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?

Home births that transfer to hospital DO NOT then count on the hospital statistics.

Studies are conducted on low risk comparable mothers and outcomes compared on the planned place of birth. Not the actual place of birth.

I had two hospital births, all very quick, first one 8 hours but forceps delivery due to DS1 presenting his forehead rather than crown. DS2 was a 4 hour labour, just got to hospital with 40 mins to spare.

DS3 was an unplanned home birth with a 20 minute labour. The hospital was 10 minutes away, but it may as well have been miles away.

I didn't enjoy the unplanned home birth. Not at all prepared and no medical people there until the ambulance arrived 10 minutes after his birth. Very scary and shocking (and messy!) Although completely uncomplicated. I'd just suggest being prepared for any eventuality, but my personal choice would be a hospital birth everytime.

I love all the completely non-evidence based assertions on this thread.

You do live quite far from a hospital.

However, there is some evidence which might be of use to you: the BirthPlace study 2011 found that the best outcomes for both first me second time healthy women AND their babies was in women who laboured in freestanding midwife led units - average transfer distance 17 miles.

Hope that helps.

By the way - these freestanding MLU's have no access to on site obstetric input. No different from a home birth.

Well, yes, to me statistics matter when I'm trying to make a choice about something in the future.

It was an important part of my decision making process. That's my opinion, and also why I gave it.

If a large sample shows the same likliehood of a bad outcome whether or not you're at home then that's inportnat. It doesn't guarantee your outcome obviously, but why not use evidence as part of the decision making process?

The MLU here has closed, the nearest one now is around 18 miles away but that adds another 7 miles onto the transfer to hospital time so doesn't really solve anything.

Does anyone know - if I gave birth in hospital alone, would DH and dc be allowed in once baby and I were all cleaned up? Or would they have to wait the (hopefully) 6 hrs for us to be released?

No, it's too far for me.

I needed an ambulance transfer during an attempted homebirth, I live less than 2 miles from the hospital and I can usually drive it in less than 10 mins, unless the traffic is horrific. I genuinely thought I had been taken to a different hospital by the ambulance as the 5/6 (?) minutes felt like about 3 hours.

Doesn't make a difference to statistical safety, but I can imagine a 50 min transfer being a really uncomfortable experience.

We had the same decision to make last year.
We live on an isolated farm over an hour from hospital (could probably do it in 50 minutes are seriously illegal speeds).
It was DW's first pregnancy and even though the whole pregnancy was textbook perfect we just felt better having the birth in hospital, knowing that should anything happen there were doctors and equipment on hand to take care of things.

One of the benefits of home birth flagged up is the fact that you're able to relax in your own home, which in turn helps labour progress, makes the experience more positive, etc. etc. etc.

Would you, knowing that the hospital is 50 minutes away (you also have to take into account the distance from your nearest ambulance depot- could be half an hour or so before an ambulance gets to you plus that, say, 40mins transfer before you get to hospital) really be able to relax? I don't think I would be. I wouldn't want to pass kidney stones that far away from hospital if I'm being honest.

Please choose this option because it's what you want, not because of childcare concerns.

Yes I would. I gave birth at home to my third child after two previous births that sound similar to yours OP. I live in a rural area and was an hours drive from the nearest big hospital (there is a MLU closer by).

With DS1 I had a slow labour and straightforward birth in hospital and DD was a very sudden birth which meant a manic drive to hospital and giving birth at the entrance. Because I didn't want to give birth en route with number three I had DS2 at home. It was a fantastic and relaxing experience with a midwife I knew well who had sent me for a scan a couple of days beforehand to check the baby wasn't breach.

I didn't give much thought to the distance to the hospital as my previous two had been born at the MLU and if anything had gone wrong I'd have been transferred by ambulance to the larger hospital anyway so there didn't seem a lot of difference between that and being taken by ambulance from home in an emergency.

Contact the hospital and ask them OP. My local maternity unit offer tours. Perhaps you could see if yours offers something similar so you can go and see what the facilities are like, see if it seems like an environment you think you could labour in comfortably and ask questions. You should discuss your concerns with a supervisor of midwives.

Also have you considered hiring a doula so you wouldn't need to birth alone if DH is occupied with your DC.

The best place for a (low-risk, no complications) pregnant woman to give birth is the place she feels the safest, with competent midwives (at least two) to assist her, who have all the necessary equipment, including infant and adult resus, and drugs/cannulas/fluids to manage a post-partum haemorrhage.

The time an ambulance takes to get to your home is not time spent doing nothing: the midwives will manage any emergency exactly the same way it would have been managed at the hospital. For instance: for a post-partum haemorrhage, the steps are usually:

1 - Fundal massage
2 - Oxytocin IM
3 - Syntometrin IM
4 - Oxytocin IV infusion and hydration
5 - Bimanual compression

All those things are done at home by the midwives, or at hospital by the midwives. The ambulance will have harder drugs (carboprost/Misoprostol) that would only be given as a last resort when steps 1 to 5 have failed to stop the haemorrhage.

