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To want a home birth?

(651 Posts)
InMemoryOfSleep Tue 20-Mar-18 08:28:51

I’m not pregnant (yet), but chatting to my mum and some friends recently I mentioned I’d like a home birth next time. Their reactions weren’t positive, to say the least confused - despite me explaining that, for a 2nd baby, home birth is as safe as an MLU, and both are safer than a hospital. They’ve made me really doubt myself - having read the research and stats I was convinced it’s the best option, but am I missing something?!

Peregrina Wed 21-Mar-18 23:03:12

A lot of women get sent home again, because they are not considered to be in established Labour. With your first, it's not easy to tell how far on you are, but especially for those who have already had a baby and have an idea of how they are progressing, IMO if the woman feels in need of support she shouldn't be turned away. Again this probably comes down to staffing.

As a PP said, she felt staffing was the key. I do too, and I think we took something of a wrong turn in promoting hospital over home, instead of trying to consider the quality of the attendants and getting the right one(s) for each woman. As we have seen from some posts, it doesn't matter how spankingly new the equipment is, it's only as good as the people operating it, and if they are too rushed off their feet, it might as well almost not be there.

Pikehau Wed 21-Mar-18 23:10:05

Fishinthesink* 100% agree

Snowmagedon “But what I dislike is the sort of brain washed mantra that hospitals are bad and automatically lead to bad intervention”

I don’t think that’s the case on this thread though.

Intervention has to be mentioned in a hb thread because intervention is less likely (if at all) in a hb than hospital and intervention can lead on to further interventions / issues not possible in a hb.

Hospitals are NOT bad. I think a tiny % of hb woman would say that they are.

sycamore54321 Wed 21-Mar-18 23:28:20

@inmemoryofsheep you are wrong. There is some possible correlation with induction or section but certainly nothing that "significantly increases" risk and so avoiding these at most might marginally decrease your risk. But there is nowhere near the protective effect you imagine from the absence of intervention.

vampirina Thu 22-Mar-18 00:12:09

Lots of talk of Drs intervening too quickly etc. I wouldn't have a home birth personally but had hoped to have a MLU water birth (attached to hospital).

Lots of complications and ended up consultant led, with tubes everywhere and an epidural.

After an hour of pushing my amazing midwife said she could buy me 10 minutes but that the consultants watching the monitors outside would be wanting to come in and look at an instrumental delivery. She helped me push my baby out without the need and with only a minor second degree tear.

I had gone through labour convinced an epidural would = an instrumental birth and that consultant led would be awful. But actually it really wasn't. I don't think HCP are looking to intervene for the fun of it, there's a reason stillbirth rates have improved so much since the 80s. The whole MLU / homebirth is best narrative isn't massively helpful for a lot of people. Being sceptical I often wonder if the ML option being pushed to all non high risk people as default is more about cost saving. Appreciate that's necessary but there were lots of markers in my pregnancy to suggest ML wasn't going to happen for me. Luckily it was a short trip upstairs.

Although I agree wholeheartedly with PP who said the midwife makes a huge difference.

For me personally, not being monitored may have been disastrous as other complications were picked up incredibly quickly.

Fishinthesink Thu 22-Mar-18 05:23:48

*pikehau exactly. I don't think anyone has said they are not thrilled that hospital care is available.

One of the other challenges is there is no control group for your individual birth. So saying that something would have been worse/better if the place of birth was different is an assumption. There are such a wide range of factors making up birth outcomes that the interaction of these on any given day is unknowable (the US has pretty much the highest rate of consultant led birth in the developed world; it also has the highest maternal mortality rate. This tells us there are other things going on that are not about the hospital itself).

minifingerz Thu 22-Mar-18 05:58:39

You are not unreasonable to want a homebirth.

www.nice.org.uk/guidance/cg190/resources/choosing-place-of-birth-resource-for-midwives-msword-248730877

According to NICE (for someone in your situation) you are 5 times more likely to have an emergency caesarean if you choose an obstetric setting for birth than if you opt for a home birth.

No evidence of any gains in safety for babies.

Why expose yourself to 5 x the likelihood of major surgery, 4 x the risk of instrumental birth and 2 x the risk of needing a blood transfusion?

So no, completely reasonable on the basis of the evidence to be at home for birth.

VioletteValentia Thu 22-Mar-18 06:16:05

As others have pointed out, you are scaremongering

No, I’m not. My son would’ve died without one immidiately. He would’ve died at home.

90% of women tear, episiotomy or not. And most women say it’s never the same.

DeloresJaneUmbridge Thu 22-Mar-18 06:44:56

Violette, I've not read your birth story but it sounds a scary time for you.

As an ex Midwife Ive helped women deliver their babies in all kinds of environments...including a field (I kid you not...it was planned that way too lol).

However in any environment (including hospital) there is the risk of sudden and unexpected events. These events can be minimised by good antenatal care of both mother and baby which can predict the risks of this happening.

Babies die sometimes due to these sudden events but that takes place regardless of where the mother is.

