To consider booking a home birth even though DH isn't keen?

[NoRoomForALittleOne]

I suspect that IABU but I'll let the MN jury decide.

Background: I'm expecting DC5. For previous births the most pain relief I've had has been G&A plus the pool. For easy reference:

DD1, born at 34+6, 4 hour labour, 6lb 3oz (officially large for gestational age) had a minor PPH and placenta took an hour to deliver despite syntometrin injection.
DD2, born at 39+2, 2 hour labour, 7lb 9oz, all straightforward.
DS, born at 37 weeks exactly, 1 hour 15 min labour, 7lbs 8oz (just below cut-off for LGA size), all straightforward.
DD3, born at 38+6, 25 min labour - started at hospital as went in for reduced movements, 9lbs 13oz (definitely LGA!), gave birth on all fours in pool but had a shoulder dystocia

So I'm being good and having a GTT on Wednesday when I'll be 26 weeks pregnant. Then next Thursday I start having growth scans and will see the consultant to discuss birth options. So far I've seen a few registrars who all have differing opinions about the birth. One suggested induction at 38 weeks as I have a history of LGA babies and quick births. Another has suggested admitting me at 37 weeks to the maternity ward until I give birth (it's hideous there so no thanks) to ensure that I give birth in hospital. The other suggestion is to have a home birth if the baby seems to be of 'average size' to avoid giving birth during the 20 minute drive in.

I don't want to give birth in that hospital. I've had enough of their inability to listen and treat me like a human being. They are currently in special measures with the CQC because of the number of preventable maternal and neonatal deaths that have occurred. I'm not surprised. The obstetric registrars are generally AWFUL. The midwives are mostly nice enough.

Add in to that the fact that I know that I won't want anyone to touch me/talk to me/generally make their presence known if I'm going through another intense precipitous labour. That's not me being grumpy (DH thinks it is) it's simply that I know how much I will need to 'zone out' and concentrate on what my body is doing. I feel confident about my ability to birth if I'm allowed to move about/adopt positions that may look weird/make as much or as little noise as I want/whatever gets us through the birthing process without someone needing me to fulfil hospital policies.

I'd really like to build a birthing nest at home where I can get on with giving birth on my terms. DH wants the backup of being in hospital even if that means he doesn't get there on time.

[HolyTerror]

I don't think its unreasonable in the circumstances - you are pretty experienced at this, after all, and you don't live far from the maternity unit if you need to transfer at any point. I appreciate your husband's concerns, but it's your call, in the end. Reassure him that if there any any medical contra-indications closer to the time, you'll reconsider if necessary.

What will you do with the other children if you are giving birth at home and need to zone out and concentrate?

[SusanIvanova]

Your body, your decision.

[NoRoomForALittleOne]

There's a whole list of people who are willing to help with/take the children. I don't think they'll need to be gone for long but I do want a list of 'on call' people in case I have to transfer in.

[PonderousTortoise]

I don't think yabu if medical professionals are happy for you to have hb.

Not sure I understand your DH's opposition? Is it just nervousness about things going wrong? have you talked through together various risks, and how you'll be prepared for any necessary transfer to hospital etc. to reassure him?

Is a doula an option? You're obviously quite a 'pro' at giving birth and will know your own body and needs, but a good doula can be really helpful in supporting partner as well, and ensuring everything goes as you wish as regards to interference and so on, whether in hospital or at home.

[AppleAndBlackberry]

What are the chances of another shoulder dystocia? That's the thing that would worry me, I guess the chances for the baby are not as good if born at home. I totally understand losing faith in the hospital, not wanting to be touched etc but I would be worried given your history.

[wanttosqueezeyou]

I'd be more interested in the opinions of the medical and midwifery staff than your DH. If they are adamant that you shouldn't have a home delivery I'd think very carefully.

If your DH said he wanted you to have a section would you?

Of course not, you have to weigh up what is best for you whilst considering the medical advice and the situation at the hospital very carefully.

[Idontseeanysontarans]

Have a solid point by point back up plan to go into hospital - that was all DH needed to be persuaded that a home birth was a good idea. DD2 was born in the wee small hours and the DC's slept right through it! It was a wonderful experience, I wish I'd done it before.

