To consider booking a home birth even though DH isn't keen?

[NoRoomForALittleOne]

I suspect that IABU but I'll let the MN jury decide.

Background: I'm expecting DC5. For previous births the most pain relief I've had has been G&A plus the pool. For easy reference:

DD1, born at 34+6, 4 hour labour, 6lb 3oz (officially large for gestational age) had a minor PPH and placenta took an hour to deliver despite syntometrin injection.
DD2, born at 39+2, 2 hour labour, 7lb 9oz, all straightforward.
DS, born at 37 weeks exactly, 1 hour 15 min labour, 7lbs 8oz (just below cut-off for LGA size), all straightforward.
DD3, born at 38+6, 25 min labour - started at hospital as went in for reduced movements, 9lbs 13oz (definitely LGA!), gave birth on all fours in pool but had a shoulder dystocia

So I'm being good and having a GTT on Wednesday when I'll be 26 weeks pregnant. Then next Thursday I start having growth scans and will see the consultant to discuss birth options. So far I've seen a few registrars who all have differing opinions about the birth. One suggested induction at 38 weeks as I have a history of LGA babies and quick births. Another has suggested admitting me at 37 weeks to the maternity ward until I give birth (it's hideous there so no thanks) to ensure that I give birth in hospital. The other suggestion is to have a home birth if the baby seems to be of 'average size' to avoid giving birth during the 20 minute drive in.

I don't want to give birth in that hospital. I've had enough of their inability to listen and treat me like a human being. They are currently in special measures with the CQC because of the number of preventable maternal and neonatal deaths that have occurred. I'm not surprised. The obstetric registrars are generally AWFUL. The midwives are mostly nice enough.

Add in to that the fact that I know that I won't want anyone to touch me/talk to me/generally make their presence known if I'm going through another intense precipitous labour. That's not me being grumpy (DH thinks it is) it's simply that I know how much I will need to 'zone out' and concentrate on what my body is doing. I feel confident about my ability to birth if I'm allowed to move about/adopt positions that may look weird/make as much or as little noise as I want/whatever gets us through the birthing process without someone needing me to fulfil hospital policies.

I'd really like to build a birthing nest at home where I can get on with giving birth on my terms. DH wants the backup of being in hospital even if that means he doesn't get there on time.

wantto no they were hospital births, the shoulder dystocia particularly difficult, it was beyond the midwives intervention, we had neonatal consultant and drs rush to the birth as soon as emergency buzzer pulled. This baby wouldn't of stood a chance if at home the baby had to have its clavicle broken and then the cord was around its neck.

Oh, another question, how directive would you be on a hospital birth plan? Normally I think that things like 'don't talk to me, don't touch me unless absolutely necessary' are ridiculous and will make a midwife quite unhappy. But I REALLY want to get on with it as uninterrupted as possible as that honestly feels like the best way to get a good outcome. I sound like a total hippy but I just know all too well what I'm like in labour. I (somewhat embarrassingly) put the registrar in his place when he suggested that a 25 minute labour was something that all women should be envious of. I may have been a bit hormonal that day

Cyclops I can't help but wonder what labour has been like up until that point. But thanks for sharing. I may have to side with my husband too after those stories. The details of working out a hospital birth terrify me though.

noroom my friend also labour's incredibly fast (30 mins from start to finish with her first and 15 with second) so opted for home birth for ds2 and is planning on same again for ds3 however they were no complications in her first hospital labour. the op has detailed her previous complications so if you had had similar issues I would go with the bring admitted prior to full term for monitoring until labour occurs. I understand it's not ideal but it is the safest thing for the baby imo

Hi! I jut had a home birth 6 weeks ago for similar reasons to you OP, I hated being manhandled and treated like nothing in the hospital.

I would suggest having a plan for all eventualities. If you go into labour pre-37 weeks you call an ambulance/try to make it to the hospital. (You can't have a homebirth then anyway).

37 weeks plus you go for the home birth. When contractions start you hop in the bath to relax you, call midwives out, and slow things down while DH gets kids settled. Next door neighbour maybe?

You should consider where the on call midwives live. My first midwife took half an hour to arrive and the second took nearly an hour, due to coming from her home. Not an issue for me as I was 8cm but not in any pain and progressing slowly, but for you they could miss the main event!

My baby was 11lb 2oz and took some effort to get her out. The midwives realised how big she was and took charge, pushing me into an open pelvis position and doing what was necessary to help baby out while ensuring I didn't crack open like an egg...

The homebirth healed all my fears from the hospital birth. It was perfect.

My husband was convinced when he realised there would be no visiting hours, no yucky hospital food, no midwives bossing him or me about (in our own home they are the guests and were fab!), and we could have champagne and a take away!

It sort of sounds like you've made up your mind already and decided that you know better than the doctors. How can you judge the obem team when you only see about seven minutes of the woman's birth in total?

