Thoughts on a homebirth with an IM for first baby

[PinkFondantFancy]

Hi all,

I was hoping to get people's thoughts on having a homebirth for my first baby. I know this thread has probably been done 1000 times before but I'm finding it hard to find a balance of opinions. This might be a bit rambling, sorry....

I had originally planned a hospital birth. However, now that I've started thinking about my birth plan and from reading www.freewebs.com/birthresearch/homebirth.htm and www.homebirth.org.uk/, I think that a planned homebirth could be the ideal way to have a positive birthing experience and avoid intervention where possible. It would also allow me to attempt a water birth, whereas this is very unlikely to possible at my local hospital, as they only have one pool which is currently out of action in any case. I have an independent midwife whose original brief was to be my and DH's advocate in hospital. However, she is very positive about the prospect of a homebirth.

The facts are - I'm considered a low risk pregnancy with normal BMI, blood pressure, iron levels etc. and live about a half hour drive from the closest hospital. I'm currently 36 weeks pregnant, and the baby is head-down and partially engaged.

From talking to my IM, it seems that there are very few situations in which the level of treatment I would receive from her (and the accompanying midwife) is lower than in the hospital. Her view is that I would be monitored at least as closely, if not closer, than I would be in hospital, and most dangerous situations would be picked up early enough before they become an emergency.

I was feeling pretty confident about the idea of a homebirth, until I read this thread. I also heard a friend's birth story today where she required a crash c-section under GA due to baby being in distress when she was ready to push. This is pretty frightening as clearly under these circumstances, a half hour is just too far away from the hospital.

I would really appreciate people's thoughts on this, both positive and negative as I'm feeling so confused.

[speculationisrife]

Hi PFF. I can understand why that thread would have put you off! You hear horror stories of both homebirths and hospital births going wrong, though. What you will hear on this thread is people's personal experiences and opinions, and then you will still be in a similar position to the one you are in now - by which I mean you can never be 100% sure you are making the right decision. One thing to bear in mind is that you can arrange for a homebirth and then change your mind and go to hospital at any point (although it might be harder once you are in active labour unless you have to transfer in an emergency situation!).

I had a wonderful homebirth with my first (and only, so far) dd. I had a long early labour but I felt very relaxed. Then I had fantastic midwives, whom I totally trusted, and they were with me for the seven hours it took between the onset of active labour and dd being born after two hours pushing. I had an episiotomy and afterwards the midwives stayed to stitch me, help me bathe, clean up, and see the three of us into bed.

I live ten minutes from hospital, and my reasoning was that should I or the baby be in distress and need a c-section or other help, it wouldn't take much longer to get a theatre prepped and get me in there than it would if I was already in hospital.

I would think twice, though, if I was a half-hour drive. But I stress that this is just what I personally would feel is outside my comfort zone.

Do you have a midwife-led birthing unit near you? I think that's a great halfway house, and is what I would have chosen had I not been so near a hospital.

[speculationisrife]

I should add, I didn't have an IM - and I didn't know who was going to be with me until they arrived. All four of them (there was as shift change) were fantastic, though. And actually, for nearly an hour all four of them were with me, as the first two stayed because I was in transition and they thought I might give birth faster than I did, and they didn't want to miss it - how's that for service! I'm not sure how it works with an IM - presumably you would have to have two MWs attend the birth...

[PinkFondantFancy]

Thanks speculation, really appreciate you coming back to me. I agree with you that if it was 10 minutes I don't think I would hesitate - the half hour journey is the part that worries me the most. There is a MW-led unit within a hospital about a half-hour away but I really can't bear the thought of going to that hospital - it's dingy and dirty and generally horrible. The hospital I'm booked at is also a half-hour away but doesn't have a MW unit so it's either a homebirth or a full-on labour ward which is a pretty stark choice.

Yep the IM has another IM with her, and there are other IMs which I've also met which allow them to shift-change in the event of a long labour.

A crystal ball would be very very helpful right now!! :)

[speculationisrife]

It's a tough one. On the day I must say I did feel really confident. And on reflection I think that I may well have had the confidence to continue at home even if the hospital had been half an hour away, as I just had a strong feeling that all was fine, and that the baby and I could do this thing! Had I felt at all unhappy or nervous about it, I would have gone into hospital without hesitation, though. And you will have that option, too.

