they must know better. Surely they must know more. Surely they must be right. Even when we've got massive amounts of data that are saying no, is they're telling you that hospital is safer for you to birth your baby for the vast majority of people. They're not telling the truth. They're telling you a lie. They're believing they're from the cancer and they're not willing to read things and recognise that they're not telling the truth and that's yeah that's not okay. You know the second psychological thing is that we really love simple explanations even when they're wrong and there was a paper released in 2003 by Newman and the core idea of which explored that complex phenomenon like childbirth because childbirth is complex and has many different attributes to it. Don't lend themselves to simple cause and effect stories. So the media and most clinicians fall into this trap of telling simple narratives hospital equals safe home birth equals risky because they're easier to communicate than talking about nuance and individualising care and of course oversimplified messages sell better. They distort the science to do it but it sells more doesn't it? And what the news actually says about birth so in 2010 there was a paper by Romano is going go. Who analysed mainstream news reports and they found of course that we all see many stories about birth focus on drama or complications because you know the only evictory is podcast normal boring free birth. Love the title of that podcast because the thing is birth is both miraculous but also it's a physiological event that normally happens without any kind of problems you know as your as your famous quote. Yeah. The majority of birth should be normal without the need for medical intervention not the other round. We get complex risk statistics get translated into faithful headlines and we see this in appointments with doctors. They were you're risk of this doubles and you're like oh goodness because in our minds we're thinking oh gosh it goes from like an almost double. It's going to be massive when usually it's like 0.1 or 0.1% to 0.02% so it's still 99.9% that you're going to be fine. And of course in the news positive or evidence-based stories about normal birth including home birth. Well there's news fest nobody wants to hear that you had your baby pop your baby out snuggled up in bed and had a cup of tea. Well I want to hear about it. I cried. I mean for a fight with mine. Oh I didn't tell you this cheme actually but my client she sent me this most beautiful picture that her hubby had taken where I was leaning over to kiss her forehead because I just I want to well up about it now because she she just really wanted to have her baby at home and just be able to cuddle up in bed with her bigger babies because she hadn't had that with her previous birth. She managed it and it was just the most wonderful thing. So papers don't want that kind of story but I want that kind of story. We love that we thrive on it. That's what that's what humanity fries on. It's so nice and he caught a picture of us both having a little cry about how it was now. Look at that. And for him to actually catch that pose. I will treasure that picture forever. I'm really well. So lovely. I'm so grateful. So yeah in other words we get this dramatization you know it's like one born every minute again they dramatize it you put the music on. They make the breaks so you're like what's going to happen you know because otherwise you wouldn't want to watch it we love drama. And they said to one the news. It doesn't mean it's accurate it means it's sensational and you need to dig below it and when you get this kind of media mayhem and misrepresentation. It's a massive amount of fear and this chaotic anxiety selling dramatization of rare events you know lack of expert voices from midwives and dolers because the patriarchy don't consider women-centered-addominated roles as experts. Yeah I said it. We don't ask them. Do they? No so that on that panorama thing a few years ago where they're investigating Gloucestershire Trust and about half of the episode they were naming and shaming these midwives and that the midwives are called to death and dah dah dah dah dah dah and they you know talking about them. Then in the second half they just almost brushed over the fact that this woman had come in not given adequate translation. The doctor gave her an induction which shouldn't have happened. There was no medical reason for it I believe and didn't manage it properly and she lost her life. They didn't name the doctor. They didn't spend half the episode demonizing the doctor. It was just like a passing passing thing. So this is like this duality. It's really it's really evident and we've got to be careful that we don't get ourselves caught up in the drama so that we then end up making decisions on made up nonsense basically. We've got to dig down and think okay actually I need to go below that fear. I've read in the paper that a mother and baby died and that is really awful. Very tragic and but was it because they were at home? Actually who knows you know who knows that truly? Did the coroner speak if there's that you know for death as that did the coroner speak to the doers? Did they just make up their own assumptions about it based on the kind of witch-hunt attitude that a lot of us fall into because it feels I don't know for Phil's or dopamine or whatever it's happening. We'll have to get a gender run to talk to us about the psychology