An undiagnosed breech presentation in a woman without complications will also be managed by midwives.

A shoulder dystocia will be managed exactly the same at home as at the hospital.

A baby requiring resuscitation will be managed the same at home as at the hospital. baby intubation and adrenaline infusion are last resort procedures that would not be done until everything else was tried.

Doctors love to tell women how "they saved their lives". However, after doing my placements at the hospital, I have been very surprised how they never tell women that, had they NOT been in hospital, most of these emergencies would not have even happened, as many of them were the result of unnecessary intervention due to reluctance to let labour progress at its own pace (induction of labour increases risk of haemorrhage; oxytocin infusion increases risk of haemorrhage, fetal distress, uterine hyperstimulation, malpositions and obstructed labour; frequent vaginal examinations increase risk of infection; epidurals increase risk of forceps/ventouse and cesarean section; directed pushing increases risk of haemorrhage, perineal tears and fetal distress... should I go on?).

Nice post aurynn
I also think what the pp poster said about relaxing is important. As well as the pp who commented on the fact that positive experiences don't seem to count as much as negative ones. I think that if all has gone well so far and everyone is happynfor you to birth at home, then the likelihood of something going wrong is small. Of course it might happen that something goes awry, as proven by people here, but with comments such as aurynn's about management, and the positive experiences of others, don't discount it necessarily.
Like I said, I had my first baby at home in a pop-up birthing pool, and think the comfort and familiarity of it made the whole thing great and really quick because I wasn't stressed about the environment. I was an older first time mum too. 4hrs in total labour with 30min of pushing, no pain relief, baby calm, dh played a huge part, MW pleased as punch, nuchal cord dealt with swiftly and professionally, injection for placenta because MW felt I was too tired to hang about waiting for natural placental delivery - in other words she made a deliberate decision in the best interests of me and baby. Things can go well. Mostly they do. When they don't, it is important to listen to why because it is so important, but don't forget to listen to the other stories too.
In the end, our decision for home birth rested on this: are we willing to except the risk and responsibility of not being hospital if something went wrong, also understanding that it is not likely to, and we were. Being confident in your decision goes a long way, I think.

Of course, things can go wrong. Every time you take your child to the ski field you are increasing their chances of having a serious accident and dying/getting permanently disabled. Wouldn't it be great that all ski slopes were built inside hospitals? (sigh).

Some posters say that labour and birth are a means to an end. It may be for some mothers. But for most, the experience of labour ad birth can have long-lasting mental and physical consequences. Some women end up with traumatic experiences of birth. For others, it is a profound experience that will be remembered forever. "Birth as a means to an end" is a very medical way of seeing a physical experience which is extremely significant and emotional for most mothers. Only now science is starting to expose the intricate, fragile combination of hormones that have crucial influence in the brain development of babies, and that is deeply affected by artificial hormones and some forms of anaesthesia, as well as traumatic births and lack of skin-to-skin contact between mother and baby after birth.

(this last message was not directed at you moxon, it was just a general comment :) )

I had a fairly low intervention birth in a hospital (I had gas, no other "medical" help) with midwives.

I'd go down that route, as a back up is available. A midwife can't do everything a doctor can in an emergency, although in a non emergency birth they can.

The other thing I would consider is a quick discharge from hospital once you ave the all clear. I stayed two nights, next time I would leave hospital within 24 hours. My bed is comfier and the food at home is better.

To reply to a post up thread, of course everyone's opinions and experiences are valid. OP asked and people have shared various; good and bad. It's up to her to decide.

For me, it's not about being anti-homebirth but the distance to the hospital. As for the skiing analogy, well I'm a clumsy cow, always have been. As an adult, I was told I have mild dyspraxia. Anyway, due to being clumsy and poorly coordinated, my parents never took me skiing as a child, the risk was too high.

Same here - I'm v pro home birth, but would want a quick trip to hospital in case of sever haemorrage. (v unlikely etc but I wouldnt want to be in that scenario).

cloudia I'd ask about your family being allowed in. In my hospital it was birth partner only on delivery suite, partner and baby's siblings fairly open hours on the ward (any time 10-8) with more restricted visiting hours for anyone else.

Despite all the negative stories on here, I'd have another home birth, though I understand why some people wouldn't as it's such a personal decision.

DC1 was born in hospital, assisted birth (ventouse) with all the pain relief available.

For DC2 we opted for a home birth, we lived 45 min away from 4 different hospitals and 1 midwife led unit. We didn't have any family locally who could help out with DC1.

There were times, especially near the end of the pregnancy that I wobbled about having a home birth, but for me, and us as a family, it was absolutely the right decision. The attending midwives were absolutely amazing, and I'm so grateful to them for giving me the birth I really wanted.

'negative stories' makes it sound as if our experiences aren't true.
I can tell you that when you hear the words 'she's in theatre, they don't know if she'll come out', it stops your world.