Consultant said no homebirth 'cause of fibroid

[HyacinthBouvier]

Hi all - my MW has been very pro homebirth as I'm relatively young with healthy BP etc... a straight forward pregnancy and we live 10 mins from the MLU and hospital.

MW is aware I have a fibroid and has done homebirths with women with fibroids before. MW advised re possible bleeding due to the fibroid but not always an issue.

Had to have growth scan with consultant - fibroid is approx 3cm, hasn't grown at all and is nowhere near the cervix so wouldn't be in the way.
Consultant recommends not having a homebirth due to slight increase in post partum bleeding due to the fibroid - also that it's my first baby (which is contradictory in my opinion) and went on to mention baby being starved of oxygen at home (!) and basically that hospital was best.

I am going to discuss with MW at next appt and prepared to go with the flow but just wondering what other people's experiences were of consultant attitude to homebirths?

[CountessOfStrathearn]

"also that it's my first baby"

While I am fairly pro-home birth and actually had DC1 at home, that was before the BMJ birthplace study that there are slightly higher risks to the baby for a first time mother. The risks are fairly similar for second and subsequent mothers and babies.

www.bmj.com/content/343/bmj.d7400

[HyacinthBouvier]

As I understood it, the reason most homebirths weren't successful for first time mothers was because MW were (rightly) very cautious if anything looked even slightly concerning and would transfer to hospital. So labour taking longer than usual etc...
I'm confused because of my fibroid is the issue, it will still be an issue for subsequent births so my being a first timer is irrelevant? I just wish they could be honest - the bit about baby being starved of oxygen was said directly to DH - "increased risk" - she didn't actually provide any numbers/facts to back it up!

[CountessOfStrathearn]

"the reason most homebirths weren't successful for first time mothers was because MW were (rightly) very cautious if anything looked even slightly concerning and would transfer to hospital. "

So you've got two things there that I think you are confusing slightly.

Yes, the transfer rate is higher for first time mothers, partly because MWs are cautious and very understandably and appropriately, as you say, transfer early in home births to prevent issues at home.

Also, the women choosing home birth second and subsequent times have already gone through labour, so their pelvis has been "tested", they know the pain of labour and are less likely to be transferred for more pain relief etc, have had (normally) an uncomplicated delivery before so that bodes well for this time round, labour is normally shorter second time round etc.

But also, that study showed that first time mothers starting at home (so it included everyone who had a baby at home as well as those transferred) still have a higher risk of serious harm (9.3 events in 1000 births compared to 5.3 in 1000 births in the obstetric unit).

(Events were stillbirth after start of care in labour, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus, or fractured clavicle.)

As for the fibroids, I've found this paper that might be helpful in stratifying the risk or for you as you ask questions:

"Pooled cumulative data suggest that postpartum hemorrhage is significantly more likely in women with fibroids compared with control subjects (2.5% vs 1.4%)" - but that does bunch together smaller (3-5cm) and larger (5cm+) fibroids.

www.ncbi.nlm.nih.gov/pmc/articles/PMC2876319/

Hope that is helpful.

[Caridge]

I would add that consultants only usually see emergencies / women who are high risk and not natural low risk births very often. I personally feel this hinders their advice. If you feel happy to progress at home remember you don't have to do what the 'experts' say and its your choice. Good luck with whatever you decide and if that does mean being in hospital you can still recreate a home environment as much as possible by bringing in your own duvet, aromatherapy, hypnobirthing or music perhaps? Xxx

[WhoTheFuckIsSimon]

I was involved in caring for a lady recently with a 5cm fibroid. She bled 6 litres very quickly and had to be ventilated in ICU. Don't let being ten mins from hospital reassure you when you're high risk. You can lose All your circulating volumne in that time. Of course plenty of women with fibroids won't have a pph, but you don't know until it happens if you're going to be lucky or not.