The midwife also let me push for over two hours before giving me an episiotomy (dd was in a good position but relatively big compared to me). I do think she may have made the decision to give me an episiotomy earlier or called an ambulance had we been further from a hospital, but I could be wrong.

If you do decide to have the homebirth, one thing I would advise is that you should listen to your body, and prepare yourself really well by reading up on positive experiences. I don't mean that you should ignore any risks, but just that if you've decided to have a homebirth you are most likely to have a positive outcome if you are not fearful. I would say fear is the biggest enemy of a natural birth. If you haven't already read it, this is a wonderful book Ina May Gaskin

[eaglewings]

Had 2 births with a IM, first in hospital, wish it had been at home and 2nd at home. Both brilliant.

First IM had done 50 deliveries since going independent, none needed a CS. The second IM had done hundreds and only once taken a mum to hospital during labour that was due to panic of the mum mostly (she was my friend, the IM did not tell me details)

[soandsosmum]

I had an almost homebirth with DD. Quite long (23 hours, 9 'active' ie 4cm, 5 mins inhospital) with great nhs midwives. I was transferred after 3 hours in stage 2. We're 18 mins from hosp but its quicker with a blue light ;) wasn't an emergency - the MWs made sure we had time to get there.

I did hypnobirthing and also read the ina may book speculation mentioned as well as child birth without fear. I hired a pool and would highly.recommend it. Love it. So relaxing and great to take the pressure off my tired body

[nannyl]

im 38+4 and am already for a home-birth with my 1st baby whenever he or she decides to arrive.

I had decided to have a home birth way before i was even pregnant, and it has never entered my head to do anything but.
I have had a text book pregnancy and baby has (so far) been doing exactly as he or she should

I live 45mins +++ from hospital and decided that being a passenger in a car for that amount of time while in labour would really stress and upset me, and i see no reason to go to hospital, without a reason to go to hospital so to speak.

Should i need to go to hopsital (as about 1/4 1st time mums who home birth do) then i would rather have a much much quicker journey in an ambulence with a midwife.

Once i became pregnant i have been looking even more at the risks etc with homebirth and was suprised to find that both me and baby are in fact less likely to die at a PLANNED home birth, than if we (the same low risk people) decide to go to hospital. Also intervention and infection rates are less for planned home births.

In the beginning i was really considering the IM option too. But the continuity of care i have had from my NHS midwife, could not have been better. I feel completely looked after by the NHS and by my midwife who i have a great relationship with and trust.

Unfortunately she is on holiday from when i am 41+2 but she has said that if i go into labour before then, she will do her very best to attend my birth. I cant ask for more than that, and it hasnt cost me a penny!
She is in a team of 5, and i have met one of the other midwives a few times too. Id be delighted if either of them attend my birth.

I also like the idea that buy choosing NHS i get 2 midwives present for the actual birth. Also they only send experianced midwives to home births. If in hopsital i may be sharing 1 newly qualified midwive, by being at home i get 2 experianced ones.

Good Luck in making your decision thats right for you. Hopefully in not very long i can report on what it was actually like!

[Milliebow]

Hi again nannyl waves :)

i'm 37+6 and planning a hb. Similar situation to pinkfondantfancy. mw unit half an hour away. Hospital unit half an hour away in other direction. In end the way I have looked at the risk is that it would take me as long to transfer as it would from mw unit to hospital, more chance of water birth at home, I am low risk, stats on hb show similar morbidity and mortality to hospital birth. Most reasons for transfer in first time hb are delay - ie time to transfer, more emergency situations are thankfully much rarer and would be no less risk if I was at mw unit as they can do no more/have no more equipment than the mw's will bring to my hb.

On the other hand I have taken quite a lot of thought to get to this point, esp as you say due to time to hospital and semi rural location. If anything changed to make me not 'low risk' then I will be going in. Eg earlier this week had rotten cold and asthma playing up. Much better now thankfully.

Not sure what anyone says will help you make a decision. As was said earlier its all opinion both positive and negative and what's right for me etc may not be right for you.

[Iggly]

I had my first at home with an IM. hospital was 10 mins away by ambulance.

