When UK midwives put the lives of mothers and babies at risk, the solution is not more homebirths

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It’s enough to make a person cynical.

1. It has become startlingly, painfully clear that UK midwifery promotes vaginal birth above the well being of mothers and babies.

2. Not surprisingly, the amount of money paid for bad outcomes and the cost of insurance coverage have skyrocketed (A fifth of maternity funding spent on insurance).

3. Only 6 months ago, a UK government report delivered a scathing indictment of UK midwives, and their weak system of self-supervision that allows them to avoid accountability for multiple maternal and infant deaths.

It is unfathomable, therefore, that a government health group has just recommended more homebirths.

More women should give birth with only midwives present, including at home, because that is better for them and their babies than labour wards where doctors are in charge, the government’s health advisers say on Tuesday.

Midwives should advise mothers-to-be who already have at least one child and whose latest pregnancy appears straightforward to opt for a midwifery-led unit (MLU) or a home birth when deciding where to have their baby, the National Institute for Health and Care Excellence is urging.

The 40% of women giving birth who are first-time mothers should also be advised to choose either location, Nice is recommending in draft guidelines to the NHS in England and Wales.

Both groups of women should select either location “because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit”, Nice says.

Let’s me amend my previous statement:

It is unfathomable for a system that purports to care for mothers and babies to encourage UK midwives, who have caused unbelievable suffering by failing to adequately monitor and care for laboring women and their babies, who have failed spectacularly to supervise themselves and learn from their errors, to increase a practice that leaves midwives with even less supervision than before.

Of course it makes perfect sense if your objective has nothing to do with mothers and babies and, instead, is devoted to the twin aims of fulfilling the ambitions of midwives and saving money.

UK midwives have demonstrated over and over again that they value their personal autonomy over the lives of mothers and babies:

Promoting normal birth is killing babies and mothers
Midwife : UK deaths result of failing to meet the needs of … midwives?
New document on British maternity services is fundamentally unethical

They apparently believe that their autonomy resides in “normal birth,” woman’s wishes and women’s health be damned, and they have relentlessly promoted “normal birth” to catastrophic effect. Increasing the proportion of homebirths is the next logical step in increasing the autonomy of midwives, but it mind bogglingly cynical for a system that is supposed to promote the health of mothers and babies.

It is cynical on a variety of levels.

First, is a cynical misuse of the results of the Birthplace Study. I have long maintained that Birthplace Study appeared to be designed to reach the conclusion that homebirth is safe regardless of what the actual data showed. In order to achieve the desired result, the investigators created eligibility criteria that are substantially stricter than the actual eligibility criteria for homebirth in the UK. So the Birthplace Study NEVER showed that homebirth in the UK is safe. It showed that homebirth might be safe if the eligibility criteria were substantially tightened.

It is cynical because there is a growing body of evidence, particularly from The Netherlands, that midwives caring for low risk women (home or hospital) have a higher perinatal mortality rate that obstetricians caring for HIGH risk patients.

It is cynical because there is no evidence that increasing homebirths will address the known deficiencies in midwife death rates.

It is cynical because in a system already struggling with a shortage of midwives, it defies reason to promote a practice that has the impact of increasing the shortage by assigning two midwives to one patient at home, instead of centralizing the location of births so that two midwives can each care for multiple patients at a time.

But most of all, it is cynical because all the existing evidence points to a need for GREATER supervision of midwives, not greater autonomy.

NICE is promoting the interests of MIDWIVES above the very lives of newborns, its most vulnerable patients.

That’s not healthcare, that’s politics.

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  • Steph

    Can i ask a question? have you ever worked in a UK hospital recently and worked with midwives? Have you ever attended homebirths in the UK? I’m guessing the answer is NO because you clearly wouldn not have written this atricle if you had. Working as a midwife for many years in hospital, community and home birth setting i can assure you our women are well looked after and safe.
    I myself opted for a home birth with both children and my midwives were quick to transfer me in when meconium was evident, they know the warning signs and have good plans in place to deal with situations effectivley at home and/ or transfer in. I would not have risked my childs health if i felt midwives in the UK were not more than capable of providing me with a safe environment for both my self and my baby both in or out of hospital. We constantly risk assess and put health and safety as priority.
    Now i myself have no comment to make regarding American hospital or home births…because i’ve never worked in this area and do not feel it is my reposibility to pass judgement on things i know nothing about!!! Maybe you should do the same!

    • Amy Tuteur, MD

      My personal experience is irrelevant as is yours. The statistics (which are the personal experiences of thousands of women) show that midwives are responsible for many preventable deaths in the hospital as well as at home. The solution to the problem is NOT more autonomy for midwives, it is LESS autonomy since they apparently abuse the autonomy they have to place ideological goals above patient safety.

  • Smallsey

    Lol shut up already you dumb twat. Midwives are safe health care practitioners. Just because you have your own person vendetta about midwives doesn’t mean people want to hear what you have to say!

  • http://radicalfeministforlife.tumblr.com/ Wharves of Sorrow

    Sad to see ideology but over the lives and health of women and their babies.

    • sdsures

      Terrifying.

  • Perturbed midwife

    I think your comments are outrageous and disgraceful! I am a midwife in the UK and put the women’s health and that of their unborn at the top of my list of priories! I ensure they are cared for by the most qualified professional and take that responsibility very seriously! I would never put ‘my autonomy’ over the well being of a woman and neither would any of the amazing midwives I work with! I take great pride in my job and work very hard at it. Midwifery is one of the few professions that have supervision and must show on an annual basis that they are up to date with training and learning and demonstrate safe practice. Furthermore, if and when an issue or any form of unsafe practice occurs there are stringent rules and regulations in place to prevent an unsafe practitioner continuing to practice. As for your claims that promoting normality is just fulfilling midwives ambitions ‘women be damned’…..unbelievable! Promoting women’s choice is what we all strive to do. Childbirth is a natural physiological event and women are very capable of delivering babies without intrusive monitoring, intrusive examinations and synthetic hormones. Of course not all women fall into the same category and that is why we have obstetricians and obstetric led units. But for low risk women without complications, promoting normality and midwifery led care should be the norm. If a woman chooses otherwise then that is her choice. I would also like to point out that the only time I have come across a poor outcome with a home birth was with a woman who chose a home birth despite the midwife AND the supervisor recommending delivery on an obstetric led unit. Perhaps what needs examining are your clearly cynical and outrageous view on midwives

    • Christina Maxwell

      How nice to know that one of you is decent and responsible. I’m sure there must be others, sadly I have never met one.

    • Siri

      I agree with you. I used to be a UK midwife, and am still a health professional. I have never encountered anything remotely resembling these attitudes; on the contrary, I have worked countless shifts alongside colleagues whose integrity, passion, skill and commitment was only matched by their readiness to call for help in plenty of time. No one I knew ever had a baby die on their watch, or ignored a non-reassuring trace, or treated any mother with anything but respect and kindness. I have also been lucky enough to have four babies with the help of wonderful UK midwives; the community midwives, in particular, went above and beyond (I had one and a half homebirths). I would love the chance to work a shift alongside Dr Amy; I think she’d find herself fitting in very nicely indeed.

    • The Computer Ate My Nym

      Promoting women’s choice is what we all strive to do… for low risk women without complications, promoting normality and midwifery led care should be the norm

      I’m sorry, but there’s a disconnect between these two statements. Are you promoting women’s choice or normal birth, regardless of what the patient wants? You can’t do both.

    • Amazed

      “But for low risk women without complications, promoting normality and
      midwifery led care should be the norm. If a woman chooses otherwise then
      that is her choice.”

      … and she deserves all those horrible unnecessary INTERVENTIONS because she didn’t choose what I consider to be the norm.

      Fixed it for you. Sorry but that’s how I read your post.

      Since I would always feel safer with a more qualified health care provider, I say fuck you to everyone who tries to make it sound like I am being irrational, beyond the norm THE LESS QUALIFIED PROVIDER decided they are entitled to choose for me and frankly, being placed at the same level as the high risk pig of woman who insists on her HVBA3C with breech twins. We’re both making choice, after all.

      Not all choices are created equal and they should not be treated as equally responsible.

  • Due diligence

    This is reminiscent of the decision to stop reporting on maternal mortality rates for elective caesarean sections after the last time this figure was reported in the UK “Why Mothers Die” 1997-99 report of maternal mortality. It showed the same or lower maternal mortality rate for scheduled, non urgent caesareans compared to vaginal birth. Of course this was unacceptable, and subsequent reports have failed to separate scheduled CS from elective CS for medical complications.

    • Young CC Prof

      INteresting. I will have to look up that report.

  • Hannah

    “In order to achieve the desired result, the investigators created eligibility criteria that are substantially stricter than the actual eligibility criteria for homebirth in the UK.”

    This is slightly misleading, as the UK doesn’t actually have eligibility criteria for homebirth, as such, although I imagine the counselling you receive will be different if your a third time mother with a pristine obstetric history compared to a multiple breech VBAC. Ultimately, you don’t have to come into hospital and if you don’t a midwife has to attend you at home (although in practice the local service may make excuses to try and dissuade you)- ironically birth centres are more restrictive in their admission criteria.

    • ga

      This! The new recommendations are for low-risk, second-time mothers. The NHS definition of low-risk will include information gained from looking at previous births.

      And ultimately, you can still choose to give birth wherever you want (just like those women with high-risk birth excluded from the study gave birth at home).