of that right? Can we I can't wait to get that woman on? I think that'd be really good. I don't think it's a digression even but just believing propaganda and the way the society curves around obscuring truths. What we'll notice in the coroner's reports as well is it's a question I'm forever asking is what was the mode of Labour onset? So just to append what Shelley saying? We've been taught to oh it's like someone's got their hand and say no don't look over there, don't look over there just look at the scary outcome but no one wants to talk about it and I will be doing some posts on that over the next few days. No one wants to talk about okay but why why was she in theatre? Okay so why was she in the hospital? She was trying for the Jinal birth. She was trying. Oh so what was what did that trying in tail? You know so they might say all those terrible midwives weren't monitoring weren't watching the CTG monitoring or they didn't interpret it accurately but and then I'll go but why was she on the CTG but why was she in the hospital from early Labour? So it just becomes a bigger question which leads back to what Shelley and I will say so so why did she leave her house? It all cascades it's like dominoes. Yeah you get this misleading impressions about how common or how dangerous certain outcomes really are and often it's skewed that you know the woman was aiming for this natural birth but then when you dig into it she wasn't having a natural birth natural had gone out the window when she'd had a sweep and then she'd had artificial rupture of membranes and then she'd had a a a wiff or a little vehicle a wiff of oxygen and it's synthetic and honestly I know we're pains in the butt for this and we'll continue to be so because the whole of society and all the press are saying no no no it's oxygen and then you've got midwives that are supposed to be the guardians of normality are saying no it's oxygen is it's certainly the same no it's synthesized it's synthetic and it's pumped in at certain rates and it has outcomes I noticed at the moment they're all having this conversation now about old but we'll stop it when she's in active labour so everyone's caught up with that now because there was some evidence that came out in the last couple of years showing that when you've got the catastrophic outcomes caused by synthetic oxytocin right which I will just skip that bit we'll just skip that bit but what we're saying now is that we're going to stop it in active labour and not kill so many women and kids which you know I'm pleased that's a move forward but we've got to go back to the origin why was she on synthetic oxytocin in the first place why was she in the hospital why was she being continuously monitored why did she leave her house If people want to blame midwives, they want to blame dolers, female dominated professions, rather than recognizing the institutional issues that are really more at fault, and this theme repeats over and over and over, like we say, it's look over there, look at those women, look at those lower skills people, you know, than the godly doctors, than the institution of white coloured men that knows best, and we've discussed it in our red totes episodes, it just repeats over and over again. It's so much easier to blame midwives and dolers than recognize lack of trait proper training for midwives, lack of proper rest for midwives, lack of birth experience for midwives, like a mother traumatized by her previous hospital experience who wouldn't want to go into a hospital who doesn't trust care providers because of what has been done to her in the past, lack of continuity of care. I mean, there's just no excuse to have lack of continuity of care in my opinion. There's so much evidence to show that it improves outcomes, but that's brushed over. And they'll buy a batch of new CTG machines instead. I saw a hospital as a London hospital to the bed, completing on a bank, we're going to be, you know, participating better in the births, you know, Baroness Cumbleidge, you know, her whole beautifully orchestrated engine for change in Charbo. She was driving forward the evidence space of continuity of care. And right in the middle of that, big London hospital with money slushing around, just went and bought a batch of CTG machines instead, where there's no evidence to support that they're improving outcomes, in fact, they're worsening them, but they just spent their money there instead. So that's why, you know, when I, you know, I observe people saying, "Oh, you know, let's plead with the government to change the way they spend their money." This is willful. It's willful. I don't think this is a pleading with the government issue. I think this is a choice that women and midwives have to make about the future of birth care. I don't think we can leave it to, you know, the white collar, big wig, dusty, old, white men. No. No, because it's easier to blame women than it is to change institutional problems. Yeah. It's easier to blame women than it is to look at your own behaviour or your own practice or your own guidelines. Much easier. Just say women are older and fatter and more complex, even though they're not that much older. Being fatter doesn't really make any difference to most outcomes. And they're only more complex because you've changed the goalposts. And so you're calling them more complex. When previously they wouldn't have been more complex. We are going to include a good section in an episode about this because it is