If you decide to go to the hospital then you are well within your rights to put don't touch me, don't talk to me, don't be in the room unless requested. Who cares if midwife is unhappy, she's not giving birth?

I think if your husband is giving birth, it must really be his decision.

I might ask for a section at 37 or 38 weeks given your history of early babies and your worries about giving birth in the car.

Two of my four children were homebirths, after previous hospital births. Last one was large, but all went well. But, to be honest, I am not sure if I would make the same decision now. The reason for this is somebody I knew died in December during childbirth at home, leaving 5 children and a newborn without a mother. It was one of those situations that had she been in hospital it is far less likely to have happened. It so desperately sad.

It is a really difficult choice, especially when you have already had negative hospital experiences. I think all you can do is your 'homework' and try to objectively evaluate the options available to you, and what plan A, B and C would look like in the event of problems, at hospital or home.

And yet despite the usual horror stories it is generally safer to give birth at home...

Fewer unnecessary interventions.
More attention from midwife (?resulting in them noticing a problem sooner or perhaps acting quicker, knowing they're at home?)

It's a tricky one op. I had a hb with dd2 after a hideous experience with Dd1 involving stirrups and ventouse.

I was under a consultant with dd2 due to previous tfmr but that was the only issue. We are lucky enough to have a dedicated hb team where I live with 4 full time midwives who look after you from booking in. The consultant I saw was very negative about hb and suggested dd2 would have shoulder dystocia due to a large abdominal circumference. I did a lot of research around this and found out that there is nothing the midwives can't do at home that the hospital can do. This was from the home birth website but also books that I borrowed from a midwife friend. Initially dh was worried but my research reassured him and he knew how I felt about the whole thing so supported me in the end (and almost acted like it was his idea all along ) It also helped that we were able to talk through everything with the dedicated home birth midwives. I don't suppose there is anything like that near you?

Fwiw there was a lady at one of the antenatal talks on hb who had very similar situation to you. She very much wanted a hb for her 4th child. In the end the decision was taken from her as she went into labour at 36 weeks and was ambulanced to hospital.

Good luck whatever you decide.

Also dd2 didn't have dystocia and having a hb was the best decision I ever made! I was watching bake off while in the pool and Dd1 slept through the whole thing.

It's worth thinking though that you can have different plans depending on when you go into labour.

For eg:

Before 37 weeks - 999 and blue light ambulance to hospital

37-38 weeks - assuming baby measuring reasonable size home birth

38-39 weeks - admit to hospital to await labour to avoid home birth sd / delivering in car

39 weeks - planned section if still not here (in most cases this is the earliest they'd do this bit talk to your own doctors /midwife)

These could all be movable depending on size of your baby. And obviously you might put different deadlines /plans in depending on what works for you

Reading CyclopsBee post just confirms that hospitals are equally 'dangerous' places to give birth.

I too would lean towards an elective c-section at around 37 - 38 weeks, or would want to at least raise it as a possibility with the medical team. I'm no expert though.

Your body, your choice, though your husband's concerns are valid. Shoulder dystocia could be a real possibility, and you seem to produce big babies (I did too, though it was years ago now). Better safe than sorry.

I remember the OBEM episode. I know it is only a few minutes of the birth, and heavily edited, but I think it proved a point. It was traumatic, and I felt that each and every person in that operating theatre was desperately wishing that they had opted for c-section instead. It was etched on their faces.

Now that's quite an interesting idea, Yellowdinosaur.

Wobbly, birth is dangerous anyway. The risks can never be fully removed.

To me the Cyclops posts just reinforce what can happen if things do go wrong. She mentions a case of SD which happened in hospital. That baby would be dead now if the mother hadn't been in hospital for the birth. Hospital was definitely the safest place for them on that occasion.

Hmmm, it's a difficult decision. I already had 3 children when I opted for a home birth for dc4. My dd1 and dd2 had previously had very mild shoulder dystocia requiring a simple manoeuvre to get them out (the name of it escapes me). My ds who was my second child was born easily with no complications at all. Thinking I had done all of my research I opted for a home birth for dc4. I had had lots of extra scans in the run up to labour as previous 3 children had been 9lb+, all looked good. No one could have prepared me for the 11lb5 baby I delivered at 38 weeks. She had severe shoulder dystocia, was head out for 7 mins, had her arm broken and suffers erbs palsy as a result. We were lucky-she suffered no brain damage. Had I not been blue lighted to hospital (thankfully only 4 mins away) there is no doubt in my mind that she would not be with us today. There is not a day goes by when I don't regret my decision. I had romantic ideas of cosying up in my own bed with a glass of champagne and our newborn, labouring in a candlelit birthing pool. The reality was that my selfishness nearly cost my daughter her life. I should have had a c-section let alone contemplate a home birth.

OP I don't think you are unreasonable to WANT a home birth, but on the basis of the previous dystocia alone means you are playing for high stakes.

