Birth plan for home birth and just in case of transfer?

[TheGrumpySquirrel]

Hi, I had a very straightforward first labour with my DD (4 hours from first cramp to baby, including just 1 hr active labour, 5 min pushing) with no intervention or tearing and just gas & air. However this was 13 years ago and I'm not that young anymore. I'm planning a HB due to the expected speed of this one (we shall see...) and (mainly) because hospitals make me very anxious.

BUT I'm aware I need to be prepared for all eventualities including the potential for transfer to hospital and interventions if need be. I live a 2min car journey from hospital so comfortable with this plan. I just need some help thinking through the "what if things aren't straightforward" scenarios.

For example - forceps vs EMCS or episiotomy vs allow tearing... I've heard horrible stories about high forceps and thinking of specifying I do not consent to them and want CS in that situation. My pelvic floor is not what it used to be, although not bad.

& What if I go overdue and they want to induce labour? Almost everyone I know who has been induced has ended up with traumatic EMCS so why would i not just ask for ELCS instead.

Thank you in advance!

(& home birth scare mongerers please don't bother, this isn't what this thread is about)

[TheGrumpySquirrel]

Also I think I want synto injection for placenta as I had it last time and was all very easy, are there any benefits to not having it? Are the risks of PPH greater with or without?

[GummyGoddess]

Regarding the injection, the benefits are that placenta is out quicker with less blood loss at the time. Waiting for it to come on its own takes longer but the lochia will stop quicker.

List all the interventions and then decide which are acceptable to you and which are not. I would also confirm with the home birth team that you are anxious about giving birth in hospital and that you would want a c section instead of an induction, best to get that conversation out of the way asap.

[TheGrumpySquirrel]

Thank you. I'm wondering if inductions are more likely to be successful with second babies. Although I suppose there is less data as not many second babies are that overdue

[Dinosauratemydaffodils]

I've heard horrible stories about high forceps and thinking of specifying I do not consent to them and want CS in that situation.

Rotational forceps I would never consent to in a million years but with ds, I had an attempt at a mid forceps delivery after they explained the risks of c-sections at full dilation after a long labour (also potentially unpleasant). As it happened for us, forceps couldn't move ds but I had no tears/cuts from trying and all the worse case c-section possibilities didn't happen either but in that scenario there are definitely risks either way so I'm not sure it's black and white.

[mustbemad17]

Home birth planned here, we live 30 minutes from the hospital with decent traffic so have had a very in depth chat with the MW about all eventualities.

Re the injection for the placenta, i have had it both times & found it worked well, placenta came easily & no damage done. Will be having it again for sure!

Regarding other interventions, i have basically said i will take medical advice. I'm lucky to be almost guaranteed my familiar midwife at home, & she will transfer with me shoulf i need to go to hospital, so she can advocate for me based on what she knows. I have no real preference about forceps etc, my theory being if a doctor thinks they're needed, then who am i to argue? My only panic is with the idea of a c-section, for some reason it makes me panicky & quite tearful. Have said i want a GA if it happens, because i don't want to be totally stressing out & therefore adding stress to a potentially already stressful baby. My MW is happy to advocate that for me.

[Doublechocolatetiffin]

I’d highly recommend reading the positive birth book. It’s brilliabt for going through the different possibilities and interventions in birth and helping you decide what you’d agree to. It also has a brilliant template for birth plans which use pictures and cover lots of different options.

I also read a great, research based book on induction called inducing labour. It gave me the confidence to cancel the induction I had booked at 40+12 so I could wait it out. I ended up having my DD at home at 40+11 which was a vastly different and much better experience than my first DD who I was induced for.

[Doublechocolatetiffin]

Apologies for bad spelling in my post, trying to type and feed and clearly failing miserably.

[doleritedinosaur]

I had a homebirth with my second as my first was 1 hour active labour too.

Definitely set up a plan as it helps the midwives too. They deliver a home birth kit around 36 weeks & access the house for ambulance transport etc & go through it with you then what happens.

They also tell you any items you need like a jug & torch are required in my area so I put them in there too.
Also had a hospital bag ready for baby & I just in case but it was handy as Oh just grabbed the baby bag to dress baby when he was ready.

I’m hoping to have another homebirth with my third so I’m going to tell the midwives to be more hands off this time as they slowed me down.

They also deliver the gas & air which has to lie flat but we just put them behind the sofa.

