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.

And read merrygiants very informative and balanced post from the point of view of someone who is a community midwife....

I have seen it. It is still not a choice I would ever knowingly make.

Two of my three births (first and third) were medical emergencies which both began to happen whilst I was still at home and in bed, so had nothing to do with where I was at the time. In fact, for the third one, if I hadn't gone into hospital and stayed there where a pre-term and emergency c-section could be performed quickly then my youngest daughter certainly wouldn't be here, and I very likely wouldn't either.

She was my final baby. Before I had her I might have entertained the idea of home birth, partly because we live about 40 minutes drive from the hospital. After that experience - definitely not. I am aware though that this is my feeling, and not everyone's.

statestis should read statistics

I think that it is important to be aware that every case is individual. By far the worst case of shoulder dystocia I had, happened at home. I had no epidural (obviously) or anything else. The most mild SD I had happened in hospital. I was already on all fours when it happened, was turned onto my back in seconds and put into the mcroberts manoeuvre, twice. No problems.

I did click on the link. I would agree that it looks like just a few lines that seem to be about the author's opinion axe to grind and very dubious imho.

Anyone can put anything onto the internet. Just because you read something on the internet does not mean it is correct. A little knowledge is a dangerous thing.

We are all citing our own takes on things now, are we not? That doesn't make them medical fact (aside from a midwife who has posted, which was very informative).

People need to be responsible before they post.

OP - Really this is a judgement call that you need to make, but it sounds as if your husband has good reasons to prefer you to be in a hospital. You are the one giving birth, but if something went wrong, that would be your burden to shoulder for the rest of your life.

Personally I think you should be speaking to medical professionals about what they would advice. Your "preferences" should be a firm second to what would be the safest method for delivery in case there were problems.

It is somewhat taxing to see people who have given birth a couple of times and read a few articles, suddenly considering themselves to be the leading expert on childbirth.

That's not a specific dig at you OP, but worth bearing in mind - these people have seen THOUSANDS of births and spent YEARS learning practise, theory, what to do in complications, etc etc. Not sure how giving birth a few times is an equal qualifier to that...You only know what worked for you on those specific occasions.

Merrygiant I'm having my GTT on Wednesday. I had two in my last pregnancy because I consistently had 3+ glucose in my urine (after I'd cleared the ketones from having HG). Both GTTs were normal. I'm not peeing out glucose this time but I'll have the GTT anyway just to know for sure. As for DD3s shoulder dystocia, there was a 5 minute delay and it was a wood screw that released her. How bad is that? Incidentally after her shoulders were free, she delivered very slowly because she had such a huge abdominal circumference!

I'm looking forward to the first growth scan because I'll be 27+1 and I had a growth scan at 27+1 with DD3 (the neonatal consultant requested it as I was admitted with TPTL and he wanted to know if she was at least 1kg). I can remember her estimated weight so it will be interesting to compare. DD3 was big on scan at that stage. But when I said t 34 weeks that I felt as big at that point as I did just before delivering DD2 and DS, I was given a talk about how my stomach muscles will be rubbish after 3 previous babies so I will look big and how my fundal height was only 1cm bigger than expected (DD3 was direct OP at that stage) so they wouldn't growth scan me. I was also given the talk about how the body won't grow a baby that is too big for it to deliver. I tried to explain that I felt heavy, not just looking big was all ignored.

I can't decide how big I feel this time. Baby is already reaching up to my ribs so in some ways I feel quite big for 25 weeks, but then it may be in an interesting position. I think I'll be a better judge a bit later on.

It is really helping to hear the range of views because I have my scan and then go straight in to the discussion with the consultant about the results without much time to think. I'm also aware that all of our babies have been short in the leg. Given that femur length is one of the measurements used to estimate weight, the growth scan is more likely to underestimate the baby's weight.

And just to make it clear, I know that my pregnancy hormones are making my birthing instincts VERY strong. That's why I'm asking for opinions. I am aware that I could make a very silly decision based on a mixture of bad experiences and very primal instincts.

But equally I do not have complete confidence in my local hospital and for good reasons. It's no wonder that I'm fearful of going there to give birth with their track record and my own experiences of the obstetricians so far. Let's not pretend that every obstetrician and midwife are brilliant just because they've studied for years.

If I were to have another baby (unlikely due to other circumstances) there is no way on god's green earth I would have anything other than an elective c-section.