just fascinating when you see how we're being manipulated by lies. And the thing is the Royal College of Midwives also weighed in with their shit. Royal College of Midwives, imagine that to me, I would have hoped that they would not have bought into this crap. But they share premises with Royal College of Stetrics and Gynecology and everything. And they are the ones saying, 'Oh, it's a kids women are older and fatter. We should know better.' And I see somebody who was the other day or who was the report or somebody told me it's because there are more IVF. No. So just to be so tiny in the number of frequencies is just rubbish. Absolutely rubbish. Yeah, that's right, so mad. Anyway, so really what the media would like you to believe is that home birth is dangerous. What obstetricians would like you to believe is that home birth is dangerous. What many midwives working in the institution would like you to believe is that home birth is dangerous. And that is absolutely not what the data shows. In the birthplace study, which had over 64,000 births across different settings, there were no maternal deaths recorded. In the Netherlands, I'm going to say John is J-O-N-G, but I don't know how you say that in Dutch. In 2009, they studied 530,000 births in total, 321,000 of which were at home and 163,000 of which were in hospital. There were so many deaths there at home. Zero. Zero. Zero. Zero. So that's a study like almost 10 times the size. Yeah, in hospital there were several deaths recorded, but the numbers were too small to draw statistical significance. Interesting. Yeah. So even with these massive numbers, it's very clear that maternal deaths are very rare overall during birth. But then what are we thinking about after? What are the biggest killers up to a year after birth? A third of maternal deaths occur after six weeks postpartum, and mental health related causes, including suicide, are the leading cause of death between six weeks and one year after birth. Then we've got cardiac disease and thromborembolism. And large observational studies show us that emergency cesarean severe hemorrhage and ICU admission are associated with increased risk of postnatal depression. Posttraumatic stress disorder, reduced quality of life and long-term health problems. Women with severe obstetric complications have two to four higher, two to four times higher rates of postpartum depression and PTSD symptoms because they're being traumatized by these things. And as you will hear later in this episode, intervention and complication rates are significantly lower in planned home birth cohorts irrelevant of whether you remain there or not. Okay. The other thing, if you choose to have a home birth, you do not have to die on the sword of home birth. If at any point you think this doesn't feel right for me, I want to change my location. You can. It's not a failure. It's you prioritising your needs in the moment as to what is best for you, what feels best for you, what is medically best for you, whichever way it is. Okay. What's interesting is that it has been hypothesised that long-term health outcomes could differ by birthplace, but I couldn't find any large study comparing birthplace to outcomes for mothers or babies. I would say that our experience would tell you that a place of birth makes a very significant difference to women's mental health outcomes. I mean, it's just they're not even the same for me, people who choose into birth at home compared to people birthing in a hospital. It's the whole feeling about birth is very different. In hospital it's like, I thank God everybody's alive and at home it's like, this is one before I feel amazed, it's very, very different for you. And when we look at the data, UK confidential enquiries consistently report that many maternal suicides involve primal health history, traumatic birth or complications, and postnatal depression or psychosis. They all are all increased dramatically by choosing to birth in a hospital. What better way to help avoid that than playing to birth outside of a setting where your chance of that is happening is much higher. In complications in interventions, they're linked to worse, worse long-term outcomes. And they're less common, significantly less common in low risk planned home birth cohorts. And as we see from some of the data, actually even if you are labeled high risk as well. And it's not just about mental health, but things like thrombo-embalism. You know, so the second biggest killers when we're looking at thrombo-embalism and surgical birth, the zaryn birth increases the blood clot risk by about two to four times that of the vaginal birth. Now you're thinking, yeah, but why are you talking about zaryns if I'm choosing a hospital birth? Well, the NHS data shows us now that if you step through the doors of an NHS hospital your chance of ending up as a zaryn is 50/50. Yeah, obstetric complications are associated with long-term cardiovascular mortality. And home birth has obviously a much lower zaryn rate, severe hemorrhage, and infection rates, and also much improved breastfeeding rates. And the single biggest factor that people often don't know in women preventing cardiovascular disease later in life is success in the longevity of their breastfeeding. If the world really cared about women's heart health, they would be prioritising breastfeeding support. There's an excellent head talk on the subject, actually, so I highly recommend you listening to it. But it's the single most