  • NoLongerCrunching

    It would be interesting to know how many women on the committee had epidurals… and if the men would change their minds if they had to undergo some sort of birth simulator process. Of course the latter would probably be considered unethical (eyeroll).

    • Karen in SC

      My thoughts exactly! Just like those Youtube videos of men hooked up to a simulator.

    • pettelly

      Does it matter? No one is talking about denying anyone epidurals. It’s about choice and there IS demand for more home births or births in birth centres in the UK. Any woman who is planning a home birth is entitled to transfer to hospital at any time, including because she wants an epidural.

      • Karen in SC

        I think the language is definitely pointed to *not* having the choice of a hospital birth for low-risk women who have already had one birth.

        • pettelly

          No, you’ve misread it completely. The report talks about midwife led units AND home births. Midwife led units are usually in hospitals. This is not about denying home births. The maternity system in the UK is NOT the same as the system in the US. This is about increasing choice.

          • Karen in SC

            Quoting: More women should give birth with only midwives present, including at
            home, because that is better for them and their babies than labour wards
            where doctors are in charge, the government’s health advisers say on
            Tuesday.

            This is about choice? I don’t read it that way at all.

          • pettelly

            The words INCLUDING at home should give away the fact that we’re talking about hospitals as well as home births. Midwife led units in hospitals are very common.

          • Amy Tuteur, MD

            Why should the government encourage form of birth over others?

          • pettelly

            It’s not the goverment. These are guidelines released by NICE which is independent of government.

          • Christina Maxwell

            It certainly is. I knew this was coming, the moment the current government let it be known that as far as they were concerned any woman should be able to have a caesarean if she wanted it. It was only a matter of time before the midwives and NICE got up on their hind legs and started screaming for THEIR agenda.

          • Karen in SC

            Can you get an epidural in a MLU? Easily? When you want it?

          • Christina Maxwell

            No you can’t. I would also like to add that in parts of the UK the MLUs are absolutely bloody miles from the nearest hospital.

  • Beth S

    Okay, homebirths are supposed to be safer than hospital births? What would the UK have recommended in this outcome. I presented footling breech at 39 weeks. I was scheduled to go in for a C-section tomorrow due to my own health issues. My normally well controlled gestational high blood pressure was climbing fast, and I was six centimeters dilated with a history of rapid labor and delivery as well as post natal seizure. I was able to forgo the full emergency C-section routine because they were able to get the epidural in and get me into an OR stat. Baby weighed 7 lbs 8 oz and was a 8 9 on her apgars. Although my DH still wants to know why they weren’t perfect, everyone was healthy and baby and I came home yesterday happy and healthy.
    Would the UK have wanted me to have this baby at home where it could have killed me and my baby? Would they have advocated for me to die leaving my DH to raise a baby by himself at forty? Or even worse for DH to have lost both baby and I in childbirth? It sounds like they’re trying to take the world back to the dark ages where women died during child birth regularly?

    • Montserrat Blanco

      You would not be a good candidate for a homebirth in the UK due to footling presentation, high blood pressure, previous seizures post delivery. They only encourage it for really low risk pregnancies. But, as Dr. Kitty explained before they have to accomodate your wishes if despite being high risk you still want to have a homebirth. But they would make absolutely clear that this is not a good option in your case. You would probably be offered exactly the same care by your OB in the UK that you have received.

      Congratulations for the new baby!!!!

      • Beth S

        Actually, I was being sarcastic, and thanks for the congratulations BTW. When I asked my OB here what he thought about me homebirthing (it was more a test than anything else because I knew how high risk I am) he looked at me like I was nuts and told me he’d drop me in a heart beat.

        • pettelly

          The thing about the NHS is that you can’t just ‘drop a patient’ because you don’t agree with their choices. You can strongly advise against but you can’t refuse to care for that patient.

          • Poogles

            “The thing about the NHS is that you can’t just ‘drop a patient’ because you don’t agree with their choices.”

            I think a large part of the reason it doesn’t work that way here in the US is the medico-legal environment. A UK doctor is (apparently) mostly protected from legal action or losing their license if they can show the mother was advised over and over that they were making a risky decision and then there is a bad outcome.

            In the US, on the other hand, a mother can be told repeatedly her choice is risky and can hurt or kill babies, still make that choice and then turn around and sue the doctor if there is a bad outcome, even though it could have been avoided by following the doctor’s advice to begin with. Thus, doctors are much more likely to “fire” a patient and refer them to someone else who may be more agreeable to their desires than to be on the line for risky choices they don’t condone.

            Of course, the lack of universal/national healthcare in the US is also a huge aspect (one of the main reasons a family sues for a bad outcome in birth – they have no other way to pay for the care of child severly injured).

          • Beth S

            But there are fall backs, most children who are severely injured at birth can in fact be covered by social security and either medicare or Medicaid, especially under the relaxed guidelines of the ACA. There are some reforms I feel are needed when it comes to the medical liability laws in this country don’t get me wrong, but I do think the malpractice industry in it’s own way has helped make things safer for all patients.

          • deafgimp

            First of all, it’s a misconception that all children with severe birth injuries can get SSI. The parents’ income is taken into account. It’s household income, so if the child has a parent and a stepparent, the stepparent’s income can be used to see if the child qualifies. If the parent makes too much money, no SSI for the child until it hits 18 and the child is legally an adult and can qualify on their own. They can’t get SSDI, which is based on employment, since of course they are children and have no employment. The child might qualify for Medicaid depending on the individual state guidelines. Even if the child has SSI and Medicare, Medicare only pays 80% unless you pay for supplemental insurance. Micropreemies have different rules than other babies/children, but they are only covered by Medicaid for a short while, it’s not for the life of the child.

            http://www.socialsecurity.gov/ssi/text-child-ussi.htm

            http://www.socialsecurity.gov/ssi/spotlights/spot-deeming.htm

            So no, there is no real fallback for people who work and earn money and have a severely injuried child from birth. The income guidelines for SSI are extremely low, and you’re only allowed to keep a set amount of cash in the bank (like 2k or something like that). That’s because they expect you to use up all of your own resources first, and you can only apply for SSI if you truly have no other options. You can’t even save up for an emergency, so if someone loses their job you’re immediately in trouble. SSI is not an easy or comfortable way to live. It’s not a true fallback, given you have to have so little money to qualify for it.

          • Young CC Prof

            Not totally true. If you are severely disabled at birth, or at any point before the age of 21, you can qualify for SSDI under your parents’ work credits. Starting from birth or the time of disability.

            However, SSDI is not that much money, and if the child requires custodial care, it’s just plain not enough at all. A friend has a sister in that situation, and it’s extremely stressful for the whole family, both financially and otherwise.

          • Beth S

            I like the fact that if my doctor felt I was doing something majorly wrong during my pregnancy he could refuse to be a part of it. For some it can serve as a wake up call as to how dangerous their choices are.

    • Mishimoo

      Oooh congratulations on the new baby! Good to hear that you’re both doing well.

      • Beth S

        Thank you! This time was so much better, no fear, no ambulances, no pain during birth, and the pain was and is well controlled post labor. I’m not sleeping, but bah who needs sleep.

    • Dr Kitty

      Nope, you’d have had your CS with a spinal or epidural just the same.

      The recommendations are for low risk pregnancies.

      My local MLUs risk out pre-e, GDM, breech, twins , high BMI, epilepsy, asthma, previous shoulder dystocia, PPH etc and women have to opt in to deliver there.

      To be clear, while the guidance is saying that low risk women should be encouraged to deliver at home or in MLUs, every woman still has the right to decline that option, and high risk women will not be offered the option at all.

      In fact, women here are so uncomfortable with how far away one of our MLUs is from hospital, that they are declining to use it. Despite a rising birth rate it has had a year on year fall in use, and is averaging less than 20% of the predicted numbers.

      • Beth S

        I’m glad to hear it, I really don’t mean to be dramatic, but I did have someone tell me it was selfish for me to have a CS just to save my own life.

      • Christina Maxwell

        Except in Scotland. A friend of mine had to scream blue murder for weeks to get permission to use the ONLY OB unit in the area. She only got her way after her bladder prolapsed. She was absolutely terrified and nobody cared. She was booked into the local MLU which is 35 miles from the nearest hospital. As it happens she ended up with an emergency cs.

    • Mama

      No need to be so dramatic. I live in the UK and regardless of what the guidelines state they don’t mess with high risk pregnancies. I was flat out refused to have a VBAC in a midwifery led unit even though it was attached to the main labour ward. And all the equipment and expertise were just down the hall.

      • Beth S

        It was a what if scenario. That wasn’t me being dramatic, that is the problems I had during my own pregnancy. I like presenting my scenario around and seeing what people say about it, because I did have someone tell me it was wrong for me to have a CS even with all of those reasons.

        • Steph

          you have 2 risk factors… footling breech and high blood pressure. just one of those risk factors would deem you high risk and both midwives and doctors would advise against a homebirth in this case. Was i wrong for you to have a c-section… no idea without all the facts but we definitley wouldnt encourage you to have a home birth in the UK.

  • Amy Tuteur, MD

    OT: Doula Dani is featured in an excellent article on SteadyHealth:

    http://www.steadyhealth.com/articles/doula-dani-homebirth-after-c-section-a-gamble-a3842.html

    • fiftyfifty1

      Really well done Doula Dani. A terrific review of some key data without losing sight of the real-life emotional and social needs of individual women. This is the sort of nuanced, in depth, article that is empowering.

      • KarenJJ

        I agree, that was awesome. Well done to all involved.

