Homebirth - would it be dangerous if prev baby got stuck?

[pookey]

Hi sorry this is a long un I have a 25 week app with my community midwife next week and wanted some advice on here before i talk things through with the midwife. I had planed a homebirth for my ds who is now 19 mo but after a couple of days of not progressing quickly enough I transferred to hospital where i was induced, had an epidural after another 5 hours and only progressing another cm and finally gave birth assisted by a dr who turned ds who was facing forawrd and gently guided him out with forceps. The surgeon and midwives said vaginal birth was a very good outcome as ds shoulder also got stuck - i also noticed in the notes for the HV that his cord was wrapped around his neck and while in hospital he did have low blood sugar.

I have had a homebirth agreed for this second pg but the consultant has frightened me and DP is really begining to worry about homebirth. I saw a registra for my last hospital medical (about 6 weeks ago) but he was useless and spoke to the consultant in the next room about whether or not I should have a homebirth. The consultant was shouting and saying that homebirth is dangerous but it is my baby etc. He then came in and spoke to me and said that the risks for me are the baby getting stuck and my having to transfer to hospital to be stitched up - he homed in on fears i hadnt even thought of.

I feel guilty for considering homebirth but dread the aftercare at ealing hospital which in my experience and that of others on here is not great. The consultant did say I am less likely to get an infection at home, eek. I have been quite down/depressed about this recently but am feeling much more positive after a chat with dp.

Any advice? My concerns are will the midwives be able to deliver if shoulders get stuck and I am hoping to avoid tearing badly. I have to go to bed now but will see if anyone has posted tomorrow tia x

[gingernut]

I don't know if it really helps, but my first got stuck (very long labour, epidural, long second stage culminating in ventouse delivery in theatre - I was prepped for c/s just in case as his head was still very high and they had to turn him). Second was born in hospital too but unassisted (also v long labour and they were about to do ventouse when he popped out). I did need stitches though - but not as many as first time. Can they not do stitches at home? As for staying in after second birth, I had a 6 hour discharge and never went on to postnatal ward (stayed in delivery room, although I guess I would have been moved if they'd been busy).

[chocolateface]

I think you should ask the midwives who would deliver your baby at home what they think. If they're confidant, you can be too. They'll take into consideration travel time from your house to the hostpitalif a transfere is needed, etc'.I don't think any Midwife delivering a baby at home is going to take any risks. My first baby got stuck, after an epidural but I had much better births with the other 2.

[chocolateface]

Sorry about all the mistakes in my post - it's late!

[runnyhabbit]

Pookey - this could been me!

Ds was born 22mths ago with ventouse delivery. I was induced (10 days over) and all was well until for some reason I couldn't get past 9cm dilated. Ds was facing forward, as well as stretching his head out. All was ok in the end, and I am now expecting our next lo in 3 wks.

It was my mw who first suggested a homebirth. I thought I wouldn't be a suitable candidate, considering ds birth, but as she pointed out, I had already given birth vaginally (sp?) therefore, my body has already stretched, so should/would be able to do it again.

Agree with chocolateface - talk to your mw. If they are confident with homebirth, then go for it. We had a prebirth appt at 34wks to talk about birthplans etc, and it gave dh an opportunity to talk to the mw about the concerns he had. She had answers for everything, (and a load of leaflets) which was reassuring for both of us. And although we've decided on a homebirth, I can change my mind at any point (either now, or in labour)

hth

[mears]

Midwives are trained to deliver babies who get stuck. Thing is to remember that this is highly unlikely in home birth situation wherte mother is usually active.

Baby getting stuck is more liekly due to delivering in bed with epidural. Shoulders getting stuck are a risk of forceps as the baby's shoulders spread as the head is pulled down.

The fact you have had a baby vaginally makes it highly likley thatyou will manage on your own next time. Doctors know nothing about homebirths - have a talk with your midwife.

[pookey]

Thanks so much all of you, thats really reassuring, I am regaining my confidence in giving birth naturally all the time Gingernut and chocolate face I am glad things went better for you second time around it really gives me hope for a better experience.

Mears that was really interesting, - are you a midwife doula I think I remember. I want to be as well informed as poss and will probably do another thread about positions for the final push (want to make tears low risk but also getting stuck think that might be mutually exclusive?). Luckily I will not be as naive as last time when i had unrealistic expectations and thought giving birth is natural and nothing to worry about!

One of the reasons I wanted some other opinions is that it is poss i will not even meet the midwife who helps with home delivery so wanted to make sure if i spoke to one reluctanat midwife it wouldn't put me off unnecessarily. I will bring a list of questions with me to the appointment but i think without mnet I would be so negative that i wouldnt be a suitable candidate for homebirth mentally. I know in theory I can change my mind at any time but I feel bad as though Id be dissapointing the midwives or something, silly I guess . At the moment I have a low lying placenta so will have another scan in 10 weeks so that will be a big deciding factor.