I think that’s everything, I loved mine, was doing housework until 2 hours before baby made an appearance haha.

[GummyGoddess]

How overdue was your first dc?

[doleritedinosaur]

Oh yes forgot to say I had the injection to get placenta out & it came within 2 minutes.

& I’m 15 minutes blue lights from hospital but my midwife assured me that they have to get the theatre ready no matter what. Plus the midwives are very good at noticing when it’s goinf downhill & transport in plenty of my time.

In fact my friend started at home & gave birth in hospital as she wanted more pain relief so it’s perfectly okay to change your mind.

Just take paracetamol as soon as baby is out as the after pains with the second are a lot more painful.

[Babdoc]

“Home birth scaremongers, don’t bother...”

Why not? Do you have some magic immunity from massive intrapartum haemorrhage, cord prolapse or severe fetal distress? What is your plan to cover these eventualities, given that a home midwife cannot perform a forceps or Caesarian delivery, and doesn’t normally carry a 6 unit shock pack of o neg blood as is standard in hospital delivery suites?
I also had a very easy first birth. I could have considered a home delivery. My DD2 arrived after another fast normal labour, but almost dead. She required cpr, intracardiac adrenaline, intubation, ventilation, three different anticonvulsants and a week in ITU.
If I’d had a home delivery, she would have died or been severely brain damaged.
She graduated uni six years ago - because I had the sense to have her in a hospital with a highly skilled paediatric crash team.
By all means risk your own life, but I think it’s a bit tough on your baby to risk theirs.
And yes, I’m a doctor, so no doubt biased in favour of safety and modern health care! But seriously, you wouldn’t want to have any other high risk medical procedure in your own home- why do it with childbirth, when a fully equipped hospital is available free of charge?

[gryffen]

Hi lass

Was induced with my first in 2014 and had forceps delivery with episiotimy- no damage done and healed very very quickly. Also had a PPH of 958ml but I'm Oneg and it wasn't caused by the forceps etc.

I'm due in 9 weeks and will be induced again by request or potentially planned Csection as baby is big - again no concerns here.

Your planning is sound, be prepared for all eventualities and staying calm is the key - if you want a HB then go for it just be adaptable.

[TheGrumpySquirrel]

@Babdoc no I don't have magic immunity from these things. I've done my research and weighed up the risks. This is my second baby and first was straightforward so very low risk. I have a phobia of hospitals. I'm sorry that you had such a terrifying time of it with your daughter. But I am not "risking my baby's life" when I am a 2min drive from hospital. I've been told I'm unlikely to make hospital in time anyway. I don't want to give birth in triage waiting room. Responses like yours are ridiculously unhelpful. I posted don't bother because I hate the way any thread that mentions HB gets jumped on and made into a for / against argument where people misquote statistics and argue. That's been done so many times.

If you read my op I'm trying to make a sensible plan that includes scenarios of things not going well.

Thank you to everyone who has posted useful tips. I will check out those books. My first baby was not overdue she was 4 weeks early (36w) so if I go into labour before 37w I will be going into hospital anyway.

[GummyGoddess]

@Babdoc I don't know about op, but I have had two home births because I am terrified of hospitals and I didn't think my mental health would survive a hospital birth intact.

As a medical professional I don't think you would be able to fully understand how traumatic I would find it, my mum is a midwife and she was supportive of my plans but doesn't see what I have to be afraid of in a hospital setting. The only way you would have got me into a hospital to give birth would be a c section.

[TheGrumpySquirrel]

I didn't have any after pains as injection got placenta out within a couple of mins. Hoping for similar this time.

[mustbemad17]

MW at home births work to a lower threshold than in hospital, so you would likely be transferred earlier from home than you would be moved in hospital (this is from my MW). Ours wasn't at all concerned about the distance from here to the hospital because of this, which is reassuring.

Definitely have a 'birth bag' ready just in case...i've got all the first bits in so DP & DM don't have to root about to find stuff. I'm planning a water birth so also have things like a shower curtain, puppy training pads, plenty of towels & a brand new hose with tap adaptor...it makes for interesting convo when people come round & see it all on the changing table haha

[TheGrumpySquirrel]

Yes mad I've also got a birth pool arriving at 37w which I'm setting up in my bathroom (wet room with hose shower attachment which may come in useful!). I'm hoping the floor of the pool is padded ?? If not will have to think of something as I'd like to be able to kneel.