protective factor above diet, to exercise. Do you think exercising to it belongs in our show notes? Yeah, I'll put a link to the little kind of show notes. Sorry to interrupt you. No, no, that's really important. Yeah, we're close apart and for so much longer. Yeah, the whole set up starts from preconception, pregnancy and the way you give birth is all important. Regardless of what the press is trying to tell you, like, "Oh, don't know why zaryn has been stigmatised." It's like we're just having fun, poking fingers in the wound of those that have been cut open to have their children. No, it's because it all has an effect on the postpartum health. You know, as I keep saying, I was a postpartum. I've been postpartum for what? 35 years. So, I'm continuing and seeing the knock-ons in my paramedicals, my menopause, my health, in my late 50s going into my 60's.请opخ y fabisans handlarhysiaeth odi terabyte cad a hach ginkais hj Jim efo hynna hefyd yn achysg— ac yn cael wybodaeth syna, pethau y gweld yma. Mae'r ail o fo 날 feid cywlch am letihau mentioning fungrydaeth hope teg白 ar yn ffilmwn yn doeddwn amserog. Mae'n droch dyna eraill am drwfodaeth gonddysciaeth uciudau on gelywng yn gallnol keyswag llonom yw Megan Andrews ddysig o arch rydygu,au rhan o ddyn hefyd ac yn moi gwntau a'r aptyflyd verschieden o'r aptyflyd yn y tepau o ffysod ac yn yw'r aptyflyd yn achysg. Mae'r aptyflyd yn achysg. 80% lower unplanned cesarean root and 76% lower instrumental birth with the same outcomes for the safety of your baby. Okay, so this isn't you stay at home and your baby dies because you don't have access to those things. This isn't you stay at home and marty yourself in pain and don't have an epidural because you want one. No, you can choose those things if you need them. They are there if they are needed. But all that harm when they're telling you you're high risk because you've got less than 1% chance of something and they're ignoring 77 80% chances of things. It's just madness. It's madness. It makes me feel mad sometimes when people are just not realizing how much worse things are when you go into a hospital they're so much worse. And now the difference is full first births are slightly less than that. So it's for first births but it's still a 34% lower chance of cesarean. 37% chance lower chance of epidural. 32% lower chance of apesia to me. Okay, and these these figures they're not it's not unique to England. We see it in other countries as well. In the 500,000 birth meta-analysis that I spoke about earlier comparing home birth to hospital, they found 42% lower cesarean at home. 58% lower operative births, so that means including four sets of ontoes. 70% lower epidural use. 55% lower apesia to me. 43% lower severe tear. 63% lower oxidose augmentation. 77% lower maternal infection. As fingers up your vagina, unnecessary fingers up there of course these are 34% lower post-parts and hemorrhage. And there were no maternal deaths across those 500,000. And the outcomes in terms of the babies being alive were the same in both. They're massive. Massive differences. And when if we look at the likelihood of a severe post-parts and hemorrhage at home, it's around about 1 to 2% of births. In an obstetric unit, it's 2 to 4. It's a 2 and a half times higher odds of severe post-parts and hemorrhage if you choose to birth in hospitals and you do at home. So when people are like you know that's the thing I find that often people worry about with home birth. What about bleeding? Well you can half your chance of bleeding if you stay at home. Just like that. Well severe bleeding because the difference between moderate bleeding so under 2.0L is huge. So they're quite used to seeing us waiting through like you know 1500 ml of blood in the unit or 900 ml of blood in the unit if you're not in the theatre. But at home you've got the minutest percentage of even a moderate bleed. So it's in comparison to the obstetric ward. You know the severe hemorrhage scenario is quite a small one. Yeah so leaving how you really profoundly changes your probability of intervention and your probability of harm. That's what it is. It's harm to being done to your body. And I think the other thing that people get concerned about is transfer. And people often frame it in their mind that it's a failure. It's a part of the system to help you be safe. So sometimes things do need medical assistance. And something you know people I suppose people worry about what that means and why does it happen? So I think often people think that transfers are going to be emergencies. When people are transferred they think it's going to be an emergency. It's really not. It's really not. And if we look at the transfer rates I always like to say to people about transfer rates because they're like oh yeah but I read the birth base study and I heard that the home transfer rate is 45% for first-time mothers. That's really high. And I'm like yeah but if you're choosing to birth in an obstetric unit your transfer rate is 100%. 