The reason I am worried about tears is that my ep'my didnt heal well last time and midwifes dont tackle bad tears?

Hope your homebirth goes well runnyhabbit I will keep an eye out for your birth announcment, exciting!

Thanks again

[lulumama]

great advice already ! if your baby;s shoulders get stuck, there are two things that can be done IIRC, the McRoberts manouvre, which i beleive the RCOG has said is the best way to deal with shoulder dystocia. which is legs up round your ears ! and also the all fours position which both make the pelvis wider and should really help....if it does happen again! which it might well not !


homebirth site

[hertsnessex]

just a quick msg as im off out..........but my last client was a HB, for her 3rd baby. her last one got stuck. no probs this time and baby was OP.

good luck.

cx

[pookey]

legs round my ears dont think im that bendy lol. Thanks both.

[jdd0709]

ooh this is interesting. I am pg with ds2 and had a shoulder dystocia with ds1 last time. I am convinced that this is because I stood throughout the labour, all was going swimmingly, but near the end the midwife told me to get on the bed. I was leaning over the top of the bed but far less active and basically went to sleep, all the contractions stopped and I had to push him out without contractions. he got stuck, they did the McRoberts thing eventually and he came out with an apgar score of 1 and had to be resusitated. Thankfully no after effects.

ANYWAY, I am really keen not to have this nightmare crap NHS birth again. I have been to see private midwives at a birth centre who said it should be called bed dystocia not shoulder dystocia, they really downplayed it and said it was probably due to mismanagement of the labour (I agree) and that it would almost certainly not happen again if I had a natural, active birth in a birth centre (or at home) - this is my instinct too. However, I was referred to a consultant because of last time whos position is that it hapenned because ds1 was 8lb 3 and I am 5ft and that I should have a medical birth, constantly monitored in hospital with an epidural for ceserian standby!!!

My dh was so traumatised last time that he wants to go with the whole medical hospital thing but I feel confident that it could be ok - but don't know how much of a risk to take. home birth is out of the question (for dh) but I would like an active birth, albeit in hospital, with none of the last minute drama of last time. What do people think and what would be the best positions to minimise chance of it happenning again - I thought maybe standing with one leg up - which was how it was going last time until they moved me.

[lou9879]

Hi, I have had 2 homebirths, my last one was 11 days ago, I am 5ft 2, my first daughter weighed 8lb 8oz, and 2nd weighed 8lb 4oz. Both no problems. The thing i find with homebirths is you have 2 minimum qualified midwifes present and if you have a complicated pregnancy or labour is not progressing well, you will be advised to go to hospital. Midwives will not take risks and have said to me that there are normally signs during labour that normally indicate if there is going to be a problem, and they will take you to hospital. 2nd child is normally a lot quicker and a lot easier!! It is true about the infections as you are immune to your own bugs in your home. Midwifes are able to do everything at home as they can in hospital including stitching!! etc.. the only thing they can't do is give you an epidural. With regards to consultants etc.. everyone has there own views on safe deliveries, some swear by c sections, others home birth, same as midwives. you just need to listen to all the advice and facts and do what is best for you.

[lou9879]

Sorry, me again, just thought I would mention I had a homebirth and quite a nasty tear for my first child and my midwife stitched it up, and must have done a good job as it healed lovely and I didn't need stitches for my 2nd child, something I thought I would definately need after tearing previously.

[lulumama]

jdd-- have a look at the homebirth site and have a read of 'active birth' by Janet Balaskas....the best position to adopt is the one that feels best for you at the time, so being able to listen to your body....squatting, all fours, kneeling all open up the pelvis more and are good positions to try......

[hertsnessex]

just wanted to say that '2 minimum qualified midwives' is not the case, you will get a very experienced one and sometimes a trainee/newly qualified, but they wouldnt send out two 'minimum qulaified' (im guessing your talking about there experience?) midwives.

[jdd0709]

Thanks all for your advice - that is really helpful - Pookey sorry for hijacking your post. The issue I have is that I know all the ins and outs of Active Birth (have read that book), went to Active Birth classes, read up on water birth, am really behind ithe whole philosophy, have no desire for medical intervention (was fine last time on gas and air and TENS) but I just feel that it is hopeless in NHS hospitals as you just get sucked into the system. I would love a home birth but don't want to traumatice my dh anymore (he was really freaked out as baby basically came out dead last time and it took 8 mins to resusitate and he saw it all wheras I wasn't really aware).

I thought about paying to go to the Birth Centre in Tooting or for an independent midwife to come with me to hospital but cost is an issue - do you think I would be more likely to have a natural birth in hospital if I did - or maybe a doula?