DS1 severe shoulder distocia, foreceps, 9lb11 baby.

If we'd been at home we'd both be dead now. Can't really see any argument that trumps that to be honest.

Some of the advice on here is making me mad. I've already commented but although it's your choice and majority of home births are fine- with your history (which some people don't seem to understand) there is a higher risk your baby could die. Knowing what I know I could never get over such a life changing event. If you end up in an emergency you need to be in hospital. You NEED to be there. It's a guessing game chances are all goes well....
I'd go for home birth myself over hospital if I was young, fit; no history of big babies... But god a history of shoulder dystocia??? Do you want to be the one that doesn't have the good outcome?

Topseyt to be fair that link has been published in a midwifery journal so not just some random posting whatever they like on the net, and that website has most peer reviewed medical journals on. Still doesn't mean it's anything other than the authors opinion though, but at least the journal editor had to think it was good enough to publish...

Op see what they have to say after the scan. And don't feel pushed into anything at the appointment. It's totally reasonable to ask for time to think and talk to people and have another appointment nearer the time to discuss again.

Op here is a link to the royal college of obstetricians and gynaecologists guidelines on shoulder dystocia. Might be helpful...

www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg42/

I would hate to put anyone off the birth they would like to try for but my sister - in- law gave birth, initially at home, after a previous section, and it went very wrong. My niece died a week after her birth. For that reason, I would suggest (as I'm sure you will, you sound very experienced and sensible) taking any professional advice very seriously indeed. And asking for it. (I am not for one minute, by the way blaming my brother or sister in law for their choices, they are really sensible and thoughtful people just that I think it's made us all a bit wary iyswim)

I totally get why people are being so cautious. Having been through a shoulder dystocia it's not the sort of thing that you forget in a hurry. And I am very keen to hear advice from the professionals (although I am requesting to see the consultant this time rather than one of his many registrars as per my midwife's suggestion). I know that I am likely to be booked in for regular growth scans to see just how quickly baby is growing (I'm told every 2-4 weeks) and that a series of scans is more accurate than a one-off growth scan. I'm not particularly keen nor happy having the GTT and all of these scans but it seems like the sensible thing to do. I figure that if I want to have a more 'measured' chat with the consultant about pros/cons/options then I need to at least play ball and tick some boxes. Believe me, if I think this baby is in the same league as DD3 was size-wise, I shall be the first person demanding help (and quite possibly a c-section even though they utterly terrify me). BUT... I also want to have the chance to reason a bit with the consultant. It is so clear that the best way to avoid another shoulder dystocia if I give birth vaginally is to allow me to labour in the most comfortable and undisturbed way for me. There is so much evidence that birthing a baby, especially a big one is easier if you can move and moo as you see fit So if I do end up having a vaginal delivery in hospital, I would like to negotiate the most low-key and hands off approach possible unless it becomes clear that a shoulder dystocia is happening. For instance, I really don't need the world and his wife wandering in and out, talking to me while I push. Some privacy and head-space is far more helpful. I know that I push very well and I can clearly remember the sensations of baby descending, the stretching sensation and the head being born. I don't need or want a running commentary! I know. I sound like a nightmare. But having fitted a whole labour including a shoulder dystocia in to 25 minutes, I know what will keep me calm, what will annoy me and what will totally freak me out and shut me down.

I don't think you sound a nightmare at all and I hope you get the birth you want :) I just am so worried now (probably irrationally) about home births with any heightened risk factors after what I saw my brother and SIL go through last year. I think they were probably badly advised though. Good luck!

YANBU. You know what suits you best. But I also fully appreciate your DH will be concerned, especially given your labour history. He probably feels it will be safer in hospital for you & baby if anything goes wrong. I don't know what Id do in your situation. I agree hospital births can be horrible. The uncaring, unlistening staff at hospital made birth of 2nd DD a traumatic experience for me I will never forget it. Good luck whatever you decide.

It is so clear that the best way to avoid another shoulder dystocia if I give birth vaginally is to allow me to labour in the most comfortable and undisturbed way for me.

See, this is something I would dispute (disclaimer: not a HCP). I understand what you're saying, and of course you want some control over your labour (especially when you always labour incredibly quickly and intensely - I can't imagine!) but I don't think preventing a shoulder dystocia is as easy as that.