  • pettelly

    This is not all about midwives. The Royal College of Obstetricians and Gynaecologists also supports homebirth.

    There have been some failures of oversight in midwifery in the UK but no more than among junior doctors or nurses or, indeed, senior doctors, and accountability should be improved throughout the system.

    But the model of care in the UK isn’t the issue – it’s the lack of funding and the shortage, not only of midwives, but also of obstetricians, especially in the face of a baby boom.

    Fair enough to query the report and to question the motives but don’t blame this on midwives. This isn’t about them.

    By the way, just so you know for the stats, women cannot be refused a home birth on the NHS. They can be very very strongly advised not to but if they insist on it, midwives and even doctors WILL come out and attend. Someone I know had a previous shoulder dystocia and is insisting on a homebirth even though the home birth have advised against it. If she insists, she’ll get it.

    • KarenJJ

      I agree with the underfunding but I disagree that midwifery is not also at fault. I think there are some ideology issues in midwifery regarding pain relief for women at the very least and possibly some ideology/turf issues regarding access to further medical care/obgyns/maternal requests c-sections.

      • pettelly

        Partly. There are some big issues with pain relief but that’s not only in the UK and the OBs are just as much to blame in refusing maternal request c-sections, for example (it wouldn’t be the midwife’s call – she’d have to refer to an OB if a woman insisted on a c-section). The gatekeeper issue is one which is pervasive throughout the NHS, not just maternity.

        I’m not passing judgement on the NICE guidelines. People who understand a whole lot more than me made that call and I have no reason to believe that it wasn’t on the best available evidence. But I do think that blaming NICE findings on pressure for midwives is a bit ridiculous and shows a lack of understanding of the system in the UK.

    • Renee

      When the MWs are the ones putting their philosophy over evidence based care, I do blame them. They have a vested interested in so called normal birth, I am sure they had everything to do with this recommendation. IN the USA our lay MWs have influence because they are loud, I am sure MWs that are part of the health system are even more influential. Don’t blame some OB failures for this.

      It makes NO SENSE to use HB as a way to cut costs or add personnel, as it is so much more intensive than a hospital ward, which is why I think it is a political and ideological move.

      They ought to hire more OBs, and put some more money into maternity. They cut resources here because it effects primarily women, and you know we are second class citizens even in Western nations.

      • Durango

        And I think midwives are going to be even slower to transfer if the policy is to have as many births at home as possible.

      • pettelly

        No, midwives don’t have a vested interest in vaginal births or even home births. Midwives in hospitals attend c-sections as well (a bit like L&D nurses in the US). There are more than enough jobs for midwives in the UK. Many midwives prefer attending home births because they feel they can give the kind of care they’d love to give women in hospital (two midwives for each patient).

        NICE is not a midwife based organization. The RCOG is not a midwife based organization.

        Blaming this on midwives shows a complete lack of understanding of how the UK medical system works.

        • Amy Tuteur, MD

          They most certainly do have a vested interest in promoting vaginal birth and homebirth and they are quite upfront about it.

          • pettelly

            How do they have a vested interest (assuming you mean the Royal College of Midwives?) any more than, say, obstetricians (represented by the Royal College of Obstetricians and Gynaecologists)?

          • Guest

            Why do they have a vested interest? They attend the sections and care for the women in exactly the same way regardless, they’re paid the same. There’s no vested interest,

        • toni

          I don’t think the blame is misplaced exactly (just watch any of the recent programmes documenting what goes on on Biritsh maternity wards and you’ll see that midwives are more likely to dismiss a labouring woman’s pain than take it seriously) but I do think it should perhaps be more equally shared. I mean what exactly do British obstetricians do to counter this nonsense? Big fat nothing as far as I can see. They’re of course not as committed to NCB and avoiding interventions as the midwives tend to be but many of them are just as pitiless when it comes to ignoring pain e.g. not using lidocaine before cutting episiotomies because we don’t feel it if they do it during a contraction (yeah right) and none or very little for instrumental deliveries (which they seem to prefer to caesareans)

          • pettelly

            That’s the point I’m making – this ethos of denying pain relief until ‘absolutely necessary’ to labouring women is pervasive throughout the NHS. I’m not saying it doesn’t exist but that it’s not some kind of world view of midwives alone. Obs support it and perpetuate it just as much in my opinion. But this blog seems to blame midwives for all the ills of the NHS maternity system.

          • toni

            Yes I think perhaps Dr Amy should delve a bit more into that.Are British obstetricians having their arms twisted by the midwives? I think not. I might have had to have my baby in GB so I was asking friends/aunties about their experiences and it became apparent to me just how shamefully commonplace it is for doctors to not even think to offer anaesthesia for painful procedures. Just google ‘forceps no pain relief’ all hits from the UK

    • Phascogale

      What I don’t get is whether the midwife (who works for the NHS) can refuse to go out to a homebirth because of the high risk woman who insists she wants one. If I was that midwife I wouldn’t want to risk my registration or be the one to preside over a bad outcome. Same applied if I was the doctor that ‘had’ to go out.

      • Dr Kitty

        Nope you can’t refuse.
        You CAN document everything very clearly, and you are unlikely to lose your registration over a poor outcome that was predictable and which the mother was repeatedly advised could happen. In that case the woman would be seen by at least two consultants and advised against HB in full and frank terms. Medico legally the MW is covered.

        The NHS midwives are indemnified by their employers and don’t pay their own premiums. I actually think this matters in terms of decision making.

        It is still pretty terrible to have to watch a disaster unfold in front of you, but the numbers of women who would insist on HB against medical advice ( and with that documented repeatedly in their notes) is very, very few, thankfully.

        • pettelly

          Exactly. There’s a duty of care that seems lacking in the US.

        • Hannah

          Indeed, in this case the NMC struck off the midwife but it was overturned by the High Court, even though the birth was a disaster waiting to happen, she failed to call an ambulance in a timely fashion, and may have actively colluded with the mother to encourage her to give birth at home:

          http://www.bailii.org/cgi-bin/markup.cgi?doc=/ew/cases/EWHC/Admin/2012/3021.html

      • Mattie

        No, a midwife cannot refuse to attend a birth if it is ‘her’ birth to attend, s(he) would probably attend the birth with another midwife and the midwifery supervisor who would be there to document and ensure best practice was followed even in the difficult situation, the hospital would also be aware of the situation and the Labour Ward co-ordinator would be making plans for if the mother decided to transfer in. Saying this, a midwife can ‘hand over’ lead care to a more experienced midwife, so if the baby was breech and the midwife had little experience with a breech she could be second midwife to a more experienced lead.

        Finally, the midwife would be unlikely to lose her registration but there would be an enquiry if the outcomes were severely bad, and possible referral to the NMC (Nursing and Midwifery Council) for review.

    • The Computer Ate My Nym

      But the model of care in the UK isn’t the issue – it’s the lack of funding

      And who is robbing the NHS of adequate funding? The officials you elect. Vote them out and get a real government. (Yes, I know, I have no place to talk given the US government, but someone has to start the economy going again and it’s not going to be a country that’s into “austerity”.)

      • pettelly

        I agree on that one. Maternity has been notoriously under-funded throughout the years (the biggest problem in the UK isn’t the actual labour and delivery but post-natal care which is atrocious). The problem has become more acute because of the increase in fertility rates AND population.

        But it’s not about midwives exerting undue pressure on NICE or on the government! If they had so much influence, they’d have got more funding. In fact, the RCM has pointed out that the NICE guidelines on home births cannot be implemented safely with current staffing levels.

  • AnotherGuest

    I’m so worried about this NICE guidance. It will have a huge influence on women in the UK.

    • GuestS

      I think the guidelines are actually more in favour of promoting ‘out of hospital births’ which means birth centres. Some hospitals now have birth centres, or maternity hospitals, attached to them. The headline and article focus on homebirth because it gets a better response in the comments section and traffic.

      • Renee

        Birth centers are just as bad. If they don’t offer pain relief, they ought to be closed, unless we start denying pain relief to all others as well.
        Women MUST stand up and demand better care, or we will not get it. Feminists were instrumental in getting pain relief for women to begin with, it can be done again.

        • Wren

          I honestly think when we are discussing birth centres located within hospitals that are a matter of choice for the woman, not forced upon her, they aren’t a terrible option. I gave birth twice in the UK. The first was a c-section for footling breech presentation and the second a VBAC without pain relief. The lack of epidural truly was down to me, as I arrived at 10 cm. Hospitals will vary, but I think the idea that women are being denied pain relief on requesting on a regular basis may be untrue, given what I have experienced and heard from friends. Additionally, midwives can and do offer some forms of pain relief even at home births, unlike lay midwives in the US.

          • Phascogale

            I agree completely with Wren on this. The woman is not denied pain relief in a birth centre located in a hospital. She has all the non pharmacological methods available to her. She can also have gas and morphine injections.

            If she wants an epidural then this is what she can’t have unless she transfers over to the birth suites that are hospital orientated.

          • Dr Kitty

            My friends who have had IV Remifentanyl in labour loved it.

          • GuestS

            A lot of the birth centres are attached to the hospital, as in, down a separate corridoor, and you are able to have pain relief in them. Possibly not an epidural but you can transfer for that and, as I said, often it’s just down the corridoor, so no biggie.

          • Amy Tuteur, MD

            In other words, all the ineffective methods of pain relief but not the only effective method. That barbaric.

          • Wren

            I don’t think it’s fair to call it barbaric when it is the woman’s choice. Now, if women are not being allowed an epidural or a hospital birth, that is a problem. Women choosing an option knowing all the while an epidural will not be available is a different thing.