I got a lot more monitoring during pregnancy with my IM (weekly as I approached my due date) - on my second pregnancy and hardly see MW now!!

One thing that convinced me about having a homebirth and IM was the stats - the level of intervention with an IM vs hospital - especially as people who tend to use IMs are considered higher risk but have been denied a homebirth by the NHS. I found my IM was a lot more positive about childbirth compared to NHS staff who could only talk of risk etc. Even though the majority of women are fine.

One thing to bear in mind is that first time homebirthers do end up in hospital compared to subsequent - from what I remember it's because of pain relief etc. Then you have a cascade of intervention and being in a hospital (bright lights etc) isn't exactly condusive to a relaxed birthing environment. I remember when at home as soon as I went into a room with bright lights during labour, the contractions were a lot harder to manage and I can easily see how I'd end up having pain relief if in hospital.

I'm a strong believer in the idea that our bodies were designed to give birth, and in the majority of cases it will be fine. However if you approach it with the idea that something will go wrong then no wonder it does (Ina May Gaskin had a very low rate of intervention in her birth centre).

I still believe this despite having a PPH and ending up in hospital for stitches. Why? Because I was able to walk to the ambulance despite the blood loss, the blood loss is an estimate and DS was absolutely fine during labour - probably because I was too. Soon as I got to the hospital it was stressful with people manhandling me and DS. If I'd birthed in hospital, I suspect I would have ended up with an epidural, a baby in distress etc as pushing for two hours isn't "allowed".

Next time around I'm going for the midwife led unit - I feel a lot more confident about handling midwives and medical staff and so does DH. plus I'm not sure about the practicality of a homebirth with a toddler and living in a flat where I know the neighbours can hear!!!

[stella1w]

I had a homebirth and my only regret was not having an IM as the one that was sent to my house by the NHS was a complete bully and totally traumatised me and treated the whole event like a medical emergency. I think being comfortable and not fearful and feeling wellprepared are really important for a good birthing experience and I wish I had had the support I deserved from the midwife..

[balia]

I dithered about answering this thread as I don't want to be seen as scare-mongering, but if I had opted for an hb with my DD I would have probably have died. I had a lovely low risk pregnancy, very low stress early labour in the hospital, in the birthing pool etc...but when she was born the cord was round her neck twice and I started to haemorrhage massively. I remember them running down the corridors to get me to surgery. I have no idea of the statistics at all but half an hours seems like a LONG time if something goes wrong. I lived 5 minutes from the hospital where I gave birth and that would have been too long.

[stella1w]

btw, another reason to have IM is the continuity in antenatal care.. I saw a different midwife everytime on the NHS, my notes were a mess, there were huge contradictions in what I was being told - eg. you are not diabetic, eg. you are diabetic eg. you are OK for a home birth eg. you are NOT ok for a homebirth (this from the bully midwife who called me as I was in established labour)

I was transferred to hospital due to a postpartum hemmorage. However, when I got there no one saw me for two hours and I was not stitched up for another two hours, so I don't think it can have been a very serious hemmorage. Sorry re spelling, am v tired..

[ClarityMa]

I had my first baby at home at the age of 42 with community midwives. Homebirth was amazing, so empowering. Just makes sure that if required you are not too far from the hospital. transfer rate is higher for first time mums but try and do some birth preparation with pregnancy yoga, I really found the gentle birth method very helpful and read new book out called The Heart in the Womb

[Parietal]

It is all a question of how you see and manage risks. Consider 100 women in the same situation as you, who chose a home birth.

50 of them will say afterwards - it was great, do it.
50 of them will transfer to hospital, and for almost all of them, things will work out too.
So for almost everyone of this low risk group, a home birth is great.
BUT (and it is a big but) there are occasions when something goes wrong, and mum and baby need immediate medical care. Not 30 mins away and not something that can be predicted in advance.

I was not prepared to take that risk with my baby, but I can't make your choice for you.

[nannyl]

balia

what an awful experience for you and yes, what a bit of luck you were in the hospital etc.