100% of the time you're going to get into a car to transfer to the hospital. So by choosing to birth at home you've already reduced your transfer rate by 55%. Tim, don't I mean? You gotta think about it that way. Because the car ride in labour is no joke. It's not fun. Really not fun. And it's really important to understand that most transfers are not due to emergencies. So in the birth base study around 32 to 37% of transfers were for slow labour. Okay so can we just say here that the majority of that may be to do with the facts that the midwives who are supporting you do not understand how to support anatomy and physiology. So they don't understand that maybe your baby is just not quite facing the right way and you need to change position in a particular way or do a little technique that helps to make space and your baby can then fit through your pelvis like a little key going into lock just a little tweak and then they can go through. So most of them don't understand that they don't know it. So they're like oh okay well we've been here a bit long. They're also maybe going on medical models of labour and thinking. Yeah they are expecting expecting your you know you're labour to go like this. When sometimes labour's go a little bit you know up and down take a little bit of time you have pauses because physiologically your body's like oh we need to have a little bit of a rest here. You need to transfer your baby and that's normal and it's okay and if you feel safe and supported at home then all is well you don't need to transfer. So a lot of that 32 to 30% percent is unnecessary. The next biggest reason for transfer is muconium okay and I think we've spoken a bit about this on a previous podcast haven't we? Then it used to be that the recommendation was for if there was thick muconium you know that there might be a concern about what's going on with the baby. Now it's like any kind of hint of muconium they'll transfer which is probably unnecessary in the vast majority of cases so again you know the numbers bigger there than it should be. Feet will be total heart concerns is around 7%. So they're hearing something on a Doppler as it can okay maybe it's worth transferring into the hospital and I think Dr. Gerstin's more is good to really learn about heart rate things and the assumptions that we make about heart rates when actually we don't really know what we're talking about. And then the 5% is for people wanting an epidural okay so when people are worrying oh well at home I won't have an epidural and I'll be I won't be able to cope. Well you can because your physiology is supported so you get your natural dolphins you get the unnatural pain relief, you feel calm, you feel safe and so your nervous system coats with the sensations of labor and very few people 5% of people feel that they need to go to hospital because because of that so it's very small and then we also have postnatal transfers so 7% of those were for retained placenta and again if you are having registered medical professionals there who have having strict time limits who maybe don't understand how to support physiological birth of placenta i.e. shutting the fuck up in your birth space and leaving you coddled up with your baby to just let things happen. You know that's again going to be more transfer than you probably actually need and you know the other things that they were transfer for is if there is a complex tear okay so midwives can repair most hairs that would happen. I hope if they need repairing at all because most don't really we know we have good evidence really to show us that first and second we tear most of the time don't need need repairing don't need stitching that they will heal better if they are left alone more comfortably you know all that kind of thing you know it would only be if there was a complex tear which is quite rare in a physiological birth. Most complex repairs happen because there's been a piziotomy four-seps use etc which this is not going to happen at home so it's quite unusual to have they didn't even in fact i couldn't even find the percentage for the number it was so small for that and the other one is for keeping an eye on the baby so maybe the baby's temperature is not quite right or their breathing is not quite right and it can be transferred in you know but that's not an emergency it's just okay we'd like to keep an eye on the baby and see how they are so let's take them to the hospital do you want to do that you know it's not nice either the signs that we're seeing is this what I like about. So the emergency transfer rate across all of the big reviews is from 0% in some of the reviews 0% of people having emergency transfers to 5.4. Yes so it's it's tiny yeah now it's 100% to 94.6% of the time there's no emergency transfers and and for the amount four of people were concerned about it for if there's a place past and hemorrhage that that percentage of transfers 0.2% of transfers okay so really really tiny really tiny not something you need to worry about as much as it and this data is comparable to other studies so you know when we look at international data from Australia Canada level of New Zealand, they show similar patterns that there's a transfer rate of about 25 to 45% for first babies and 5 to 15 for subsequent babies and they think a lot of the time it's just down to confidence and not feeling nervous about what's happening in your body and you're just sticky, oh yeah that's okay I felt like before I understand that I know that and relaxing into it more, so your physiology is working better second time rounds your body's done it before you can relax into it more and you know so transfers are normal in integrated systems they're a part of the safety mechanism that makes home birth safe and it's there for when it's needed, you go and we know from the state that even if you have to have a hospital transfer you're still going to have so significantly fewer interventions you know just planning to