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.

Incidentally, there are other things which increase the risk of a S/D happening in the first place, one of which is being induced and the other of which is having a supine birth with an epidural in place.

People are very quick to say 'don't have a home birth' but very slow to say 'maybe you want to think twice about having an epidural or being induced'.

Because you know - there are only meaningful risks associated with birthing out of hospital, not birthing in a hospital.

Good god. i don't think anyone would say that hospital births are less likely to have complications - I think - but if there are complications there are teams of midwives and doctors to help.

My opinion (note - MY opinion) is that at the end of the day, you want a healthy baby and a healthy mother. If you get that - it's a win.

Deciding you want a home birth for your own comfort is putting the life of the baby in jeopardy.

"My opinion (note - MY opinion) is that at the end of the day, you want a healthy baby and a healthy mother. If you get that - it's a win."

But women having their second babies at home have only a fraction of the rates of emergency c-section, which, as you know is major abdominal surgery, from which some women will emerge with infections, some experience worrying bleeding, and a tiny number, god forbid, will end up in intensive care from surgical complications. And that's why the government is pushing out of hospital and midwife led births for low risk multiparous women - because they are SAFER.

In the OP's case everyone feels like they have a handle on the issue of the shoulder dystocia - that it's a clear indication of the need for a hospital birth, despite the fact that being in hospital may put the OP more at risk of having a shoulder dystocia in the first place. The idea that 'well it's ok if something goes awfully wrong, because the doctors can fix it' isn't sound, because sometimes doctors CAN'T fix the problems that the medicalisation of birth can occasionally cause.

Personally I think the OP needs to take the advice of an experienced homebirth midwife. If someone like this feels homebirth isn't appropriate then I'd listen to her.

But women having their second babies at home have only a fraction of the rates of emergency c-section, which, as you know is major abdominal surgery, from which some women will emerge with infections, some experience worrying bleeding, and a tiny number, god forbid, will end up in intensive care from surgical complications

Yawn.

Was enjoying reading posts until this boring stupid comment comes out.

Op, as you have had lots of births and know exactly what childbirth entails and indeed in your situ have had a variety of births I would say your an excellent candidate for a HB! Its first timers I would urge caution for....going into the big un known at home.

BTW just to balance minis statement above I have had a so called easy text book birth and a requested ELC. The ELC was a dream compared to labour and there was nothing more I could have done to have a good labour, massage oils, plenty movement, gave birth on all fours, one small tear...yet for me it was horrendous and major surgery was much better and preferable in my case ( and indeed I was only one out of nct who was up and about the others had repeated hosp visits from vaginal birth damage. Sorry op.

BTW my community MW said a HB when it goes well is lovely but horrific when it goes wrong and pulled a face.

DS2 was a home birth, no problems except shoulder dystocia. The midwives were experienced and sorted it out - very painful for me as they rummaged about and it almost seemed they were pushing him back in but it was soon over and no ill effects for him or me. HB was wonderful, much better than being in hospital.

when/if we have dc2 I want a hb, I'm just going to lay in the bath till I have to get out. my labour was quick and easy 6 hours half spent in the bath in hospital 3 pushes and ds was born with no tears, so I'm hoping this will work in my favour to be allowed a HB

I've spoken to DP about it and he has basically said "do what you want, it looks effing painful so you have the right to decide whatever"

Will - what do you hate about my comment?

The fact that it's true?

Are you really going to try and argue that there are no risks that come with major surgery?

And if you accept that there are risks, can you not also accept that the massively lower rates of unplanned c-sections in mums planning homebirths compared to similar mums planning hospital births is going to result in an excess of maternal morbidity in the latter group?

I'm in the risk-averse category, too, OP. In your situation I would be demanding an ELCS at 37 weeks. Hospitals do allow them in tricky situations even if there is no immediate medical need.

DD1 was stillborn at 41+3. No reason was found for this whatsoever. No one knew anything was wrong until I was in early labour and she died. I'm not trying to scare you or suggest that your baby will die if you hb, please don't think that. I'm saying that I was then given an ELCS at 37 weeks with DD2, despite a problem-free pregnancy, merely because if we had stuck to the consultant's suggestion of 38 weeks, DD2 would have been born 3 days after DD1's first birthday. All I did was point this out and ask if the date was flexible or not - had the consultant said no, you need to be 38 weeks minimum before we'll do an ELCS, I would have sucked it up. However, the consultant immediately volunteered to do it at 37 weeks instead to avoid sod's law. So if you eventually conclude that you want a CS, they should be prepared to do it at 37 weeks - don't let yourself be stressed with talk of 39 or nothing. They did it for me on emotional grounds - you'd have solid medical ones of having had 4 early babies plus sd.

And yes, I agree, that mums who have vaginal births may well have longer recoveries than someone who has had a c/s - perineal pain can be awful, but the point I'm making is it's less likely to land you in intensive care. That was the point - that a hospital birth isn't always going to be safer if it quadruples your chance of ending up on an operating table.

I had two vaginal births and one emergency c-section.

I preferred the c-section to the other two, and if I could have my time again would have them all that way.

My first and third deliveries were very complicated and that makes me very risk averse when it comes to childbirth. If I hadn't delivered them in hospital then it is doubtful whether either of those girls would be with us now. I might not be either.