Okay so hospital bag will be packed just in case. Looking up positive birth book for list of interventions & explanations, will list my views on them in birth plan.

Hopefully I don't end up needing an induction but I'll ask my MW for statistics on second baby inductions. CS also terrifies me but I'd rather have a planned one than emergency one.

[TheGrumpySquirrel]

@doleritedinosaur "I’m hoping to have another homebirth with my third so I’m going to tell the midwives to be more hands off this time as they slowed me down. "

Thanks for sharing your experience! What do you mean slowed you down?

I've got an online Hypnobirthing course to do. At first I dismissed it as hippy woo shit but anything that can make me feel calmer should help even if things don't go to plan.

[mustbemad17]

Mine isn't coming until the MW does which makes me sad...but i don't have to pay to hire it so can't complain haha. From what i can gather they are quite decent at the bottom & quite thick to maintain water temp, so you should be okay. I intend to be on my knees too, so am hoping anyway!!

[doleritedinosaur]

@thegrumpysquirrel I had a bad induction at 37 weeks with DS1 & was on my back ended up ventouse so I have intense fear of giving birth in hospital plus consultants do not listen or appreciate patient care so this is why I opted for home birth.

The midwives moved me out of the position I gave birth in & kept annoying me every contraction as I was waiting for the one to push DS2 out as I felt him go back.

I know now for next time for less intervention & to just signal OH to tell them what to do.

I did the Sophie Fletcher hypnobirthing book from 12 weeks & it helped amazingly. I got to 8cm with no problems & the last part it really helped me focus & keep control. I highly recommend it.
Will definitely do so again with music this time.
Pregnancy yoga I highly recommend as well.

My consultant after being incredibly rude about homebirth at 16 weeks with DS2 signed me off at 36 weeks for home birth but I got him on board at 24 weeks.
We agreed natural for all eventualities as originally my placenta blocked my cervix but it moved. If I had a C section it was to be planned & done naturally with minimally lights & baby crawls out.
If I gave birth in hospital I could set the room up as I wanted it, lights, ball etc as I did not want to be on my back again.


Also the pool can take up to a hour to fill that’s why I didn’t bother as my active labour is around a hour for both labours.

Ignore the doom sayers, my hospital has a rate of 40% unassisted deliveries. I could not relax in a hospital, I cannot relax around consultant’s.

You get 2 midwives at home, I had 3 as I had a student as well, all eventualities are covered.

[GummyGoddess]

Birth pool in a box pools have inflated floors and a little inflated seat in, very comfortable to kneel on.

[TheGrumpySquirrel]

I think mine is from barefoot birth pools but the make is the BPIAB mini

[MollyDaydream]

The only things it's worth deciding on beforehand is whether you want a managed 3rd stage and how you want vit k administered.
Everything else - do some reading beforehand, take medical advice at the time, and make decisions as they arise.
Ime even when you have expressed preferences in a plan eg for pain relief or skin to skin they still double check at the time anyway.

[Levithecat]

Hi Grumpy,

Re safety of HB, I think the birthplace study is still the best/most evidence we have and that says for subsequent births home is as safe as hosp. www.npeu.ox.ac.uk/birthplace/results

have you come across the midwifethinking.com blog? Written by an Aussie mw/academic - lots of interesting analysis of evidence for approaches/interventions, including ‘hands off’ approach during pushing.

And worth checking the Cochrane database for evidence on different interventions.

With my first I’d planned a HB but went into labour at 35w and ended up with a hosp birth. I had a retained placenta in the end, which needed to be removed in theatre so would have had to transfer if I had been at home. So a hosp bag is worthwhile.

This time my consultant is keen on induction at 38w. I am not, but we’ll see (32w now). She said that they’d do a balloon / foley induction this time, which does not involve drugs, instead an uniflated balloon is pushed behind your cervix and inflated with saline, to put pressure on the cervix (like the baby’s head). I am planning to avoid induction unless there’s a strong clinical case (as opposed to my obstetrician wanting to control birth :-)), but if I do need one then this seems better... appparently it’s less intense for subsequent births and for ppl who have had fast labours (my last was 4.5hrs excluding the placenta!).

[TheGrumpySquirrel]

Thank you Levi I will check that Cochrane database out. I'm comfortable that HB will be as safe as hospital for me having read the studies and convinced I'll be more relaxed.
May I ask why they want to induce you early this time? Does everywhere offer this balloon induction?