Once a woman is in labour then good labour care and monitoring of the baby can keep an warn of impending issues and if at home will give ample time to transfer to hospital. I've never had any issues with this and transferred once or twice with women whose labours were showing signs of not being straightforward. In one case the woman delivered her baby safely a few hours later and in another the woman had a ventouse delivery.

A woman who decides on a home birth following a straightforward pregnancy is unlikely to have any issues in labour but if she does then can be transferred.

She will have less interference in labour beyond monitoring of her health and the baby's health. As a result she is more likely to have an uncomplicated birth. Look up labour and the cascade of intervention for more about this.

However women must be able to choose where they feel safer when giving birth. For some that will be the hospital with all the risks of intervention causing problems (it happens). Most will then go on to birth their babies safely.

Some women will choose the MLU knowing the hospital facilities are nearby if needed.

Some women will choose home (or a field hmmgrin) knowing that if transfer is needed they will end up transferring when in heavier labour which isn't a great experience.

Go where you feel safest ...the evidence says that in an uncomplicated pregnancy and labour then home is perfectly safe but many women will not want this.

Teateaandmoretea Thu 22-Mar-18 07:35:15

OP I haven't rtft but talk to your midwife and be led by their medical advice.

My own experience of homebirth is that in truth you are better looked after and so any issues would be picked up earlier than if you are shoved into a room on your own without a midwife. They come out when you go into labour rather than you basically labouring in a traffic jam and going in at 7cm.

There will always be women who come in with awful birth stories and how they/ their baby would have died. Equally it's hardly unheard of for second babies to be born before arrival.

The only person who was negative about it in my case was my Dad, and one friend. Mum was neutral as were most other people. I definitely wouldn't have gone against medical advice though or fought 'tooth and nail'.

But like you I don't see what the advantage of an MLU is that is in the opposite direction to the hospital. And bizarrely no one would turn a hair at that confused

LP17 Thu 22-Mar-18 07:43:20

@OP At the end of the day, the only person that could make the decision is you & your partner. Do your research and make an informed decision. If you want the support of your family then share the research with them.

I'm TTC at the moment and know I want a home birth, which should be achievable as long as I have a low-risk pregnancy. Obviously, if anything changed and I became high-risk, I would reassess my options at that time.

It's not selfish to want a home birth nor is it an additional burden on the NHS. If anyone who is interested would like to refer themselves to the One to One midwives website, you can find more info (for example, they bring a big sheet to put under the birthing pool to contain any mess, as one PP had mentioned!).

VioletteValentia Thu 22-Mar-18 07:45:04

Delores I agree that the chances of something going wrong for a low risk woman at home are low, but the reason I’m fearful is I was “low risk”. I was 20, healthy, first pregnancy, no previous issues and had a scan 3 days before that said he was in a good position.

Yet when he was born (ELCS that I chose), he had pooed, was posterior and diagonal, breathed in meconium and had APGAR of 5. He was very poorly. He couldn’t breathe without assistance.

There was zero warning of this. Zero.

We also had the horrid experience of him being taken by ambulance to a hospital with a NICU as mine only had SCBU. I was left in the regular hospital until the next day.

Once transferred, I and him were treated wonderfully as I mentioned above and the care we received made what would’ve been a horrible time quite calm.

However because of this, I do think it’s somewhat irresponsible to not be in hospital. Personally I wouldn’t give birth anywhere that didn’t have an attached NICU.

I acknowledge these views are coloured by my experience, and this isn’t a common thing, but I don’t think it’s wirth the risk.

Pikehau Thu 22-Mar-18 07:46:19

vampirina the whole MLU / homebirth is best narrative isn't massively helpful for a lot of people

But that’s the point. No one is saying mlu or hb is the best for everyone. It is best for some. The majority of deliveries would be best midwife led. Sounds like with your risk markers mlu wasn’t for you but you still delivered with a midwife. But with the reassurance of a hospital / dr. And so it’s the best place for you.

Going away from the hb aspect of thread but in the majority of cases midwife led (not talking about setting) is best. That’s not me saying you shouldnt be allowed an elective section. You should if it’s your wish.

Once again I reiterate mw are birthing babies day in day out so of course most of us should be fine with a mw attending. Of course it should be the default option. And then you get to choose setting or opt out.

And agree that hcp in hospital are not pushing intervention for the sake of it but it’s to hand for the labouring woman and drs are by nature searching for problems to fix. That’s a bit simplistic but again I don’t think this thread is saying intervention is pushed. There are just facts supporting intervention that have been pointed out.

And regarding death rates just read about the US. Again I reiterate we do not want to become the US.

violettevalentia and others if you were a full term low risk factor pregnancy who would have been A very low risk /good candidate for a hb in today’s standards then yeah I see for you it seems alien. But if you had any factor showing hb would not be an option for you then I don’t think you can comment with scaremongering and flippant comments (see some of last nights posts)

Teateaandmoretea Thu 22-Mar-18 07:50:49

Violette you clearly had an awful experience but Midwives can revive babies if they need to at home. Just like they can manage it if the woman bleeds until the ambulance arrives.

