to plan a homebirth when 28 miles/50 mins from hospital?

[CloudiaPickle]

I'm in the final stages of pregnancy and think things could be about to start but am having major cold feet because of the distance to hospital. Would you have a homebirth if you were this far away?

And that's for all mothers.

The risk of assisted delivery for first time mums at this hospital is MUCH higher than that.

THey are hardly likely to do these interventions at home.

It's a bit like saying if you want to avoid death you are better staying in a hotel than a hospice.

The majority of c/s nationally are unplanned.

Bigblue - the studies comparing rates of interventions for mothers by place of birth include outcome by planned rather than actual place of birth.

Hence 13% of healthy low risk mums who opt to labour in hospital will end up with an emergency c/s.

5% of similar mothers who opt for a non-obstetric setting outside hospital will have an emergency c/s. Obviously they'll need to go to hospital to have surgery but the figures will be included in the 'out of hospital' cohort.

Current estimates suggest that in the UK, having a first baby at home slightly increases the risk of a poor outcome for the baby, including death and complications that may result in long-term health problems (from five poor outcomes in 1,000 for a hospital birth to nine in 1,000 – almost 1% – for a home birth).

Source- NHS

Transfer rates are about 1 in 10 for multiparous women, 1 in 3 for first time women (though much lower for case loading teams an independent midwives).

Most common reason for transfer is for pain relief and slow progress.

Home births could be as dangerous as 'driving without putting your child's seatbelt on'
Journal of Medical Ethics, said that the “avoidable, foreseeable disability” that could be caused, in particular by delays in access to emergency care for new-borns, should “weigh heavily” on parents’ decision about whether to give birth at home or not.

www.independent.co.uk/life-style/health-and-families/health-news/home-births-could-be-as-dangerous-as-driving-without-putting-your-childs-seatbelt-on-9078184.html

I used to be very pro-home births, until I actually gave birth. I was in a hospital, had been induced at lunchtime, it got to 9.30pm and I was told nothing was happening and to settle down for the night. Half an hour later I was having an emergency c-section and the surgeon commented straight afterwards that it was "just in time". Being 50 minutes away from a hospital would be just too big a risk for me, I'm afraid.

But you wouldn't have been induced at home!

Am confused Matilda. Was it an option that you would you have been induced and sent home? Or do you just mean you laboured much more quickly than expected?

No way ! But I wouldn't have a home birth anyway and I said this before ds who got distressed and meant I needed an emergency c section

Yes - but interestingly out of hospital births for first time mums in freestanding birth centres - where there is no obstetric or paediatric input - have outcomes as good a those in hospital, despite having no medical input that is unavailable to a woman at home.

And the average transfer distance from FSMLU (freestanding midwife led units) is 17 miles.

I'm hoping that they will do more research into why there are poorer outcomes for first time mums in some non-obstetric settings. Out of hospital birth nct be the problem per se - otherwise you'd see similar results for FSMLU, and you don't.

No, I wouldn't have been induced at home, but my point is that things can very quickly go wrong at any point, and if and when they do, I would much rather be in a place with doctors and a theatre.

That quite doesn't contradict what I was saying about the evidence base either.

But women have to pass certain criteria to give birth at a birthing centre so why would you expect the outcomes to be the same?

I also want to see research on why the differences between home and MLU

Studies control for those differences

By the way - if you want to argue about the safety of homebirth by digging out studies from other countries, newspaper articles, etc feel free. I'm on an iPad which is hard to type on and paste links, so won't be engaging in a vigorous debate about the validity of these views. :-)

Bigblue - the 2011 Birthplace study controlled for risk status.

I agree with you Matilda and just wanted to clarify your post but other posters will no doubt say that if you hadn't been induced - and this couldn't have happened outside hospital - then all would have been fine at home.

But the whole point is that in the OPs situation obstetric care would not be available rapidly if needed, it would be some combination of time from ambulance station (coming from the hospital?) to her, plus 28 miles back on blue lights, away. If she lived 5 mins away there would be much less concern about what would happen in the unlikely but potentially catastrophic event of an urgent transfer being required.

Yes baking and ambulance response times in your local area are a big consideration re: home birth too...

I don't know how you find that out inconceivable do they publish them? I did research it a bit for birth 3 as I labour v quickly and was concerned not to have an unplanned home birth after major PPH after birth 2. I was told to phone 999 if I felt baby was coming quickly and I couldn't get in under my own steam. We live v close (

They are published, yes. Some areas are consistently missing theirs so it's worth checking.

missing their response time targets, I meant...