[Wheretheresawill1]

You have largish babies, you are experienced but you had a shoulder dystocia. Please don't risk the life of your baby.
Ps health care professional not midwife; delivered some babies in training; some knowledge but not expert
Shoulder dystocia is an emergency. If you are not in the right hands of someone experience in things like mcroberts your baby will die. You need to be in a hospital so that if mcroberts doesn't work you gave best chance of either someone who will break your babies clavicle or emergency Caesar- remember it's all up against the clock... Going to hospital in this state in an ambulance is unlikely to give a good outcome.

[CyclopsBee]

Congratulations on your pregnancy
I'm going to play devils advocate here, just to give you some perspective,

I'm a neonatal nurse and I realise that I see all the bad cases in neonatal unit but I would never have a home birth,

In the last 2 weeks we have had 3 babies born that have ended up being ventilated, one has no brain activity, the other has been cooled (a process given to suspected brain damaged babies to hopefully stem the damage)
And the third cannot take oral feeds and is suspected to be blind,

All of these babies were term. One was a Pool birth, one was shoulder dystocia,the head was born 10 minutes before the body,(this was also a fifth baby)

Now, I'm not saying this to scare you, I would just hate the thought of a family going through this, I've seen those devastated parents and relations coming to see their new baby in what should be happy circumstances but they are far from happy

I do know that for these 3 babies, there are 100's born with no problems, but if you were my daughter I would beg you to have a hospital birth.
If all goes well you can have a 6 hour discharge and be back at home with your loved ones,
Good luck

[Pastamancer]

I am having a home birth but DH wants me to go to the MLU. I've told him that I will be much happier at home, it is considered the safest place and my midwife is happy with that decision too. DH is concerned that something might go wrong as my labour with DD was 4 days. I ended up having an epidural due to exhaustion as I hadn't slept for 3 days due to constant contractions but not dilating. I think DH is finally starting to accept that I am not budging and that I will only consider birthing elsewhere if there is a problem.

Your labours are quick, chances are by the time you organise someone to look after the other children and get into the car you won't make the hospital anyway and surely at home is better than in the car at the side of the road?

[hoobypickypicky]

YANBU. There's no reason why you shouldn't block out all input from your husband on how you give birth. It's your body, your decision. He doesn't get a say in that Afaiac. My own preference would be for an ELCS but if you want a home birth and your medical team aren't wholly adverse to it that's all you need to consider.

[seaoflove]

Shoulder dystocia is a big worry.

I mean, it's better to have a shoulder dystocia at home with a midwife, than in the back of a car alone, but both are really dangerous.

[SophieBarringtonWard]

How do they treat a shoulder dystocia differently in hospital than at home with the midwives (you have 2 midwives at a home birth)?

[NoRoomForALittleOne]

Interestingly a section should have been offered according to the NICE guidelines but hasn't been. I want to have a proper talk about all of the options in different circumstances so that we can get a reasonable plan together. But I'd like it to be evidence based as well and our hospital doesn't seem to 'do' evidence based... The next nearest hospital is an hour away and part of the same trust with the same problematic attitudes entrenched as seen by CQC and in the inquests in to the deaths. Next nearest hospital after that is at least 1.5 hours away.

Interestingly my desperate 'need' to be allowed to birth 'my way' and undisturbed gives the best chance of avoiding another shoulder dystocia. Recurrence rates for SD vary between 10 and 50% depending on the study. I'm Non-diabetic and have had three previous normal deliveries so that helps my chances but I do seem to make LGA babies and that is probably the real issue. I knew that DD3 was much bigger than the others at birth but was fobbed off. I wasn't at all surprised about her SD. Strictly speaking size doesn't necessarily come in to the factors but given that I was in a good position, I had given her the best chance that I could. Having such a fast labour can also mean that the baby doesn't get in to the 100% optimal position for birth. That's why early induction isn't recommended because you end up forcing a baby to be born before it has taken up the best position possible (or so one theory goes). In truth no-one can predict a SD but it is proven that maternal instinct in a multip is the best predictor of baby's size.

[coppertop]

I would be asking what help would be available to you if this baby has shoulder dystocia.