birth at home is significantly significantly protective even if you don't stay there for whatever reason you're not going to be in trouble or look down upon if you change your mind so don't worry about it I'm to birth at home and then do whatever health feels good on the day I must carry out that I think many women have experienced being looks down upon or in trouble for making that choice you know well when they get to the hospital you mean when they get to the unit yeah but that's on the peep that's on the people that are doing it that's not on it is but it's not okay on vulnerable women and you know on the fence partners and you know stress monkey grandmothers I can see why some women just want to avoid all of that kerfuffle and be compliant instead and I don't know what to say about that what you're really doing and I get the rock and a hard place that you're in but you're exchanging discomfort with the support that you've got or the way people look at you in the hospital you're exchanging that with genuine risk to health and life because by you know complying with what everyone thinks you should be doing you actually are exposing you and your baby to more harm yeah because the outcomes that are being measured aren't all you know Shelley's alluded to this earlier the outcomes that are being measured in this research they're not including whether you enjoy sex with your partner in future whether your marriage survives or whether you can go back to work whether what's the bonding between you and your baby does your baby get breastfed for long enough you know do you receive all the benefits of of offering the breast you know the microbiome you know because of mode of birth there's so much that doesn't get measured in these things that are benefits some mothers and babies that isn't big measure so please know that you know the confrontation of yourself quite early on about the good girl complex you know what you're willing to sacrifice to please your partner or your parents you know or that you're not the subject of discussion at the dinner table at Christmas etc please weigh up what you're actually losing by being concerned about those things and maybe do the work there preconception because you become more vulnerable when you're pregnant yeah and please send people who are thinking that home birth is really dangerous please send them this podcast episode so that they can hear the information to recognize where their judgment that their judgment is coming from a lie because you don't know what you don't know if you don't know that it was propaganda if you don't know that the statistics you know when manipulated in such a way to make home birth sound more dangerous than it has ever been if you don't know that the reduction in likelihood of having major abdominal surgery is such a massive percentage by choosing to birth at home and knowing that if at any point it looks like it needs you need to be in hospital to be safer that that can just happen you know it's it's a crazy idea to birth in hospital with those those kind of differences if you don't need to be there if there isn't a life saving reason that you need to be there and it doesn't just affect these things but prematurely of babies for example 28% lower in planned home birth low birth weight 40% lower either massive massive differences this isn't a difference between 0.1 and 0.2% when you're being told your risk of stillbirth doubles if you don't have this intervention if you don't come into the hospital this is 40 50 60 70% difference of things being worse for you than if you you stay at home it's big they're big numbers big big numbers and when we look at the you know when we're thinking about more complex things okay because the home the birthplace study was about low risk no birth so you know the majority of people don't get through their pregnancy these days being low risk because high risk labels are just thrown about here there and everywhere aren't they you too old you're too fat you're having a V-back two black two brown you know possibly what are there's just so many things it's just ridiculous and the birthplace secondary analysis showed that for V-back people people having a V-back for general birth weights 15% higher at home what were the adverse maternal neonatal outcomes you know because you'd be told by your physician oh yeah but you're huge or spike birth diaper and then you must be near a theatre well guess what two to three percent in both settings exactly the same but the there's an issue with an outcome exactly the same whether you choose to birth in hospital or you choose to birth at home but you'll you know 15% was also say you're 15% more likely to have with a general birth if that's what you want if you stay home there's no bad side and these and these are with obstetric nurses I'll be saying again because she was like oh no the home birth mid-wizard will mid-wizard not not always yeah but if you're much higher if you've got somebody who understands physiology if you've got somebody who understands physiology who's been who goes to like 50 verbs a year you know even half that 25 verbs a year they're going to be a much safer pair of hands so unless your home birth team are racking up that many verbs individually each midwife I'm not talking about the team and they can't in the system at the moment because of the lie that's literally it we believe the lies and we've actually now created a system where the NHS home birth teams just don't get