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?

"Would you blame a woman who lost a child in a road traffic accident for putting their child in the car?"

No but I would blame her if she took the child home instead of hospital.

No never, I had cord prolapse, why ever chance it when you have a hospital to go to.?
Insanity.

Individuals must choose what risks they feel most comfortable with - those which accompany giving birth at home or those which accompany giving birth in hospital.

The evidence On safety IS important - it's a direct answer to the question 'why take the risk of a homebirth'?

The reaction that it's not about the woman's 'comfort' or trying to get an 'idyllic' experience are flawed. Surely a homebirth is based around the experience for the woman? It's not like the baby cares where it's born....

Other than the arguments that more drugs may be involved in a hospital birth, which could affect the baby (in the short-term) or that there is a risk of infection in a hospital (which is small and surely there's also a risk of that at home) - a homebirth is chosen since it's preferred by the mother for reasons relating to her: she doesn't like hospitals, she feels more comfortable at home etc etc.

So claiming that women choosing homebirths aren't selfish isn't entirely correct: the guiding influence is their decision are reasons relating to themselves. The question is whether or not this 'selfishness' is reasonable and justified.

I certainly wouldn't. Only had one baby. Totally uncomplicated pregnancy, labour started naturally but was extremely protacted. Needed drip augmentation in hospital. Baby was back to back and wouldn't budge. Ended up with forceps in theatre with spinal and retained
placenta and 1.5l postpartum haemorrhage. Haemorrhages can happen to anyone regardless of whether it's first birth or subsequent and regardless of whether you've had one before or not. I just wouldn't risk it myself.

The evidence suggests that choosing a homebirth halves the risk of ending up having emergency major surgery.

Given that this is the most risky surgery to have, I'd say that's pretty significant.

You also might want to factor in the increased risks that come with pregnancy and birth following a primary c/s - a c/s which is twice as likely to happen in hospital despite the fact that the outcomes for babies of mothers who labour in hospital have outcomes which are no better.

"Haemorrhages can happen to anyone regardless of whether it's first birth or subsequent and regardless of whether you've had one before or not. I just wouldn't risk it myself."

Much, much more likely to happen after a hospital birth.

What the evidence says is this - mothers are SAFER giving birth out of hospital: lower rates of PPH, lower rates of emergency surgery, less chance of ending up in a high dependency unit.

"Haemorrhages can happen to anyone regardless of whether it's first birth or subsequent and regardless of whether you've had one before or not. I just wouldn't risk it myself."

But much more likely to happen after the use of syntocinon and an instrumental delivery. Both of which only occur in a hospital.

but if you are unlikely to have a serious PPH a hospital is a much safer place to deal with it. Again v.pro homebirth, but not at such a huge distance from a hospital should anything untoward happen.

Recovering - statistically, healthy women are safer labouring and giving birth at home.

That's it really.

Are those stats including the mothers who had to transfer into hospital for later intervention? Or are there figures available for the numbers of women who have had emergency surgery on the floor of their living room? Surely if you need intervention or emergency surgery you go to hospital, which skews the figures.

It may well be that labouring at home decreases the likelihood of intervention. But if you're in the unfortunate position where you or the baby need help, being 50 minutes away from the hospitals means that the stakes are much, much higher than it you're 5, 10, or 15 minutes away. By that stage the stats can go fuck themselves for all you care.

The fact that OP is already wavering suggests she isn't 100% comfortable with a home birth, which means she's already going into it feeling nervous, which in turn negates one of the positive parts of being in your own home. With that in mind, she effectively has the worst of both worlds- not being relaxed and being far away from a hospital in the event of an emergency.

Hope this is all academic and that OP is snuggling a lovely squishy baby right now :)

mini I don't think you are comparing similar populations. Births that are already high risk for pre-existing reasons will be much more likely to be in hospital, first timers are more likely to be in hospital (or have much higher home birth transfer rates) and more women who choose home birth will already have had one uncomplicated delivery. Nobody is disagreeing with the fact that most of the time it will be fine or that there are perfectly valid reasons to choose home birth. For many women the small chance that something will go wrong means they would not feel safe being 50mins away from emergency care if they or their baby needed it. The statistics are not comforting if you end up on the wrong side of them.
In an emergency, the one thing you need is lots of capable, trained hands. I work as a vet, if we have an anaesthetic emergency, or an RTA brought in, the whole team drop everything to help. The 'normal' team of two (vet plus nurse) simply is not enough pairs of hands to do a good job.

Statistics are fine and dandy if you're writing NICE guidelines. If you're a human, not a number, I can understand why you'd measure your risk on an individual level.

Minifingers that's not entirely true. You can be a "healthy" woman with a difficult pregnancy and a baby with high risk of complication. But these have healthy mothers so can be born at home, right?

Baking - the evidence I'm referring to (Birthplace study 2011, forms central plank of NHS current recommendations on place of birth) compares outcomes only for women deemed 'low risk' at the start of labour.

For The 2011 birthplaces study, the intended place of birth is the key factor. So if you had a reason to transfer in you were still counted in the homebirth statistics.

the stats can go fuck themselves craic said it better

Sorry, my response was to 'thecraicdealer' (love the name), so no, women who transfer in don't skew the figures.

Just read your response to another poster minifingers and I see now by healthy mothers you actually meant women with low risk pregnancies (I hope?)

'Crash dive' whilst I get what you're saying about stats etc and if you're that one in however many it doesn't matter how unlikely the event is, it's devastating for you It seems to be massively glossed over that if you're in hospital your risk of having many of these events we're so scared of at home increase!

Blueberry - I'm referring to the evidence from the BirthPlace study. Healthy = low risk in this context. Low risk refers to mother and baby. A mum who is completely well but who is carrying a baby who is known to be growth restricted would no longer be classed as having a 'low risk pregnancy' and would be advised to give birth in hospital.

"The stats can go fuck themselves" = "I'm going to talk shit - don't inconvenience me with reference to the facts".

Personally, if the Royal College of Midwives, and the NHS are supportive of homebirth as a safe option for low risk mothers, that would be good enough for me.

Neither organisation is known for encouraging risk taking behaviours....

Seattle I'm not saying that there aren't more risks at home/hospital/wherever, just that when I am making risk assessments, (as we do every day) my choices are not based on stats. Well, maybe a bit but emotion plays a huge role in our decision making. This is something that some people on here seem to be ignoring.

So you're perfectly at ease and make 100% logical decisions even in life or death situations? I commend you.

If you had read the rest of my post, you would have noted that I have acknowledged that the data available points towards it being a comparatively safe option. I'm not anti-home birth. However, being that far away from hospital means that a requirement to transfer has the potential to switch very quickly from being a mild inconvenience to a life threatening situation. That is the difference to me, not the overall statistics.