When this happened to my first baby (also large), arrangements were made for several members of staff to be present at the pushing stage of my other babies. I think there were at least a couple of MWs and at least one doctor. This wouldn't have been possible with a home birth.

[Greenfizzywater]

I'd suggest a MW led unit that is situated next door (same building, same floor) to the consultant led one. You really need the cavalry available in under a minute if you have another shoulder dystocia, but in a MW led unit you should be able to do things your way.

[wanttosqueezeyou]

CyclopsBee Are you saying the three seriously ill babies were home births?

[seaoflove]

How do they treat a shoulder dystocia differently in hospital than at home with the midwives (you have 2 midwives at a home birth)?

I saw a shoulder dystocia on OBEM (it was horrible) and they were already in theatre. There was a big team of people: one in charge of counting how long the baby had been stuck, plus the obstetrician desperately trying to manoeuvre the baby out. Think they had to resort to breaking the baby's collarbone in the end. They also had the instruments to perform an episiotomy, although I don't recall whether they did.

Community midwives may or may not have the skills or experience to do anything other than the McRoberts manoeuvre.

It's not a risk I would be prepared to take, especially if the baby looks like another big one. I'm not sure a positive frame of mind is enough to avoid a reoccurrence.

Good luck OP, and I hope you find a solution you're happy with.

[PiperIsTerrysChoclateOrange]

With the history of preterm labours I think hospital will be the safest for the baby.

[AppleAndBlackberry]

10-50% probability of shoulder dystocia recurring then. I just don't think I would take that risk. You could probably request a section if you wanted one? If so make sure you fully explain the extent of the trauma of the last birth.

[NoRoomForALittleOne]

The nearest midwife led unit is a standalone unit an hours drive in the opposite direction to the hospital.

I'm happy to have the cavalry in if necessary but I do not want an audience 'just in case'. And, frankly, I don't trust them. Plus McRoberts is a stupid idea for a shoulder dystocia especially if you were on all fours to begin with (it will make the pelvic outlet smaller) a gaskin manoeuvre and maternal repositioning (rocking, slight change in leg position, squatting) are all better options. I do not want some idiot putting me through a pneumonic policy that starts with McRoberts because most SDs occur when mother is on her back. I can assure you that is not a position I will be in.

As for the one on OBEM, if it's the one I'm thinking of, it was truly horrific. But that poor woman had been pushing for over an hour already and her baby's head had been going back up with her efforts! Why they thought it was a good idea to then take her to theatre for high rotational forceps rather than a section and were stunned at how bad the SD was is totally beyond me. It's basic obstetric knowledge that if second stage of labour is that obstructed then there is a good reason for it and you are unlikely to get baby out with ease of you try to force a vaginal birth that is clearly not happening! Sorry for the rant. It's just frustrating when women/women's bodies are not listened to and observed carefully.

[YoullLikeItNotaLot]

Sorry, the comments about the husband not getting a say are very jarring. It might not be his body, but it his baby and wife and if he has a genuine concern regarding their safety then this should be considered.

Of course, if there is a stack of evidence to show his concern is misplaced or disproportionate then that is one thing, but just disregarding his concerns on the basis of "not his body" isn't something that sits well with me.

OP in your situation, I'm not entirely sure what I'd do. I understand the risks of SD are less with a HB but less isn't the same as none so I think the "well what happens if..." would need to be something I could be very comfortable with. I would also be worried about the potential you've said for giving birth en-route to the hospital. I think I'd be wondering if a CS was lowest risk of all options but then looking after 5 children while recovering may be tough.

Good luck coming to a decision

[YoullLikeItNotaLot]

Cross posted.

[wheresthelight]

considering your history I am afraid I am with your husband in this one. you have had complicated issues and preterm babies. taking the risk of being at home and away from the sophistication of hospital equipment and care just seems a ridiculous risk sorry

[NoRoomForALittleOne]

A big part of my reasoning for considering a home birth is that I labour quickly and would rather give birth at home than in the car. So, for all those who are supporting hospital birth (and I can totally see why) what would you suggest to ensure that I am definitely there for the birth? What option would you choose? And for those who would prefer a c-section, what gestation would you be pushing to have the section at given that I tend towards shorter pregnancies but don't want to hoik baby out too early?