          • OldTimeRN

            What if she changes her mind, like many woman do and ends up wanting an epidural? Offered Narcan, which is a terrible choice for the baby? Suck it up and deal? I doubt she’d be transferred to a hospital for pain relief.

          • saramaimon

            why are people who know nothing about homebirth making such comments? of course women get transferred for epidurals! why wouldn’t they? seen it done my very own self.

          • moto_librarian

            Oh, probably because some of the regular commenters on this blog had to fight tooth and nail for transfers during home birth. But yeah, tell us more about how we know nothing about homebirth,

          • Poogles

            “why are people who know nothing about homebirth making such comments? of course women get transferred for epidurals! why wouldn’t they?”

            That’s quite an assumption that the people commenting (on a site that primarily discusses homebirth) “know nothing about homebirth”. Especially considering how many commenters here have HAD homebirths.

            Regardless, we’ve seen/heard many instances of women attempting homebirth being outright denied transfer for pain relief (or having the transfer delayed over and over, until it’s too late), so we know it exists, and unfortunately seems all too common.

          • pettelly

            Women ARE transferred from birth centres and home births because they want more pain relief than can be offered there. It’s a very different system to the US and much more integrated.

        • pettelly

          The thing is that women do want birth centres and home births. It’s about choice. Better care doesn’t always mean pain relief, although effective pain relief when requested is part of improving choice and care.

          • Humph3

            Pettelly, you are banging your head against a brick wall. I commend you for trying but honestly, I wouldn’t waste my time if I was you ;-)

  • OldTimeRN

    I hate the WOO..Seriously, excuse my language fucking hate the WOO. I might even hate the hospitals who are trying to please the WOO, by, imo compromising our work to try and recreate the home birth experience. Mother-baby units encouraging and almost demanding mothers to keep their baby when they are exhausted, physically, mentally and emotionally. Locking up formula so to not tempt nurses or moms for giving that poison. Skin to skin for an hour or more after birth. Supposedly to promote bonding, stabilize baby’s temp, increase blood sugar and successful breastfeeding. Our “educators” and managers are mandating it, yet have no answers to the problems we bring up. They aren’t in the trenches, we are. We know what works and what doesn’t. Are we asked? No because when we give our opinion they think we are nothing but complainers and want what is easier for us. They have no solutions to issues that are brought up. Now do any of them have plans for how it all should work, even though they have been to all the conferences and read all the articles saying it’s best.But really imo, they want to save money by having us do more work with less staff to please a few WOOers.

    STOP THE MADNESS

    • Amazed

      Bonding. Sounds wonderful, doesn’t it?

      Say it to my mom who got handed the not so mini me a few hours later and all she could think was, I went through all of this for such a tiny (9 pound) result?

      Now imagine this taking place in the sacred bonding phase immediately after birth that you’re obliged to have. Fun time, eh?

      • KarenJJ

        I was concerned about bonding for some reason prior to birth. But afterwards I read something by Sarah Blaffer Hrdy (she researches infanticide among other things) and it put my mind at ease. Bonding in the newborn days is from the mother’s end and the desire (evolutionary-wise) is for the baby to be cared for and not abandoned or murdered. I felt an enormous sense of responsibility for my babies in the early days. I didn’t feel immediate love like some people do, but I’m not someone that feels it normally in other areas either. But the main thing – a sense of responsibility and care and tenderness towards my baby and wanting to get to know them – I had that in spades.

        Bonding from the baby comes later when they start to prefer their primary carers above all others – at around 6ish months when they start showing separation anxiety.

        I cannot rationally think of anything that would have changed that feeling of responsibility and tenderness towards my baby. I didn’t need to sniff them hatless or cuddle them naked or even breastfeed them. I was happy cradling them any which way and playing with their little fingers and toes and trying my best to keep them happy and settled.

        • Medwife

          I LOVE Sarah Hyrdy. She’s brilliant.

          • KarenJJ

            When I look at these types of “bonding” directives I’m really starting to think they’re infantilising a complex human relationship. I just haven’t seen a lack of bonding amongst my stable, relatively well-off, middle class parent friends towards their newborn babies. Where babies do get abandoned/murdered in my very limited experience (ie mostly from the news) is where a mother feels isolated and has a lack of support and /or mental illness. But instead people seem to be fretting about skin-skin, breastfeeding and hats. I don’t believe that these are typically the babies that are suffering for lack of maternal bonding and I don’t think the complicated issues that people with a lack of resources and support or mental health are going to be fixed by taking away hats and formula.

        • Jessica S.

          Very interesting! I would definitely say that the first “swooning” feeling I got over my son was his first attempts at smiling. Obviously I loved him dearly already but it was a different feeling, like you said, one of deep guardianship. But I was also baffled by how much he screamed during diaper changes (turned out to be quite normal, from what friends told me and did in fact disappear the second week) and I can’t say I felt particularly enamored with him after such sessions.

          I’m veering way off topic now, but it’s funny how I used to wonder if I’d think he was as fun and cute and stuff once he wasn’t a baby anymore. Being our first, I had no reference point. But at each age and stage it’s been a joy (and a battle!) and now, as I’m looking towards the birth of our second in just 9 weeks (that will drag on forever, I’m quite certain) I wonder how on earth I won’t be bored to death by a baby! :D Life’s funny that way.

          • araikwao

            No, it’s much more fun with a little person to chat to while you look after the baby. And of course they both want stuff at the same time (i.e. NOW!), so it’s much less boring!

          • Dinolindor

            I’m so glad to hear someone else say that! I’m 13 weeks away from my second and I’ve been worried about being bored with a baby (and frazzled with having to tend to a newborn’s needs plus a 3 year old’s plus my own). I’ve been feeling tinges of jealousy when I think about how my husband will end up getting more one-on-one time with my son while I tend to the baby. My son is just so interesting and perplexing in a much more intellectually stimulating way now at 3 than when he was a baby. But at each stage along the way I thought he was at the pinnacle of interesting.

          • moto_librarian

            I didn’t really enjoy the newborn period the first time around. In large part becaus I was having a difficult recovery, breast feeding was not working, and we learned that our son had soy and cow’s milk protein allergy when he was one month old. I found the second time around to be much more enjoyable because I had more confidence in myself, had a much easier delivery and recovery, and didn’t beat myself up when my milk failed to come in for the second time. I also knew that this was going to be our last child, and I savored the experience for that reason. I will also say that one of my greatest joys as a parent has been watching the bond develop between my sons. It is amazing.

          • Young CC Prof

            Yup, I would agree with this. I definitely felt attached to and protective of my son from day 1, but now that he has that special smile for me when I pick him up out of his crib in the morning? Whole different kind of love. The difference between loving an idea and loving a person.

      • EM

        Forgive me, but I really don’t understand this NCB bonding BS. Not to mention this ideology that VB, BF, baby wearing, no hatting, patting or chatting will ultimately result in world peace because our children will be perfect. It drives me nuts.
        My son and I were separated for 9 days after birth. He was in NICU: first two days I was not allowed to touch or hold him; held him on day 3 and day 4; I was discharged on day 4; I was back in hospital day 5; in ICU days 5-9 (post partum pre-e organ failure, pneumonia etc – fun*). He’s 21 months now, strong and healthy. And we couldn’t be more bonded even if you stuck us together with superglue and added a roll of duct tape for extra security.
        Further, I think this obsession with immediate post partum bonding is insulting to fathers and adoptive parents. If everything hinges on that then they are doomed to never be bonded to their kids. What a load of….

        • OldTimeRN

          I think that is what drives many of us crazy. No matter how many times it’s pointed out skin to skin and other WOO crazy doesn’t matter in the bonding process it’s pushed aside because “research” shows. WHAT RESEARCH? It’s also crazy to think how much influence the crazy is starting to have over hospital settings. Why are we catering to them and possibly ruining it for others? Skin to skin is just the latest in a long line. IMO, that is how mother-baby units have replaced traditional postpartum and nursery units. Rooming in was considered unheard of when I started my career. Then it was a choice. Now we are suppose to encourage it. Next we will almost demanding it, by not giving mothers a choice.
          I find it insulting to fathers, adoptive parents and mother who want to you know actually have a few minutes alone without her baby, while the baby is being well taken care of and who go on to perfectly bond with their baby. Where is that research?

          • EM

            Exactly!

    • Jacqueline

      What are the problems with skin-to-skin after birth?

      • moto_librarian

        I am guessing that it’s the rigidity of the policy. Skin-to-skin is nice, but it’s being touted as a prerequisite for bonding and successful breastfeeding to the point where people are upset if their baby really does require more observation or care. If a baby’s sugars are off, I don’t see how skin-to-skin is going to help that, for example.

        • OldTimeRN

          Let’s not forget that it will be “our” fault something screwed up with their perfect birth experience. We end up looking like the bad guys.

          • moto_librarian

            And that really makes me angry too! I know that there are bad nurses, but my L&D and postpartum nurses were terrific! I held my oldest son for maybe a minute before they took him because he wasn’t crying, and then the pph started. I wok up after surgery around 8:00 to have my husband tell me that the baby was fine, but being observed in the NICU for what I now know was TTTN. I was actually relieved because I just wanted to sleep. The next morning, my husband wheeled me down to really meet our baby, and the nurses were absolutely wonderful with helping me to get comfortable and reassure me that he was fine. My postpartum nurses were so compassionate, recognizing that I had been through a pretty rough time. When we learned that our son would have to stay an additional night, one of our nurses arranged for us to stay in the family room so we wouldn’t have to go home without him. I love nurses, and I thank you for all that you do.

