Apologies for disappearing. I hate it when work interferes with the Internet :-) To be honest - I think that this discussion we are having (and I don't know about you, but I'm enjoying it) revolves around the lack of decent UK studies. NICE states that the UK studies aren't really up to scratch (same document, and yes I'm summarizing a bit) and I think that there really does need to be a decent study to sort it out once and for all. You keep saying there hasn't been a decent study in the UK, but there has been a large retrospective study of almost 6,000 women in the UK. The National Birthday Trust study is referred to and accepted by NMC, RCM, RCOG etc. There hasn't been a prospective randomised study of that size, but it would be impossible (and unethical) to do one. The NICE figures you quote were from a small study in Canada; again not in the UK, and RCOG criticised that draft on quite a few points and, AFAIK, those guidelines haven't been released yet. There is a lot of evidence that birth in home is as safe as hospital birth for the right women with the right support and infrastructure, but it's not for everyone. The 'logical' conclusion that hospital must be safer does not take into account: - how home birth really works. People seem to think that if you plan a home birth, you're stranded and you can't have an emergency caesarean if you need one - how many of the problems in hospital are caused by being in hospital - how rare unexpected catastrophic events during labour really are, things like AFE, heart attack, cord prolapse in low-risk women, uterine rupture etc I am actually planning a home birth in December with an independent midwife. Q: What will happen if I needed an emergency caesarean? A: I will transfer to the hospital. It's around 10 minutes drive and I could be in theatre within around 30 to 40 minutes. This is around the same time as I'd probably have to wait if I was on the ward to begin with. Please note that 'emergency' caesareans just means unplanned, which is different to a 'crash' caesarean. Q: What will happen if I haemorrhage after the baby is born? A: My midwife will give me Syntometrine and phone 999. Q: What will happen if I become exhausted, labour doesn't progress or I change my mind A: We'll go into hospital. Home birth is not all or nothing. Q: What will happen if the baby needs resucitation? A: My midwife has up-to-date resucitation skills, equipment and oxygen and will set up an area for that when she arrives. Q: What would happeen if there was a shoulder dystocia A: My midwife would have to deal with it, just like she would have to in hospital. In hospital, there are more people to call on for assistance, however you cannot guarantee that they will be available and I may well have two midwives all to myself at home. It would be ridiculous for me to suggest that there are not situations where being in hospital might make a difference, but they are catastrophic events which are exceptionally rare. It is even rarer for these events to occur no signs in low-risk women and I am more confident that my midwife will pick up a warning sign than if I was on a labour ward sharing an overworked exhausted midwife who I've never met with 10 other women. Those catastrophic events which could have better results have high mortality/morbidity results in hospital too. I wouldn't choose a home birth with a lay midwife as some American women have to do. I wouldn't plan a homebirth if I didn't have fantastic medical back-up not very far away; mother nature has a higher tolerance for dead babies than I do. If I had a heart condition, or developed pre-eclampsia or had any medical reason to attend hospital, that's where I'd be. If the nearest medical facility to me was 2 hours away, you get the picture ... In the UK, we are exceptionally lucky that it's possible to have the advantages of having your baby at home with the safety-net of back-up should your birth *become* a medical issue. You mention that the criticism of hospital births is hospital acquired infections and doctors/midwives being too quick to intervene. Those definitely are things that people point to, but it's not the primary objection. Being in hospital inhibits labour; women just don't labour well there. We are mammals and how we are feeling has a very definite effect on labour. Adrenaline antagonises oxytocin so if we are afraid, angry, embarrased or scared then our body tries to stop labour. So doctors and midwives offer to augment the labour with syntocin. The effects of the syntocin are very powerful contractions. The contractions are powerful and very painful and the syntocin doesn't stimulate the release of endorphins like oxytocin does, so mum asks for an epidural. Baby then may be malpositioned or distressed due to the artificial contractions, mum being on her back and/or the epidural and an instrumental or surgical delivery ends up being needed. Mum then tells everyone baby would've died at home and the doctors saved the baby's life. Make no mistake, I respect obstetricians and what they do and I will be very grateful to have one if I need one, but it';s very important for women to have the typical "cascade of interventions" explained. Once you intervene in labour, the next intervention often becomes necessary and that's how we end up with a national c-section rate 10% higher than the WHO says is acceptable. It's the commonest childbirth story today and it is simply not possible to say that a child wouldn't been saved if they had been at home/in hospital. All that wooly emotional stuff is actually a really important part to having a good *safe* labour. There's something very wrong with the way we're doing birth in hospitals for healthy normal birth, but at the same time the NHS does provide an outstanding obstetric and neonatal service to women who need it too. Unfortunately, I think that increased litigation is causing the NHS to approach maternity services more and more like American obstetricians which isn't a good thing for anyone, but I'd love to see more midwifery like the Albany practice in Peckham (http://www.albanymidwives.org.uk/albanymidwiveshomepage.htm) where women don't choose home or hospital until they're in labour, which is similar to the Dutch model where home birth rates are over 30%. Babies do die at home, but they also do in hospital too. There are some babies who might die at home who wouldn't in hospital (although there's also a whole question of 'In what condition?', but there are babies who die in hospital who might not have in other circumstances and all of those situations are unbearably tragic. I have researched homebirth (and not just from reading homebirth.org.uk!) for many many years and I've read the anti- and pro- research and if I really thought for a second that I was risking my unborn child's like, there isn't any chance I would continue with that. My mother-in-law was a community midwife with the NHS for 25 years and she is the one paying for our independent midwife to have our baby at home. I know that in that time she never had a situation at home where a women couldn't be transferred in time and I know that if she had any reservations about her long awaited grandchild, she wouldn't be encouraging it. I'm not a midwife, but if you're interested in the topic please join http://health.groups.yahoo.com/group/ukmidwifery/ where you can discuss it to your heart's content and ask some of the most experienced and well-known midwives in the country as well as medical students, Professors of midwifery and others. Best wishes,