enough practice yeah and when when you are choosing to birth in hospital maybe half of all births now involve surgical delivery so when intervention rises like this happens system-wide the place of birth becomes even more significant even more consequential and the thing is they're realizing that and they're becoming uncomfortable about that and that's why we're getting all this demonization of it in the press because women are waking up to hold on a second I'm sorry I've got a 50-50 chance of ending up with a caesarean when I step through the hospital doors I've got an increase of 70 80% in other major interventions that mean cutting them by genitals happening and things if I step in hospital I don't want that I want to stay at home so they're like okay well let's remove the option of home then because women can't be trusted to make the decision that we want them to make we want them in the hospital so we can cut them open and we can do things and so let's let's put in the press about how scary home birth is how you know they and their baby are more likely to die even though now you know the evidence doesn't show that that it's simply not true but they just they just keep perpetuating the propaganda to bring people into the meters yeah and they don't they don't have there isn't data really to look at long-term outcomes you know often in the statistics that we've spoken about before that obstetric window so they're just looking at the very short time of a baby being in the woman out of the woman and then immediately they're on to pediatrics and it goes out of the window so we haven't got the kind of long-term data about the differences between birthing at home and in the hospital for childhood microbiome and the immune outcomes we know that there are early microbiome differences and research consistently shows that the birth environment and interventions influence newborn microbiome now which is associated with immune health metabolic outcomes including cancer, heart disease, obesity, depression you know we've had a systematic review of birth mode that found in terms of microbiome the genital birth is associated with greater microbial diversity which is directly associated with health improved health outcomes across the board more maternal for genital and gut bacteria and medicalised birth especially cesarean is associated with reduction in that diversity, biocolonisation by hospital bugs which is not what you want you want you want your home right? microbiome and they've been associated with increased risk of asthma, allergies, obesity, type 1 diabetes. So, then do you want to choose a place to burst your baby where you're likely to put your child getting all these things as increased? Do they're going to have much higher zering rates? They're going to have much higher antipotic use. There's going to be much more instrumental birth happening. Or would you rather choose a place where those things are all not slightly? Would you have a 42-60% plus low zering rate? Or not? Is it, you know, there's no downsides to being at home as far as I can see, apart from the judgement of people who don't know better. Who needs a gamma listens to this podcast before they pull their judgmental face? Here we've got asthma, eczema, allergic disease. All of these, there are strong evidence links where mode of birth, antipotic exposure, early microbiome interactions have are really relevant with allergic disease. Cesarean birth is associated with a 20-30% higher risk of asthma. If you step in the hospital, you've got a 50-50 chance of hip-ma. If we look at breastfeeding success, which is much higher at home, and you're going to reduce charted infections, lower obesity rates, improve neurodevelopment. In a planned home birth in the birthplace study, they showed that 74% of people were breastfeeding at 6-8 weeks compared to 64% in an obstetric unit. So you've got a 16% increase by choosing to birth at home. And they've got the health benefits for your baby and for you, they're big. You know, not just physical benefits, but mental health benefits, mental development benefits. You know, the power, brain power of your baby is altered by this disease. And the psychological outcomes as we touched on earlier. If you're having a traumatic or highly medicalised birth, your farm will likely get postnatal depression, PTSD, alter the bonding, lower your breastfeeding rates. Or you could be at home. Have a greater sense of control, more positive birth experience. Lower trauma. They say perceived rates of trauma, but it's significant in lower actual trauma to your physical body. Do you look something? We've got the stats to show that 78% lost for. It's just so important. And if we have continuity of care aligned with places birth preferences, then we get massively strong associations with lower rates of postnatal depression and higher maternal wellbeing. So if we actually cared about women's lives, it would be being prioritised. Home birth wouldn't be being removed. The NHS, things wouldn't be looking into can we deny women at home birth? Is there a possibility that we can deny women at home birth if the doctors decide they're too high risk? You know, it's totally unethical. What is being done to women's choices? Totally unethical. It is. And I want you all to remember as well. The higher incidence of babies being admitted to neonatal intensive care. I just want to focus on that a minute just so you could really see the cost of buying into this propaganda. Because