        • Jessica S.

          I didn’t even hold my son that much the first day or so, mainly b/c I had a CS so a) it was semi-uncomfortable the first part of day after he was born and 2) since I wasn’t really mobile, it was awkward to simply hold him in bed. Someone had to be right there to take him when I was finished, and so on. Blah. And you know what? I didn’t shed a single tear (well, not over that. I shed a lot over other things!) and to this day, it doesn’t bother me one whit. I was going to have more than enough opportunity to hold him at home, more than I’d want at times. :) I definitely would feel suffocated with a bunch of skin-to-skin time and it cracks me up, the tortured reasoning of what’s lacking if you don’t do it. Short answer: if you aren’t so inclined, you and the babe aren’t missing anything.

          • Haelmoon

            I have mentioned before, my first was born via an emergency C-section for cord prolapse. She was also early and underweight for her age. She was quite unstable the first few days (no time for steroids), I didn’t even get to hold her until she was four days old (on my way home as I was just discharge). The NICU doctor tracked me down as I was leaving so I could have a little cuddle before I left hospital – she was there for another 8 weeks. She got very sick with NEC and I couldn’t hold her for several days again the next week. We have bonded very well – it clearly wasn’t a factor.

          • Anj Fabian

            I’m so glad she pulled through! What a scary time for you.

      • OldTimeRN

        There is nothing wrong with skin to skin per say. It’s the claims of what skin to skin does. Regulate baby’s temp? Not really. A wet baby isn’t going to warm up being on Mom’s chest. A wet baby can lead to a cold baby. A cold baby can lead to a baby with low sugars. Which can lead to a baby needing formula to regulate the blood sugar. See how that cycle works?
        What is wrong with skin to skin for a few minutes, then putting the baby on the warmer, for 10 to 15 minutes while Mom is being repaired up, or cleaned up? Baby can be cleaned off, meds given, weighed and warmed up. Takes less then 10 minutes, then baby can go skin to skin with a warm blanket and breastfeeding.
        And as someone right below said it something else that sets Mom up for failure,if a baby needs medical help or to be seen by a neonatologist immediately after birth.

        • Ennis Demeter

          i read a comment somewhere in which a new mother said she stayed naked with her baby (baby also naked) for TWO weeks and didn’t leave the house or put on any clothing. Blah, blah, blah, don’t judge, but that’s insane and really weird, and really hard on the mom for no reason whatsoever.

          • OldTimeRN

            I wonder what she accomplished with her baby in those 2 weeks? Is she now the bestest bonded mother of all mothers? Does it make feel like a mother? A woman? Is her child the bestest bonded baby on the planet? Will he/she pee golden urine? Will he never cry or throw a tantrum? A straight “A” student? WHAT?What was her whole goal? That’s a question I often ask myself with all these changes happening.

          • Ennis Demeter

            A lot of stained sheets and comforters.

          • OldTimeRN

            I try really hard to respect Mom’s need for resting. I also try to limit my interruptions to as brief as possible, unless Mom wants my help. But certain things have to be done, per the hospital or per the state. I try to accomplish things like hearing screens when I have the baby for morning assessment. But sometimes interruptions can’t be helped. You can thank your state, your per, or OB or hospital policies for that. But please don’t shoot the messenger(the nurse) who is just doing her job. We are not the one who asked your OB to come at 4am to circumcise your baby.

          • OldTimeRN

            Damn replied in wrong spot. This was a reply to UsernameError

          • CognitiveDissonaceHurts

            I did it all in the quest for the perfect child. It.did.not. work.

          • Beth S

            Perfect children don’t exist. Even my lovely new DD won’t be perfect forever, for now yes, forever no.

          • Sophia Marsden

            Maybe she enjoyed it.

          • AmyP

            Hello, postpartum depression.

          • Guest

            Maybe it was lovely and warm, and additional layers were troublesome to handle?

        • KarenJJ

          That’s what I noted, albeit my baby was born via c-section. I requested skin to skin and the staff was very accommodating and had warm blankets to cover us. Ultimately though I didn’t think it changed how I felt about my baby and a few hours afterwards she broke out in a rash that she can get from cold temperatures (a rare and odd issue that we didn’t have a name for at the time, but has turned out to be treatable). I didn’t worry about requesting it again for my second baby.

        • Mishimoo

          That’s pretty much what happened with my babies, except that they didn’t need warming because they were quickly wiped down on their way up to my arms and they latched on straight away. The warm blanket was heavenly! After a snuggle and a feed, they were wrapped up and hatted (oh, the horror!), taken for weighing and an exam, plus their shots (except the youngest, he had his Vit. K immediately) and their dad got to push the bassinet and cuddle them. I had the most amazing showers ever, despite the supervision, and then we snuggled some more. It was lovely.

          • Beth S

            What’s wrong with hats anyway? I kept both of the ones my kids had from when they were born.

          • Mishimoo

            Some NCBers claim it inhibits bonding due to the mother not inhaling enough of the “birthy smells”, so it has become a bit of a joke around here.

    • Aki Hinata

      I want my hospital to bring back its nursery. Seriously. After the birth, I need to be able to have rest and it doesn’t come with non-stop rooming in.

      • UsernameError

        YES! If I’d been at home, my husband would have been able to help out with the baby while I got some rest, but instead they make you stay in a room alone, with no help, and no nursery. Oh, and they come in at 2am for vitals, and 5 am for blood and hearing tests, waking you and the baby. I would have loved a nursery.

        • MaineJen

          My hospital tested the babies’ hearing AT MIDNIGHT. Seriously.

          • thankfulmom

            I had a night shift nurse come in wanting to explain the hearing screen paoer I had to fill in. I was deliriously tired and told her so. 2 am is bad timing for filling out a bunch of paper work.

          • Dr Kitty

            They asked when I was planning to get up and took her for her hearing test while I was in the shower. It was sensible and civilised…in the UK.

          • UsernameError

            I know, what’s up with that? At my last delivery they had the residents do the infant discharge exam at midnight so they were ready when the staff showed up in the morning. You’d think it wouldn’t be that hard for the staff to coordinate visits. I’d get woken up for the baby’s vitals, then 30 mins later for my vitals, and then 40 mins later the trash lady comes by, and then it’s time to check the diaper and feeding count for the breastfeeding pushers, then baby’s vitals again, and then hearing tests, and then the jaundice sticks. Seriously, people, just come in all at once. It’s more efficient anyway, and really makes a difference to mom.

          • An Actual Attorney

            But it’s not more efficient, because they all would have to wait for each other to travel in a pack.

        • saramaimon

          they’d check your blood pressure whether or not you were rooming in, wouldn’t they?
          you might consider early discharge.

          • UsernameError

            Yes, they’d come in for vitals, but if the baby was in the nursery, it wouldn’t wake him/her up, and take mom a long time to get the baby back to sleep.

            I was thrilled when I heard the AAP started very early release protocols, but then I had another preemie, and that went out the window.

            I love going to the hospital for the birth. I love that if disaster strikes we’re covered, and that if I need pain meds it’s right there. But I hate, hate, hate the post partum hospital care. I suck it up and do it because it’s best for me and the baby, but these “baby friendly” hospitals make an unpleasant post partum stay a nightmare, and that includes leaving mom and baby completely alone with no help at all after delivery. Some moms have a really rough delivery, and they’re tired, and need help! But there is no help.

    • Joy

      I didn’t get skin to skin after my forceps birth in the UK. I was told the room was too cold. They cleaned her up and brought her to recovery and made us tea and toast.

    • Guest

      Forgive my ignorance, but what is the concern with skin to skin?

      • saramaimon

        NONE. its promoted by natural birth advocates, so its guilty by association. and as she explained so honestly, its MORE WORK.

        • OldTimeRN

          Excuse me, but it’s actually less work. Leave mom and baby with Dr Google while I go help others who actually want my help and expertise.

          • saramaimon

            you said your self it was more work.

          • Sue

            Sara Maimon – you appear to be outside your area of expertise. Maybe sit back and listen a little.

        • http://kumquatwriter.wordpress.com/ Kq

          Bullshit. I was denied help with my newborn post cs in the name of skin to skin and breastfeeding. They propped him between me (like Renee above, nodding out from exhaustion) and a pillow on the railing (which can KILL a baby!) and wouldn’t take him out of my room. At all. By the time I was discharged I was hallucinating from sleep deprivation, having been awake for 3 days straight. This wasn’t because nurses didn’t want to do more work – it’s just “Baby Friendly” hospital policy.

          • OldTimeRN

            I’m sure a nurse would have loved to take your baby to the nursery for a few hours and encouraged you to sleep. Unfortunately she couldn’t because it would have been against policy.
            I find that very sad and I’m sorry moms who are having babies now a days are being almost forced into this, whether they want it or not.

          • http://kumquatwriter.wordpress.com/ Kq

            No doubt. But they didn’t HAVE a well baby nursery. At all.

        • moto_librarian

          I am really growing tired of you. Skin-to-skin (kangaroo care) has demonstrable benefits for preemies, but those benefits are not proven in term infants. The piece about bonding is pure horseshit, and the other things are questionable.

        • moto_librarian

          It’s also a convenient way to spend less money on needed staff.