It does help though, most experienced midwives seem to be of the belief that lying on the bed and epidurals are the greatest enemy when it comes to preventing SD - doing what the op suggests will significantly decrease her chances of requesting an epidural (not like to be an option for her anyway with her history of precipitate labour). I do honestly believe that letting women do their thing decreases the risk - however sometimes it is unavoidable due to the anatomy of fetus and the maternal pelvis.

Remember, ultrasound is notoriously poor at estimating fetal weight, it is a better indicator that adequate growth is occurring between scans. It is poor at predicting macrosomia however.

Be assured op, your birth attendants will be well skilled in emergency drills, however it is the care your baby might need afterwards that will be absent. Many babies require special care from a paediatrician after a SD which means a transfer to hospital, which would be incredibly stressful for all. I personally would go to the hospital in your situation, but ensure dh is well prepped to support your wishes and be your advocate. Good luck whatever you decide.

There is evidence that disturbing a labouring woman affects the hormones involved in childbirth and generally disrupts the labouring process. There's a reason why a quiet, candlelit room is so tempting and it's not just some silly romantic notion. It is also widely known that some birthing positions increase the diameter of the pelvic outlet which is helpful for birth generally but particularly so for large babies. Women who have large babies and are allowed to 'get on with it' tend to adopt these positions naturally. If I wasn't sat with my broken foot up so much at the moment, I would also be trying to sit on a birth ball or at least not recline when sitting from this point in my pregnancy as well. Keeping the pelvis balanced during pregnancy can help a lot (check out the spinning babies website). And given how painfully unstable my pelvis was and how sore my coccyx was after my last delivery, I've read quite a lot about how to help myself this time.

I understand that, really I do (I gave birth to my daughter in water in a dimly lit room and would have HATED bright lights and disturbance) but with the best will in the world, when you tick a lot of the risk factor boxes for shoulder dystocia - as you indeed do - I don't think these common sense ideas apply to you. They apply to uncomplicated deliveries.

But I see you've made up your mind. I don't envy you one bit - to say you're caught between a rock and a hard place is an understatement.

I'm just thinking on the basis that it's not a foregone conclusion that shoulder dystocia will happen again, I will do everything I can to ensure that I can labour/birth in the most optimal way to try and prevent it happening.

No, it isn't a forgone conclusion that it will happen again, but nor can you confidently say it won't. I guess some of us are of a more risk averse frame of mind, and that's why you're getting some of the responses you're getting.

If we could make birth plans with the aid of a crystal ball, that would make life a lot easier

I think you need to have the GTT and the growth scans, assess the situation at term and see how you feel. I totally understand the need to plan but you don't have all the information yet to make an informed decision. If everything seems fine at that point, I think a homebirth is a sensible option.

Sorry, I meant to come back with some comments but had a night shift

wobbly I agree, giving birth can be just as dangerous in hospital as at home. But the difference being,in hospital you have instant help at hand,
As I said, this baby would have dies had it been a home birth.

wanttosqueeze you are right! I don't know about the start of the labour,but i know at the pool birth the lady had to get out of the pool as with each contraction the babies heartbeat was dropping dangerously low, this baby had to be born ASAP, and again, paediatricians were on the scene instantly

topseyt I agree with your comments

And can I just say, I work in one of the biggest neonatal units in the country so therefore I see a lot of worst case scenarios as our babies come from far and wide,
At the end of the day, these things are still pretty rare, (but I still wouldn't recommend a home birth!)

I wish you luck,whatever your decision

YANBU

The shoulder dystocia is neither here nor there IMO - you managed to get a massive baby out with no significant damage to either of you, albeit needing a manouvre to achieve this.

I gave birth to a mahoosive (11lbs baby at home). I was aware SD was a risk and had someone on standby with the address to phone for an ambulance, two EXTREMELY experienced midwives in attendance and I live 5 minutes from a hospital. If ds was jammed to the point that the midwives couldn't get him out it would have been a dire situation in hospital or out. In the event he did get stuck, but was out quickly and fine.

A really fecking awful S/D is generally going to have an appalling outcome in hospital or at home.

BTW, I did have gestational diabetes, not badly, but it was a factor in the size of the baby.

With my next baby I cut out all carbohydrates in the 3rd trimester bar one small cup of rice or oats a day. Just ate fish, greens, nuts and vegetables (not starchy). Next baby was nearly 2 lbs lighter, despite being longer and having a much larger head circumference (and went on to become a much larger child). I'm convinced it was my diet and the exercise I did which reduced my blood sugars in pregnancy.