TwittleBee Thu 22-Mar-18 08:00:16

not worth the risk can be said about hospital births too when you consider how much can go wrong there due to negligence, unnecessary intervention and risk of infection. That is why the risk level is exactly the same for birth at home or in hospital for low risk #2s.

BalloonSlayer Thu 22-Mar-18 08:02:41

OMG Johnny was your DT1 OK?

VioletteValentia Thu 22-Mar-18 08:08:20

said about hospital births too when you consider how much can go wrong there due to negligence, unnecessary intervention and risk of infection.

The difference being, there are a whole team of experts, so somebody should be able to pick up on something.

I think it depends how much you trust doctors. There seems a lot of distrust.

Teateaandmoretea Thu 22-Mar-18 08:14:59

It's not about distrust. They are less careful with you if you are in hospital in my experience, the midwife at home concentrates solely on you right through your labour. At the same time you wouldn't even be in hospital yet. You only see a doctor in hospital if there is a problem picked up by the midwives if everything is 'normal'. Unless you are saying because of your experience it would be best for everyone to have an ELCS? That was the key factor here, not whether a woman has a natural labour at home or in hospital.

I've had both home and hospital births as many people have.

Peregrina Thu 22-Mar-18 08:28:09

My experience backs up teatea's, although it's a long time ago for me. The hospital birth was OK, but they were so busy, I had the feeling that they wanted me out of the way and were more interested in doing things by the clock than assessing my progress. For the home birth, the midwife was just as busy, but I felt just that bit more on the ball, and not rushing off to deliver a woman in the other bedroom!

At the moment it's only something like 2 -3% of women have planned home births, and I think almost all who do think very carefully about the decision. I don't think the same can be said for hospital births - it's the default option, and women are assured that "it's all there when it goes wrong", although as we have seen on this thread, that isn't necessarily the case, and some must have had quite a rude awakening.

I don't go along with the statement 'the only thing that matters is a healthy baby' either. I think the mother's health matters too, and the Place of Birth found that with home/MLU deliveries there was significantly less morbidity for the mother.

VioletteValentia Thu 22-Mar-18 08:29:56

Tea one of the reasons I chose ELCS was because I didn’t want to be on a ward at 2am full of women with two midwives between us. It made sense to schedule it for a time that drs would be around. I also avoided Monday and Friday because I didn’t want the “back to work” feeling or them to be in a rush for the weekend and me to be stuck with skeleton staff over the weekend.

I am, as you can probably tell, a perfectionist. I think it’s the leaving it to chance element which I find terrifying.

VioletteValentia Thu 22-Mar-18 08:33:23

I had the feeling that they wanted me out of the way and were more interested in doing things by the clock than assessing my progress.

I had two hospitals because we were moved to a bigger hospital due to DS needing the NICU.

The first hospital, I had one rude nurse tell me to stop whining and I’d better be discharged tomorrow because she needed the bed for someone else.

The second one was the one I mentioned up thread, it was wonderful.

Unfortunately it depends on who is working that day. I complained and got an apology from the first hospital, and was told staff had been spoken to, so hopefully that won’t happen again but I’m doubtful.

Teateaandmoretea Thu 22-Mar-18 08:34:11

Homebirth injects more uncertainty there is no doubt. Because you don't know for certain where your baby will be born. So for real planners I think it's problematic but that's not medical but based on your personality.

I think that you were lucky you had an elcs violette because if you'd stayed pregnant longer then the consequences don't want thinking about whether you'd planned a home or hospital birth.

VioletteValentia Thu 22-Mar-18 08:38:39

violette because if you'd stayed pregnant longer then the consequences don't want thinking about whether you'd planned a home or hospital birth.

I agree. I’m very thankful I went with my instincts and chose a cesarean. Every woman in my family has had trouble with natural birth, I don’t believe history makes no difference.

PasstheStarmix Thu 22-Mar-18 08:39:21

It’s very difficult to get an ELC aswell unless you’ve had a traumatic birth in the past.

TwittleBee Thu 22-Mar-18 08:40:50

VioletteValentia it is like you are actually incapable of realising stats and evidence. I understand what you went through was scary but you don't need to scary everyone else or constantly keep posting antagonizing comments. There is exactly the same stats on the the same level risks for both scenarios. Therefore things do go wrong at hospital and the medical team there are unable to save mother/baby.

If someone who is low risk with #2 baby the risk of something going wrong is at exactly the same level of risk in either environments and so is neither mum's fault in either scenario for choosing their birth because either place has exactly the same risk level.

VioletteValentia Thu 22-Mar-18 08:44:26

If someone who is low risk with #2 baby the risk of something going wrong is at exactly the same level of risk in either environments and so is neither mum's fault in either scenario for choosing their birth because either place has exactly the same risk level.

I’ve never said it’s anyones fault.

I understand what you’re saying, but the risks are different even though the outcomes are the same. The risks for a VB and ELCS are the same in outcome, but you’re not at risk of an episiotomy with ELCS or anaesthetic reaction with VB.

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