    • Renee

      I hate it too. I am tired of hospitals catering to the NCB crowd, even going so far as to not report the CPM disasters, and trying to work with them. HB moms, and the so called MWs, are the minority, as are women that do not want pain relief (even in an area with lots of OH birth). But everyone is bending over backwards trying to please them? Catering to every whim so they don’t choose HB, even though they STILL choose HB? Doing things that actually hurt the rest of the moms? NOT OK.

      After my 36 hour marathon labor, starting at 1 am, then a CS with my DS, I thought I could send him to a nursery and sleep. About 4 hours after I got out of recovery, they came in with my son, and left him! I couldn’t even move (I wouldn’t be able to get up for almost 3 days!), let alone get up to help him, and change him, etc. They looked at me like I was nuts for sending my family home, but they too had been up 48+ hours and were useless by that point. There was no place for them to sleep, so I innocently thought we could all get a good nights rest and start fresh in the morning.

      NOPE. They actually left me, nodding out and sleeping sitting up from the pain meds, and unable to get up, with a fragile newborn to care for- all alone. He was in a bassinet next to me and I couldn’t even reach him! When he started to cry, I could do nothing, so I slept instead. Eventually, a nurse came in and took him on rounds. This is NOT a good solution to rely on a nurse to add to her workload like this, and it was extremely unsafe to leave him with me in the first place.

      He ended up in the NICU that night, and I am sad to say I was relieved. He didn’t have any serious issues, just a few things that are treatable, so I took this time to relax and recover. It took days to get up, I cannot imagine having him there. They did have a day nursery, but no night one, which is like torture IMO. I have no clue what they thought when they made this policy.

    • saramaimon

      so youre saying that we should lower the standard of care because of understaffing? thats your solution? you remind me of an RN manager who once told me she couldn’t wait for the ‘old time’ staff to retire, so bonded as they were to their ‘old time’ ways.

      • saramaimon

        ps the madness that you are referring to is called a. evidence based care and b. customer service . you don’t like it because its more work for you.

        • Stacy21629

          Please show us the evidence you’re referring to.

          And medicine ain’t McDonalds where you order up and the staff is just there “to make you smile”. They do have a job to do. One that generally involves keeping mothers and babies safe.

          • saramaimon

            there is no evidence that a warmer is better, therefore there is no justification for standardized separation of mothers from their infants.
            as for bonding, human bonding is very variable, but the bonding that we are talking about i believe is the mother’s bonding. a generalization which means its often true, although not always.

          • OldTimeRN

            There would be plenty of evidence to show a warner is better if we were asked for it. Babies don’t get cold on the warmer, but they do in fact get cold laying skin to skin with mother. And when they get below a certain temp they have to go? That’s right, on the warmer.

            That’s not to say skin to skin won’t keep some babies stable, but why take that chance? I’d rather prevent an issue with a non invasive solution then have to backtrack and fix a issue, with maybe a more invasive solution.

          • Sue

            sara maimon appears to have a misunderstanding of the “bonding” evidence, which we’ve discussed here before. Everything else being equal, the only requirements for parental-infant bonding are a loving and secure relationship and enough food and warmth.

            Show us any good evidence that having your baby with you 24hours/day through the first couple of days affects “bonding”.

            Pro tip: adopted babies – even bottle-fed – bond to loving parents!

        • OldTimeRN

          Where is the evidence? Who decides what is the evidence? Do adoptive babies bond less with their adoptive parents? Do baby who spend days, weeks or months in the NICU bond less then baby who room in and who do skin to skin in the delivery room? I’d love to see all these evidence we keep hearing about but never actually see reports of.
          As for more work, you have no idea how much work it is or isn’t. But a mother who wants a home birth experience is actually less work for me. I offer and usually get turned down. That is until the baby won’t latch like Dr Google said they world. Or lost so much weight requiring a supplement. Or won’t settle during the night and mom or dad are requesting a pick up of the baby so they can get some sleep. But yes it can end up being more work because it takes me away from my other patients who I’m also in charge of. Do you want the nurse taking care of your baby to ignore your baby because she has to spent most of her time “home birthing” with another family? Why does one family deserve more services because they want to recreate a home birth experience? Don’t all patients deserve that much? Nurses end up having to give less attention to families who might not have problems because we have to give our attention and bend over backwards for others. The other families might not even notice, but as nurses we notice. There are only so much time in the day. Then to top it off when it discharge survey time it’s usually the WOO who give the least praise and the ignored patients who rave and give 5 stars. Because there just isn’t no pleasing.

      • OldTimeRN

        Who said anything about wanting to lower the standard? What is wrong with our present standard? Catering to the NCB crowd who in the end might not be pleased anyway. Taking away choices for others who don’t want skin to skin or feed their babies in the nursery overnight, imo IS lowering our standards.

        The hospital will want more work with less staff or the same staff and in the end no one will be happy and the standard will be lowered. Through no fault of the nursing staff, you know the woman who actually do the work.

    • http://kumquatwriter.wordpress.com/ Kq

      Thought of this reading your comment.

  • http://www.antigonos.blogspot.com/ Antigonos CNM

    IMO the article just showed how divorced from reality those managing the NHS are, if they think that encouraging home birth will save the NHS money. It is exactly the opposite.

    I found the comments, many of which just seem to recite the NCB woo, very interesting. As always, women whose first births were in hospital attributed the negative experience to the hospital instead to being primips; when they then had a “nicer” home birth, of course it was being at home that did it, not the differences in primip and multip labors and births….

    • Young CC Prof

      Hey, I know, let’s devote 2 fully-trained midwives to each laboring woman for the entire duration of labor. Then let’s increase demand for ambulances and STAT c-sections. That’ll save lots of money, right?

      • Renee

        And lets totally ignore the costs of all the cooling therapy and brain damaged kids that live with CP….

    • saramaimon

      yeah those dumb chicks don’t really know what their really experiencing, those drama queens
      (sarcasm alert)

      • FormerPhysicist

        They might know *what* they are experiencing (an easier labor at-home with the second) and still attribute it to the wrong cause. It’s easy to mistake. Haven’t you ever gotten a stomach bug shortly after eating a particular food and you just can’t eat that food for months? Even when your logical brain *knows* it was NOT food poisoning.

  • http://www.europeanmama.eu/ Olga Mecking

    I wanted to share this article about Dutch births: http://www.dutchnews.nl/columns/2014/05/home_births_let_the_gynaecolog.php Obviously, it has created some controversy (Scare-mongering! Doctors have never seen a normal birth and so on). I heard there are changes coming to the Dutch maternity systems and it looks as if doctors will get more say in a woman’s birth. Which isn’t a bad thing at all.

  • http://Www.awaitingjuno.blogspot.com/ Mrs. W

    I’m shocked this is coming from NICE – the same organization that has published guidelines that should establish a woman’s right to a maternal request cesarean (*I note there seems to be a bit of a difference between in theory and in practice). I’ve said it before, I’ll say it again, the economics of birth are terribly flawed because outcomes that accrue after 42 days post-partum are rarely taken into account. I’d be okay with a far more neutral guideline that said those wanting homebirths should be advised of the risks and benefits of doing so. But to encourage homebirths: that crosses a line.

  • moto_librarian

    It is telling that there is not a single word mentioned about pain relief. Many of us want pain relief, preferably from an epidural. After my first “natural” birth, I thought that I could never go through that again. I planned on an epidural from my very first prenatal appointment, with nitrous as a backup in case of precipitous labor. Given that I had a pph, I would not be considered low-risk, but it truly troubles me that pain relief is not even a consideration, to say nothing of the fact that home birth can NEVER be as safe as hospital birth.

    • Gene

      I think this is HUGELY important. Regardless of increased risk of morbidity and mortality, this group in encouraging women to undergo an (to the vast majority) incredibly painful event WITHOUT effective pain relief. We don’t ask anyone else to just “deal with it”. It smacks of the concept of original sin and women’s’ punishment. It is incredibly offensive.

      • Ash

        Don’t forget this genius statement from a UK HB midwife:
        “By the time the midwives have been with her for three hours, she is ready to give up. “I can’t take this pain. I’m sorry, everyone, but I don’t think I’m going to make it. I would rather have the drugs right now than be at home.”

        Depending on one’s interpretation, the midwife is either calming – or reluctant to admit defeat. “Do you really, really want that?” she asks. “Why don’t you listen to some music
        instead?”

        NO, TRANSFERRING TO THE HOSPITAL IS NOT THE SAME AS LISTENING TO MUSIC

        • Jocelyn

          It upsets me that people feel like they have to apologize for being in pain.

          • Carrie Looney

            Specifically, apologize for not wanting to be in pain anymore.

            What kind of sick cult mentality says that you’re a failure to yourself, the community, and your child if you want relief from pain?

        • Jessica S.

          Awful. What’s it to the midwife whether her client transfers to get effective pain relief? Oh, right: money and the time devoted to a futile ideology.

        • Renee

          I loathe anyone that does this to a mom, as if she is weak minded and cannot decide for herself what she needs. Hell, even a child ought to be able to decide if they need pain relief! They are just as bad as the docs of the 50′s that they decry. Paternalism is no better as maternalism.

      • moto_librarian

        This is why I take such issue with natural childbirth being equated with feminism. Feminism is about choices. If someone wants to give birth without pain medication, I truly don’t care, but I loathe the notion that women are being bullied into them because of misinformation or misogynistic care providers. Midwives are supposed to be “with women.” If a woman decides that she has had enough pain, it is your job to help her get effective relief, not talk her out of it or treat her like a silly child. Until you have had a baby, you don’t know how painful it is going to be, or how well you tolerate that pain. I know some women find labor tolerable, and that’s great, but most of us find it excruciating. Women had to fight for pain relief, and I simply cannot understand why it is suddenly seen as weakness to avail ourselves of modern medicine.