Just to note community midwives are fully trained and updated in the manouvres required to deal with a shoulder dystocia. If a shoulders can not be rectified with the use of the manouvres then tbh it is unlikely to have a good outcome no matter of location. Believe me, pushing the baby back up and getting it out via emcs is not an option that is tempting to anyone (and is unlikely to result in an uncompromised baby - granted maybe an alive baby but likely to be brain damaged.)

I absolutely believe that birth environment can lessen the incidence of a SD, when you consider the majority of SD are resolved by McRoberts only which is only really widening the pelvic diameter I can completely understand that a woman is likely to do this instinctively of her own accord if free to do so.

I think you need to have a good chat with the consultant and see what they think and how that tallies with how you're feeling, combined with the size of your baby (although technically not a big indicator of likelihood of an SD). I hope you come to some kind of decision that is agreeable to all.

I would go for a HB with an experienced midwife. The way you are going, your next labour will be about 15min.

Oh and my second and subsequent babies were born at home despite massive blood loss after the first, who was born at 44 and a half weeks.

Thanks to everyone who has taken the time to share your opinions and given the reasons. It is interesting to hear the range of views. I am in quite a quandary now. But I've had my GTT this morning so that's one box ticked. In just over a week, I'll find out what the consultant thinks and we'll take it from there.

best position for large babies is on your side with someone hrlping you hold your leg up.
i had my last two babies at home. 10lb (40+4) and 7lb11(38weeks) my hosp birth was 6lb 2 at 35 weeks so i also do big babies.
I think home birthd flr big babies is the best thing because you can actually listen to your body, are more relaxed, and the midwife is there! all the time - not popping in and out looking after 6 other women at the same time.
If something is not looking right, then they can see that long before it becomes a problem and they can look at natural ways of dealing with it.

My homebirhs were the most empowering, amazing experiences despite the pain.

I would agree with position being massively important. I have a strangely shaped pelvis which always resulted in babies with their back to my back and their head back. They had to turn to get out. My last midwife (20 plus years as a community midwife) was brilliant at explaining what position I needed to be in at what point in labour.

BTW my community MW said a HB when it goes well is lovely but horrific when it goes wrong and pulled a face

And a hospital birth is not horrific when it goes wrong?

BTW I had a PPH at home. It wasn't much fun. It still wasn't much fun in the 12 hours after arriving at hospital. At no point in fact was it anything other than horrific - especially when I'd been in hospital for 8 hours and the bleeding had still not stopped.

Some emotive comments above and some that are simply wrong. SD does not necessarily always have an 'appalling' outcome whether that be in hospital or at home.

If you have a nasty SD at home you will be in a worst position than you would be in if you were in hospital. if your baby comes out blue you want experienced paediatricians dealing with it not midwives.

That reality is that you will probably be ok although there is a higher risk of bleeding afterwards (11%) in deliveries with a SD.

But your baby might not be.

It is whether you feel that you could deal with the worst case scenario which might be a baby that doesn't survive birth or ends up severely brain damaged. Yes the risk is probably small, as you say there are lots of protective factors but it is there.

But you know all this and clearly have done your reading. I agree that previous SD is an indication for an elective LSCS (as is maternal choice) and this should have been discussed with you.

For those saying that it is your body and your choice, it is but if it goes wrong this decision could have a massive impact on your husbands life if you end up with as disabled child. So clearly his opinion is relevant.

I may well have my mind made up in a way that I wasn't expecting. Apparently I have failed my GTT and am off to see the diabetes nurse at the next clinic I found out when I had a text message 'reminder' of my appointment with the diabetes nurse.

Oh boo

I'm another NICU worker who has seen the very worst birth traumas.

I labour quickly, the MWs were telling me to prepare for a HB 'next time' as I left hospital last time. Never in my (professional) life have I wanted something less. I know my views are skewed but I plan for the worst while hoping for normality. It serves me well on the unit, I'm booked at a hospital with a tertiary NICU on site this time around.

Personally, I would have a long talk with the consultant (I hope you trust them, if not the registrars), regular growth scans and decide on method of delivery closer to the time. With gestational diabetes, I'm presuming a HB is off the menu? See how things go: as I'm sure you know, the risk of PPH goes up with experience...an ELCS might be the safest way, a 37-w induction might be more preferable?

Not read all thread sorry. I had a sd with ds1 and when I saw consultant with ds2 he said I had 1/10 chance of another and 1/100 of a dead baby. Almost 10 years later I hear his words as if it was yesterday. He said if I was his daughter or wife he'd suggest a cs so I went ahead.

It wasn't what I wanted. I've never had a perfect birth experience. My last baby incidentally was a vb at 35 weeks which they let me do as early. Whipped of to nnu though for 3 weeks.
Also a friend had a cord prolapse in her hospital with her 4th ending in a crash section. Ending at home would have been disastrous.

Homebirth isn't necessarily off the menu, I had one and one home to hospital transfer after a GD diagnosis. I was diet controlled though.

44 and a half weeks?! I've never heard of anyone going that far over. How much did your baby weigh? Were the hospital ok with you going that far over? Sorry for the questions, I'm just very intrigued!

Some women have a pelvis the size and shape of which makes s/d a much higher likelihood or even inevitable, even with an average sized baby. This is clearly not the OP who has managed several normal births prior to her last. You can assume pelvis is large enough to accommodate a quite big baby given that she managed to birth vaginally last time (albeit needing some manoeuvres) with no damage to herself or her baby. For me this suggests logically, that unless this next baby is larger than the previous baby that the OP is at no greater risk than anyone else in the population.