I am not skilled or knowledgable in midwifery but my laypersons understanding was that a previous dystocia put you and baby at significant risk of a further dystocia. This is a potentially lethal situation for both of you.

This is without considering the pre term labours, or the PPH.

So I am with you DP on this one. Good luck whatever you decide.

I think it's reasonable to plan for a home birth as long as everything is going well, but to be prepared to transfer if things change.

I decided to have a home birth when I was pregnant with my third child. It was supposedly a high risk pregnancy (I'm diabetic), but it was my decision to have a home birth. Several doctors tried to talk me out of it, but I kept producing Cochrane Reviews that I'd printed off to back up my position.

Every doctor and every midwife who has ever worked in a hospital will be able to come up with horror stories from their personal experience. It would be good to hear alternative perspectives from midwives who specialise in home births and have attended hundreds of straightforward deliveries. There are lots and lots of these stories too, but we don't often hear them because of the kind of catastrophising that a culture of medicalised childbirth seems to engender.

In the end, I gave birth in hospital for very good reasons (transverse lie, which resolved itself but could have changed again). My labour was so fast that I saw very little of the midwife. The doctor put his head round the door at one point and said he'd be back in an hour; a few minutes later my son was born.

You are the only person who can decide where you give birth. It's a huge responsibility because you have to weigh up the risks and benefits, which is much more complex than 'hospital is safer' and 'home is more comfortable'. But no one else can tell you what to do. I hope everything goes well for you.

I'm a community midwife and can confirm that we are all trained to perform various manouvres in the event of a shoulder dystocia. So if you were to be at home and had two midwives with you at delivery, given your history, they would be very alert to the warning signs for SD and be ready to call an ambulance if it looked likely. They can in the vast majority of cases, deliver the baby using emergency manouvres (woodscrew,reverse woodscrew, removal of posterior arm). In 9 years of experience I've never heard of a baby requiring deliberate breaking of the clavicle. Of course, if the baby were truly 'stuck' then you wouldn't be able to get to hospital in time to prevent severe damage or worse.

As some PP have suggested I think you could reasonably aim for a HB and see how things progress in the last weeks of pregnancy: how big do you feel in comparison to last time, are there any other complications like abnormal GTT result? In the case of pre-term labour you would go to hospital anyway, between 37-39 weeks and if you weren't feeling larger than last time then go for HB and if still preggers after 39 weeks then 'play it by ear' eg consider waiting on the ward for up to a week.

Out of interest, do you know/remember how bad your shoulder dystocia was last time?

The stats supporting homebirth or MLU which show that for multips these are safer places to give birth are for women without complications eg measuring LFDs. The eventual predicted size of your baby is the most important factor, even though small babies can still get SD. And how big you feel is a better indicator than scans, which can be incredibly inaccurate.

HTH x

I'd also recommend you arrange to speak to a local supervisor of midwives, she can give you very good advice and is not coming from the medical POV rather from wanting to support you in your choices.

To me the Cyclops posts just reinforce what can happen if things do go wrong. She mentions a case of SD which happened in hospital. That baby would be dead now if the mother hadn't been in hospital for the birth. Hospital was definitely the safest place for them on that occasion

Except that it is well documented that the risks of shoulder dystocia are lower at home.

www.ncbi.nlm.nih.gov/pubmed/23061146
"At attended homebirth, shoulder dystocia poses less of a challenge and has better outcomes compared to hospital birth. If you don't panic, but do call someone into the room to help you with suprapubic pressure if needed and run thru the maneuvers systematically, you will get the baby out by six minutes avoiding damaging long-term consequences. At hospital birth, it is estimated to take a minimum of two minutes to turn the woman onto all fours from the usual position in a hospital bed while connected to a monitor, IV and epidural. An epidural anesthetizes the woman making it impossible to push optimally. Epidural also anesthetizes the baby, making spontaneous breathing less likely and making resuscitation more challenging. Suprapubic pressure is difficult at the height of the hospital bed, so time is lost while the bed is lowered. Vacuum and forceps vaginal deliveries, which are not used at home-birth but accompany about 8% of hospital births, are independent risk factors for true shoulder dystocia."

That's interesting wobbly.

Check out wobblys post Topseyt it seems that hospital is not necessarily the safest place for SD.

Cyclops cared for the baby on neonate but with the best will in the world I don't believe she knows how that birth would have turned out had the Mother been at home. Maybe better.

Have you actually clicked on wobbly's link?

Wobbly is that a randomised controlled trial? Because it reads as though it's an opinion piece which is not compelling evidence imho.

Why do the NICE guidelines suggest that you can request a section after previous shoulder dystocia if home birth is safer?

I'm no expert and am only going on what I've read in this thread but you'd better be pretty damn sure of your evidence before you advise a woman at risk of shoulder dystocia, who lives 20 minutes from a hospital, that she would be safer to have a home birth...

Op I suggest you seek proper advice based on your case and not population statestis from your midwife and obstetrician