        • Renee

          IMO, feminism isn’t about choices, it is about freedom from the oppression of patriarchy. Once that happens, the other things can fall into place. You can have choices without stopping the oppression. You can have improvements in the lives of women without freeing them from patriarchal system we all live with.

          The ability to be treated with respect, and with the full use of all medical technology, just like men, is vital to fight for. To have medicines and technologies developed for us, instead of treating us as an afterthought, is also important. Making sure we have pain relief, like men for other painful conditions, is crucial.

          No one will give these things to us without a fight. Every INCH women have gained has been a battle in a long standing war. For this reason, I think women that fight against pain relief for other women, are traitors. If they want to have an NCB, that is fine with me. But putting up barriers for others to stop them from availing themselves of pain relief, and advocating policies that push NCB on the pub lic, makes them anti woman. Just because they aren’t beating women for adultery, or banning abortions in all cases, does not mean that they aren’t anti woman. We can be our own worst enemy.

    • CognitiveDissonaceHurts

      Is there any research going on for other ways to treat pain besides the epidural?

      • theadequatemother

        We’ve looked at systemic narcotics and remifentanil PCA but it’s not particularly effective sadly. A couple of good studies on it were published in A&A a few months ago. Dosing is a problem.

        Epidurals are very effective. For women who don’t like the loss of motor strength research into new local anesthetics and adjuvants could help to solve that. It would be nice to have a technique that was as effective as an epi wih an equivalent lack of effect on the baby that didn’t require needling the epidural space because that will always be accompanied by minute but absolute risks of infection, bleeding and neuropraxia. Maybe more research into pain pathways and spinal cord pain transmission will generate some agents with novel actions that won’t cause the real depression and sedation we see with narcotics…but that will be a long time coming.

    • theadequatemother

      I agree 100%. Guidelines for maternity care are incomplete unless they include provisions for maintaining access to pain relief. Encouraging homebirth and MLU effectively denies pain relief. The WHO calls pain the fifth vital sign and maintains that relief from pain is a fundamental human right.

  • Amy M

    What has to happen for the pendulum to swing back the other way? A lot of deaths? Lobbying? Women deliberating attempting to make their pregnancies high risk to get the extra care? Significant decline in birthrate? Massive increase in MRCS?

    • Young CC Prof

      Deliberately attempting to become high risk. Hmmm. I know how to cheat to pass a GD test, how do you cheat to fail it? Go drink MORE sugar while waiting?

      • Amy M

        I don’t know how she might deliberately become high risk. Maybe take up smoking and motorcycle riding? The NCB wackadoos all think the Brewer diet will protect them from pre-e, perhaps if they do the opposite of the Brewer diet, they can induce pre-e! :)

        • Dr Kitty

          Just keep eating until your BMI is 40…that’ll do it.

          • Amy M

            Or hold off on starting a family until over the age of 35 maybe.

          • The Computer Ate My Nym

            Or think about the risks the government is advising you to take while your BP is being measured.

          • Young CC Prof

            I think we have a winner.

          • Joy

            Not in the UK. Over 35 only gets you one point in the high risk category.

      • amazonmom

        Eat a plate of nothing but baked potato the night before the test. I had to repeat because of my potato craving…

        • Amy M

          And drink only Mountain Dew as soon as that 2nd line appears….

      • bomb

        Sometimes high risk is determined based on past outcomes. I don’t know how centralized the records are in the UK, but in the US you can lie your way into our out of previous bad outcomes sometimes (I’ve had 3 still births and gd and…-actually I just want to have a section at 37 weeks. or, I had 2 vaginal births before my c section for a transverse baby- actually I have had 1 child by c section due to xyz, but I really want a vbac.

        I’ve seen people do both here in the states. The latter woman ended up with a hysterectomy after a bad rupture.

        • Certified Hamster Midwife

          Was her baby OK?

          • bomb

            No. Her baby died. Sadly, the reason she lied is because she wanted a large family. Now she has one child and a box of ashes. This actually happened to a 22 yr old friend I knew when I was 18 (long before I even considered having kids). I didn’t realize the gravity of it all until much later.

          • Guest

            Can you kindly ask her to post her story anonymously?

        • Dr Kitty

          Probably not going to work in the UK.
          GPs are the ones who refer to antenatal services and GPs get discharge summaries from the hospital about each birth, information from which is coded and put on your permanent record.
          When you move from one GP to another all of your old paper notes (including hospital letters) go too…

          There is a way to scam the system, but it wouldn’t be immediately apparent, it wouldn’t work for long, and I’m obviously not going to tell you how.

          • bomb

            I was really surprised that my OB in my new city didn’t request records or anything. He just talked to me about my two previous births.

          • Klain

            Wouldn’t you just need to lose that whole bundle of notes they make you carry?

          • Louise

            The patient doesn’t carry the notes between GP practices themselves. They are sent directly from one practice to another. I have experienced multiple women who have had previous babies taken away by social services claiming that this pregnancy is their first. Of course we would probably be able to tell from a physical exam anyway, but what they don’t realise, or sometimes do but think it’s worth a shot because they are desperate, is that we have already reviewed their files and are aware of their entire obstetric history before they walk in for their booking appointment, ie before we have even met them.

    • Ennis Demeter

      I always hope that well written internet comments calling people on their BS helps. I staunchly believe that it is helping fight the anti-vaxxers.

    • Renee

      LOTS of loud women, and political action would do the trick. Fighting the woo is also key, because when there are less loud NCBers, they have less excuse to use NCB as a cost cutting measure.
      Why hire more anesthesiologists if all you hear is NCB, NCB, NCB?

  • Dr Kitty

    I won’t go into specific details for obvious reasons, but UK women have a right to Home Birth unless there is a clear medical contraindication.
    Sometimes that means knowing that a disaster is likely to happen (for example because of precarious maternal mental health or social factors) and being unable to stop it.

    I am currently in that unhappy position.
    Saying daily prayers that my fears won’t be realised for this family is about all I can do.

    • http://Www.awaitingjuno.blogspot.com/ Mrs. W

      I’m sorry you are in that position.

    • Young CC Prof

      I’m sorry you have to sit and watch something like that, and I pray that this family will either change their minds or get lucky.

    • OBPI Mama

      The daily prayers thing is me 4-6 times a year! It’s rough having friends who mostly homebirth!

      • CognitiveDissonaceHurts

        Yes, and very tough when you hear of close calls!

    • Carrie Looney

      Someone I love dearly who lives in the UK is considering a second, and whenever she discusses that possibility it’s about how she’ll have it at home as a water birth with no pain relief, and it won’t be anything like her horrible experience with the first, with the C-section and the cruel OBs and the teeming-with-infections hospitals with their >15% unacceptably high C-section rate and every NCB box ticked off. She’s educated and so sensible about so many other things, and it just makes me so _mad_ that there is a whole massive industry and echo chamber designed to prey on fears and insecurities and disseminate bad information as if it were truth. I don’t know why this issue gets to me so much, as a woman who is childless by choice, but it does. It gets to me to the point where I can’t sleep at night, sometimes, worrying about what might happen if that goes forward.

      That’s the reason I found this site in the first place – Dr Tuteur’s discussion of water birth. Which seemed bonkers to me at first, but I wanted to see what experts had to say.

    • Montserrat Blanco

      I am really sorry you are in that position.

  • Karen in SC

    This is a not-so-subtle way of denying women pain relief. I bet the number of maternal request c-sections rises significantly.

    • Mariana Baca

      And a bed.

    • DaisyGrrl

      You know, if public health care systems want to stop providing adequate pain relief for women in labour, then they should stop providing it for all patients. It’s monstrous that it’s acceptable to deprive a woman in labour of pain relied when we wouldn’t dream of it in pretty much any other painful situation.

      Severe burns? Walk it off. Kidney stones? Try breathing. Broke your leg? Here, have some nitrous. Why is labour any different? This makes me so furious.

      Edited to add: I don’t mean to imply that any of the above situations should ever be acceptable. Arg. So angry I can’t even type straight!

      • Karen in SC

        If I lived in the UK, I would be flooding my MP (or whomever) with those not-so-funny videos of men subjected to “labor pain.”

        And daring them to experience the same, on BBC1, live.

      • MaineJen

        Before they did my husband’s colon surgeries (twice last year! FUN TIMES), they gave him an epidural catheter which would remain in place during the surgery and for a few days afterward to help manage pain. During both surgeries, they mentioned that the epidural caused his blood pressure to drop dangerously, and they had to move quickly to compensate. No one AT ANY TIME suggested or implied that because of the potential complications, he should not have had that epidural. In fact, their number one priority after the surgery was guess what? Managing his pain. Why? Because what he had just gone through was horrendously painful and anyone with even an ounce of compassion would want to help him through it any way they could. Why, why, why is labor pain any different???

        • Renee

          Because he is a MAN. Their pain is always treated more aggressively and properly.

    • Renee

      I hear this is the situation in Italy, which is one reason their CS rate is the highest in the world. Having a CS is the ONLY way to be guaranteed pain relief.
      They are now having a problem with dwindling population. Denying women pain relief will make them not want to have any more kids, and lots of CS makes the risks higher. I am sure there are many other complex reason for smaller families, but this should not be discounted as totally irrelevant, I know I would love 4 kids, but if I had to go without pain relief, I would have stopped at one.