One half of me just thinks sod it - I'll just go in and do it on my own and not take any shit this time as it will likely be quite quick (5 hours last) time and get out before the post natal ward hell.

[jdd0709]

ps is the website www.homebirth.org/ I can't seem to get to it

[hertsnessex]

www.homebirth.org.uk is the site.

as long as you have a good support, i.e. husband, mother, friend, who knows what you want then that helps yuou feel more in control.

if you want to talk more about doulas you can mail me. (web link is on my profile)

cx

[pookey]

Not a hijack at all is interesting for me too. I am under 5ft4 and ds was 9lb4 the weirdo registra I saw said it wasnt surprising I had a big baby as I am quite big! Dp is worried about HB this time aswell but because I still need to have another scan about my placenta I think he isnt thinking about it yet. Hope your birth goes well.

[pookey]

Oh I didn't get as far as your second post JJD as ds wanted my attention. It is understandable that it was traumatic for you dh maybe he could speak to a midwife at your next appointment they might be able to reassure him about homebirth as it does sound like a good option for you - I am clutching at straws really it sounds like he went through a lot.

I know what you mean about expense, my mind is already running to hiring a pool having some kind of yoga or pilates or breathing classes and we cant really afford it. The thing that makes it harder to justify is that there is really no telling what will happen on the day for instance I might hire a pool for £200 then not want to go near it during labour. If you can afford to go down the birth centre route it might be money well spent and a good compromise but only if you and your dh both think you can afford to spend the money in that way? Maybe see what other mnetters think of the centre? When are you due and good luck with it all.

[baggybelly]

I didn't have a homebirth, but did have shoulder dystocia with ds (delivered with the legs around ears jobby). I was terrified of it happening again as I'd had such a long complicated labour and ds didn't cope very well. I'm pleased to say that dd's birth was a dramatically different experience. Quick (2 hrs total), drug free and no tear and no complications whatsoever. I had been told a home birth or a water birth wouldn't be advisable however it obviously would have been fine...

[lulumama]

as herts has said, a doula is worth considering

a trainee, such as myself, would cost no more than £150 ( Doula UK set this as the rate a trainee can charge) whereas a recognised doula ( 4+ births) do charge more ..

however, an awful lot of research has shown that having continous one to one support from a doula can drastically reduce your chances of a c.s or instrumental delivery...it is the continuous nature of the support that is key to it ...being able to give you that bit of encouragement when it all feels too much,being with you if your DH has to go off for a while,

a doula has understanding of the birth process and can reassure you if necessary,and speak to you on a level you are comfortable with and reassure your DH if needs be !

also a doula will meet with you antenatally and be sure of your birth plan and be able to be your advocate , if needed during the birth...

an IM is a lot more expensive and often cannot actually deliver the baby for you in an NHS hospital or birth centre, but can be there at home as a MW and in the hospital as a doula

[jdd0709]

Thankyou everyone for your thoughts - this is very useful to hear. I had been kind of burying my head in the sand and thinking I would sort this out nearer the time (I'm only 17 weeks, due beginning of September) - you have really given me food for thought.

Pookey, I know exactly how you feel - we probably could find the money for a birth centre/independent midwife etc etc but I just am not sure how justifiable it is when there is so much uncertainty about what will happen on the day, like you I really wanted a water birth last time and was really upset when the hospital wouldn't let me go on the home from home birth centre due to high blood pressure but in the end, I loved my TENS machine and would have killed anyone that tried to take it off me to get in the pool!

Maybe a hospital birth with a doula is the answer for people in our situation? For you though perhaps a home birth would be fine - certainly the midwives I spoke to at the Birth Centre were not in the slightest bit fazed at the prospect of a shoulder dystocia and said that they were perfectly well trained in the manoevure and thinking back, my (useless) midwife called in another midwife who did this and actually got my son out just before all the doctors arrived.

I don't think I could put my dh in the position of a home birth this time becasue I know he would be petrified the whole way through which would be counter productive, but the thing that worries me about a hospital is that I won't be capable of sticking to my guns in terms of staying off the bed, standing up, being active etc when it all kicks off - so perhaps a doula that knows about it all beforehand is the answer! It would also make me feel better about the randomness of NHS midwives - ie you've probably never met them before and they could be great or could be useless!

Right, off to look at the doula website - thanks again

Pookey - good luck with your decision - keep us posted - I am sure the chance are we will both have perfectly easy straightforward second births - most people do seem to.

[pookey]

Thanks for the goodwishes JJD. I think a doula sounds like an excellent idea for you, a bit of an advocate who knows what you want but are reluctant to push for. I find it very hard not to do as i am told at the best of times, let alone when I am in the final stage of labour and just want it out , its the way i was brought up I guess (catholic working class with respect for authority).

[pookey]

oops sorry JDD. JJD is a sports shop!