On the other side, i know someone whose baby did die in a hospital. She too was low risk, and everything was going wonderfully etc. Had she chosen to give birth at home her baby would have almost certainly lived to tell the tale (after a hospital transfer). Unfortunately she was being cared for by 1 very very new and inexperienced midwife (who was also caring for someone else at the same time). She was allowed to push all night, and eventually birthed a dead baby . Whilst one can never know for sure, had she have been at home, it seems very unlikely that 2 experianced midwives would have let the situation go on so long, and perhaps baby may have lived to tell the tale...

Child birth is very very risky for both mother and baby, one of the most dangerous days of our lives, and being in hospital isnt always the best place to be either.

(If only we all had crystal balls)

[TastyMuffins]

I had my only child at home with an IM. It was absolutely the right decision for me. One of the things that sold home birth to me (apart from the horror of hospitals) is that no one that I met online and in real life had ever planned a homebirth and regretted it regardless of whether they ended up with a lovely homebirth or hospital transfer before, during or after the birth.

There are many people who have given birth in hospital who say that their low risk births took dramatic turns for the worse and doubt they or their child would have survived at home but how do we know if they were never at home?

When something goes wrong in the hospital and an emergency button is pushed everyone runs, the more experienced staff run to assist and the junior staff/students run to observe and learn. A midwife doing home births would be more experienced than some you could have in a hospital as they are working alone (or with a more junior MW).

If you are happiest and most comfortable at home, your labour will progress far more smoothly than in hospital.

My baby's shoulders got stuck during the delivery. A small moment of stress. My MW dealt with this swiftly. I have seen in a hospital labour ward their procedure for the same situation, which is nowhere near as simple. If I had given birth in my local hospital they would have pressed the emergency button, a team of people would have arrived, I would have been stuck on a bed and given a swift episiotomy at the very least. I would have probably felt pleased to be in hospital and relieved that there were loads of people to save us. I would never have known that simply changing my position quickly could have resolved the issue.

I had a haemorrhage, again, if I had been in hospital the treatment would have been very different and perhaps I would have felt grateful they had saved me but I was more than happy to be treated at home and recover in my own space.

[spudulika]

Parietal - thousands and thousands of mothers have homebirths every year in the UK. In some areas 1 in 10 births is a planned homebirth. If there were significant additional risks to having your baby at home and if more mothers and babies opting for homebirth were dying - do you not think the the Royal College of Midwives would have published a statement saying that homebirth appears to be as safe as hospital birth for low risk mums?

[spudulika]

Whoops meant 'do you think'

[Iggly]

Parietal there's no conclusive evidence that a home birth is more likely to result in death of the baby (this is in the UK) vs hospital birth. Unless you can find something for me?

[ClarityMa]

There were press releases in the last two months that the Royal college of Midwives and the Royal College of Obstetricians jointly support homebirth as an option for low risk mothers. In the Netherlands, where homebirth is quite normal...the rates of death for mother or baby were equal comparing hospital and homebirth.

[FormbyDoula]

It's funny, I thought the other thread was very reassuring wrt homebirth!

But I am very pro-HB, I had one last year. I was 30 mins from the hospital too. The MWs would take you in well ahead of time if there was a problem. If there was an emergency situation - very rare - then it probably wouldn't matter if you were 3 or 30 mins away.

Everything is a balance of risks - babies die in hospital births, babies die in homebirths - both very rarely. Figures from one study showed 0.49 deaths per 1,000 births in hospital with a MW. There were 0.77 deaths per 1,000 babies in planned homebirths with MWs. So a 50% increase in deaths at HBs - sounds like a massive and worrying increase, except it is not because the figures are just so low to start with. Blog post looking at the figures here. There is a less than 0.1% risk of death based on those figures - not so worrying.

There are many benefits to HB eg you feel more safe and secure, you have 1-2-1 care (or even two to one!), you don't have the adrenaline-inducing trp to the hospital (funny how so many women report that their labour slows down or stops once they get to hospital) so you are much more likely to have a positive experience and less likely to need interventions.

Go for it - trust your body!

[FormbyDoula]

Don't let yourself be frightened by others' birth experiences.

Lots of people died driving cars today - but you still drive your car because on balance it is worth the 'risk'.

Your friend's EMCS might not have been needed if she'd been at home (impossible to tell as we don't know what went on before it).

[ClarityMa]

Totally agree fornbydoula. I know many of women whose labour slowed down in hospital because the the environment was scary....they ended up with interventions