  • ccccat

    I’ve heard a lot of grumbling from acquaintenances that NHS has gotten seriously infected with Woo. In the article a woman was quoted as saying that for low risk women a home birth might be safer than hospital birth. Is that because of MRSA? Has a single study ever shown homebirth to be safer than hospital birth?

    • The Bofa on the Sofa

      How many negative outcomes in the hospital are related to MRSA? The causes of hospital based problems are actually documented. The total number that involve “infections” are pretty small overall, and even those that are are generally due to things like GBS.

      I’d like to see some evidence that MRSA accounts for more than 1% of hospital deaths in childbirth. I may be wrong, but, then again, in getting that evidence someone would actually have to find out exactly how big the problem is. That would be a good start, as opposed to the vague assertion that it is possible.

      • Young CC Prof

        I’d want some evidence that the MRSA infection was contracted in the hospital, rather than invading the vaginal or c-section wound of a woman who was already colonized when she walked in, like a large percentage of the population.

        • araikwao

          The antibiotic sensitivity would indicate that

        • KarenJJ

          Dr Ben Goldacre had a good debunk of the MRSA scare in the UK. The newspaper journalists didn’t find MRSA until they started using some backyard lab with an unqualified chemist who was able to “find” it – except when other qualified people looked into it they found this “chemist” was finding something else – not MRSA. One journalist got some samples tested at a reputable lab and was told there was no MRSA and then told to try this other lab who then “found” it.

      • Renee

        Well, for healthy people, most MRSA is the kind you get out in the community. The hospital MRSA usually kills people that are elderly, and who have things like chest tubes, etc.
        Getting MRSA in a maternity ward is pretty rare.

        • The Bofa on the Sofa

          But again, how rare is “pretty rare”? Why not put some numbers on it?

          Then again, I still put the burden on those claiming that the hospitals are dangerous because of MRSA to be the ones to justify it.

          • Renee

            I don’t know them, but the overall infection rate isn’t very high and it includes the big ones like GBS.

  • anh

    Ok, so what do I do, as an American living in the UK? What can I do to make sure my next pregnancy will go smoothly? Do I have the right to challenge something my NHS midwives may tell me? My boss’ wife bragged to me about having her son naturally even though he was breech. Do I have the right to say “HELL NO I’m doing a TOLAC” if my next baby is breech? what is the workaround in this system?

    • Dr Kitty

      Are you low risk?
      In the UK that means no previous CS, no pre-e, no GDM, no underlying medical conditions, with a singleton vertex baby.

      If you are low risk you will get MWLC or shared care (GP and community midwives) as standard.

      If you are NOT low risk you will get consultant led care, which will still mean midwives at some antenatal appointments.

      You can ask for ERCS, you can even ask for MRCS (NICE says MRCS is ok, actually). You can decline to give birth in a MLU and request to deliver in a consultant led hospital delivery ward.

      You can ask to speak to a consultant even if you have midwifery led care.

      You can refuse a TOLAC, you can refuse ECV of a breech, you can refucse

      • Dr Kitty

        Sorry…
        You can refuse an attempted vaginal breech delivery and request a CS.
        In labour, you can refuse instrumental delivery and request CS and you can request an epidural but will be unlikely to get one before 4cm.

        Just because NICE is encouraging low risk women to give birth in MLU, you still have the option of refusing.

        If this all seems too much, you have the option of having your baby privately with an OB. Expect to pay £5000-£15000.

        In the NHS you have a right to a second opinion, so yes, you can challenge the midwives. Your GP is often a good person to get on your side. They can advocate for you, t letters and generally be a pain in the behind for you.

      • anh

        I’m really low risk. my first (and only) was a vaginal delivery and other than not having shed my pregnancy weight, I’m perfectly healthy.

        I’m just terrified of not having choices. If I get to 41 weeks (I went 41w 5d with my first) I want to have the choice to be induced.

        Glad to hear I can refuse

        • Dr Kitty

          Guidance is that everyone should be seen at term, offered a membrane sweep at that appointment and an appointment made at term+10 for induction.

          My advice is to be honest about your fears and goals from the outset.

          Also…
          Take a note of names.
          If you’re unhappy, take a note of names and NMC numbers (or GMC numbers if they are doctors).

          Our doctors have different job titles than the US.

          American patients within the UK have a reputation for being demanding, difficult to please and highly litigious…you might want to play to that…

          • Dr Kitty

            About Dr job titles in the UK

            Intern= F1/Foundation Dr/JHO/Houseman
            First Year resident=F2/SHO
            Where the USA would have third and fourth year residents and then Attending Drs, the UK has 6-8 years of further training before you can be a Consultant.

            People at the start of their training will be FTSAs/SHOs and people at the end will be SPRs/Registrars.

            If you think you’re being seen by a junior Dr (and if they are under 40 you probably are) ask to see the Consultant.

            They may not be able to see you immediately, but ask

          • Haelmoon

            In Canada, I am considered the consultant, but still have patients ask to see someone more senior. Funny thing is I am the perinatologist, the general OBs are ALL older than me, but still happily refer to me. Its funny , but the age of the doctor can be misleading sometimes.

      • Jocelyn

        Out of curiosity, would hyperemesis gravidarum be considered high risk? How about a previous forceps delivery?

        • Dr Kitty

          Neither would be automatically high risk, although many OBs will discuss the option of an elective CS if there was a previous 3rd or 4th tear or they think that forceps will be required again.

          You can always ask to have a conversation about your options. Very, very few OBs would be brave enough to refuse a CS to a woman who is adamant she wants one and who had a previous complicated instrumental delivery.

      • Renee

        I would hate to have to have MW care. I know they may be skilled, but I have zero interest in their philosophy. Only a med wife would be acceptable, but an OB would always be preferred. I am glad I do not have to birth in that situation.

        • Louise

          Contrary to Amy’s ill-informed spin most UK midwives are what would be considered medwives in the US midwifery community. But no, you don’t have a right to OB-led care without clinical indication on the NHS. However if you are unhappy with your NHS midwife you absolutely have the
          right to change to another, or to change the setting for your antenatal
          care and/or birth.

          If you wanted OB-led care for a low-risk pregnancy and birth you would have to either take out private health insurance or pay privately out of pocket. However outside of London there are no private maternity units. Women elsewhere who pay for the services of a private obstetrician see him or her for all their antenatal appointments but when they go into hospital to have their baby they are still in an NHS unit and therefore the bulk of care is still delivered by the NHS midwives that staff the unit. The doctor will oversee the care and be present for the birth, but the midwives will deliver all the practical care as we have no OB nurses over here, and most of the time the midwife will actually deliver the baby, it is just that the doctor will be present in the room. This is because doctors here do not see normal deliveries to be part of their job. The doctor takes the big fat fee, gives some of it to the hospital, the midwives see none of it.

          Even if you pay for one of the really fancy private maternity units in London, the bulk of your care will still be delivered by midwives, as they essentially fulfill the role of obstetric nurse but in a slightly extended way.

    • Karen in SC

      A young lady I know is currently living in Norway. She needed progesterone for her first pregnancy in the US, but when she got pregnant in Norway she was told she couldn’t even get an appointment until 12 weeks (or it may have been later, I don’t recall exactly). She miscarried.

      On a trip back to the US, she got a prescription of progesterone to have on hand from her American OB. Before she conceived again, she made sure to arrange private insurance through her husband’s employer. She did get pregnant again, and arranged trips to the US for ultrasounds, but her care was through a GYN, there are few OBs to be had, even privately.

      She would have been attended by midwives if not for the fact she went into labor prematurely while on a quick trip to another country.

      Why are there barriers to obstetric care? This is a feminist issue, the NCBers have it backwards.

      • Young CC Prof

        It is a feminist issue and it is a basic public health issue! The top 2 concerns for any national health agency should be nutrition and infectious disease, and maternal health should be a close third. If it means diverting resources away from other areas, so be it, this is a priority.

  • anonymous

    Just a side note, but NICE is not a government entity in the UK as far as I know. They issue guidelines and such but as far as I know hospitals/doctors/etc do not have to follow them

    • Dr Kitty

      No, they don’t have to follow them, but, from a medico-legal standpoint if you choose NOT to implement a clear clinical guideline from NICE you may find it hard to justify it to a coroner or jury.

      • Karen in SC

        In this instance – providing more and IMO better care – I don’t think that would be a concern. (homebirth with midwives vs. hospital birth)

        • Dr Kitty

          Oh absolutely, but, for example, if you go way off piste from the diabetes, hypertension or depression guidance it will not look so good.

  • no longer drinking the koolaid

    Do you know if they are making the distinction between the Independent Midwives and those employed by the NHS?

    • yugaya

      Independent midwives are being abolished by the EU Cross Border Healthcare Directive – they represent less than 0.5% of the midwives in UK and they were refused government funding for insurance. They were offered integration into national health care system, but that would also because of the EU directive oblige them to obtain proper formal levels of education and training. They refused that and are now protesting the “injustice”: https://www.facebook.com/homebirthaustralia/posts/417219865040433

    • Dr Kitty

      NICE guidance applies to the NHS.
      Independent midwives in the UK do home births, the MLUs it mentions are NHS units, which are often (but not always) co-located with the hospital L&D.

      For example, my local hospital has a MLU, birthing tubs and all, on the floor below the normal L&D, while there are two local MLUs that are 15-30 minutes from the nearest obstetric ward.

      I’m happy to recommend the hospital MLU, but not the other ones.