obviously there is financial benefit to the unit if babies are being costed for the nightly stay in neonatal intensive care. Of course the cost of the family is huge. It's huge. But the removal of that by you making fact-based decisions rather than fear-based propagandised ones is that you will gain the benefit of your baby not being in intensive care. So that will improve your bonding and breastfeeding and they will lose the financial benefit of your baby being separated from you and often in an intensive care. Just because often when we're having these conversations and I'm so grateful to work with Shelley because we have balanced conversations not just because I'm biocirously balanced. If anyone weighs them, there's a lot of people that where our podcasts is they give a very guilty pleasure where it might not be so beneficial for their colleagues, they're obstetically led colleagues to know that they're listening. But honestly the cat is out of the bag. You need to know that you need to prioritise you and your baby's well-being and long-term health first. You don't keep offering yourselves up for the benefit of the unit and their budgets and their funding. Yeah, and don't blindly believe because you've been labeled high risk so that means the outcomes are better because just read this paper this morning that came to you sent me about parinatal and maternal outcomes in Planned Home and Obstetrics unit bursts in women at higher risk of complications and it was a secondary analysis of the burst place study. And it's just going to read you the conclusion here. The babies of higher risk women, if they put it in the paper. Excellent, because I do all the time. The babies of higher risk women who plan birth in an obstetrics unit appear more likely to be admitted to neonatal care than those whose mother's plan birth at home. So if you're being told that you have to speak to a consultant midwife or a consultant in order to sign off your home birth because you're high risk, you need to understand that you do not have to see anybody. You do not have to have any conversations and if your trust are running a home birth service they have a duty of care to support you. You don't have to have coercive conversations. If you would like an evidence-based conversation and the information from people come and speak to me and can it. If you would like to understand your rights, please come to my birth rights lecture in March and I'm not sure actually when we're releasing this podcast so if it's already happened don't worry if you missed it because you can get recording and a massive PDF with it. If you need help challenging, if your trust is telling you you're not eligible for a home birth or no we're not going to support you, please get in touch with this. I have written two letters in the last month. The trust's pointing out the actual evidence regarding the things that they were saying to women to try and scare them younger than into things. I've given them the proper evidence and what the evidence actually shows to show that home birth. That would be safer. I have put down the points of the law that they are breaking by refusing to support the woman in her choice, her educated informed choice to home birth. Now they are breaking the law in trying to coerce by telling scare stories about some woman that didn't do what she was told and therefore her baby died and that was her fault for not listening to people. No, that's not what happened. People don't die because they haven't listened to the risks. It's just not the truth. It's like we're getting back to this game, I'm gering nonsense of the press. If you need help with something like that please get in touch because I'm very happy to write strongly where to let us trust. To senior people in the trust, to the people who provide the funding for the trust. Just copy it to everyone. I'm sure they're not going to be happy that they're paying money for a service that's being denied to women that it shouldn't be. Right, and then we've got to wrap up. Going back to the wonderful Marjorie Chiu who challenged the assumption that hospital birth was automatically safer, recognising that you've now heard the modern data that shows that there are substantially fewer interventions if you choose to birth outside of an obstetric unit. Basically the further away from a hospital you are, the safer you are, that there's no difference in safety for your baby, that there's significantly lower morbidity and you know that outcomes for the babies are the same. So is leaving your home neutral or is it the biggest intervention of all? Because once you cross that threshold you've heard about your probability of epidural instrumental births, a zary, hemorrhage, PTSD, trauma, lifelong implications for your sex life. Effects on your baby's long-term health. Effects on your long-term health. Change dramatically. A place of birth isn't just logistics. It's focusing down to physiology, looking at the probabilities. It's the culture and understanding where that's come from and why that's happening and who's fueling that fear in order to benefit themselves because it's not benefiting women and babies. The data is very clear. It's not benefiting women and babies. So who is it benefiting? I've got to wait in something as well because you know. Independent midwives, we're troubleshooters, we love all the lateral thinking, etc. I can hear some of you will be saying that. 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