To wince at people who have homebirths?

[TheCatsMeow]

I never used to, I used to say that everyone should have the birth they want and mean it. But my birth went wrong and I ended up with a baby who would have died had it not been for NICU. If we had been at home, he wouldn't have survived and I may not have.

Every time I hear someone say they want a homebirth my head screams "YOU'RE BEING IRRESPONSIBLE". I get visions of myself and my son lying dead. It frightens me and every time I see a woman who is pregnant I think "I hope they both survive". I don't say any of this unless someone asks and then I just say that I ended up with complications so was greatful to not be at home.

But I feel like people are risking themselves and their babies and it makes me uncomfortable. I think IABU but don't know how to deal with my feelings on this. Please don't be harsh.

YANBU. I know several people whose babies would have been in severe danger had they not been in hospital.

However, I know several people who had wonderful, dream home births.

I personally feel the hospital is the best place to be. I am more comfortable in a place where treatment is available immediately.

in your situation, I can understand your opinion.

How many hospitals have a nicu? My local hospital does but it's my counties main hospital and is a big teaching hospital. The other hospitals in the same County don't, they do have labour and delivery wards and some may have scbu. But not all hospitals have nicu just like not all hospitals have various specialist units. So my nearest brain injury unit would be addenbrooks, not my local hospital despite it being a big teaching hospital.

As others have said even if your hospital has a nicu it may not have space

sorry pressed post too soon but I think you are confusing/conflating different issues.

From the sounds of it poor hospital care played a part in your bad experience, the care that your son then needed afterwards is a different issue. Babies born at hospital or at home can need extra care after birth. Midwives at a home birth can and do resuscitate and then transfer a baby to a hospital with scbu or nicu. Just like babies born in hospital can be transferred after birth if the hospital they are born at doesn't provide the care need. A frirnds baby suffered very severe meconium inhalation, he ended up needing ecmo and had be be transfered twice and with air ambulance. He was born at a big hospital with consultant ked unit etc but they didn't have the facilities he ended up needing. Obviously this is horrible but it's a separate issue to a homebirth ie my frirnds would have been transfered in early in labour when they found meconium.

Transfer of babies after birth and availability of specialist care for newborns is a separate issue to best place to birth.

That is true actually. There is a choice of 3 hospitals for birth where I live but not all of them have a NICU.

My friend had a homebirth with her first which went disasterously badly. Her son has now got quite severe brain damage, but they won't know the full extent until he is a bit older (he is 16 months)
They were both admitted to hospital straight afterwards, and she had to spend several nights in a different hospital to him, because he was airlifted to a specialist Neonatal place. But she was too ill to be discharged and not ill enough to warrant a transfer to the big hospital. So she had to wait until she had recovered enough to leave hospital before she could hold him and feed him for the first time.

Despite all of this, she is now planning no 2 and said she is hoping for a home birth again. I'm totally boggling at the thought of it, but for some women, it really is that important that they would risk their baby in that way.
I'd be amazed if she is allowed one from the NHS but her and her husband are quite well off, so I can see her hiring a private midwife and going ahead anyway.

Minifingers
All of those additional risks as you put it, could happen at home.
How is being at home less risky.
Ie severe blood loss. What makes you think being at home could stop a baby getting stuck or mother hemorrhaging At least if you are in hospital you have an emergency team on site.

Flat - I'm just telling you what the research shows.
Low risk women who labour in an obstetric unit appear to have

• longer labours
• more fetal distress
• more labours which fail to progress
• more emergency surgery

compared to similar low risk women who choose an out of hospital birth, without an improvement in neonatal outcomes.

Not sure if anyone has the definitive answer as to why this should be the case, though it's occurred to me that we are mammals, and like any other mammal, tend to have more dysfunctional births when we're interfered with and moved around in labour.

Yes those things can happen.at home

but things are picked up much sooner with 2 mid wives there for you

than.they are strapped to a monitor in a hospital between already very infrequent checks.

being mobile, more comfortable, less stressed with staff reliant on their instincts and knowledge and observations than.a screen can mean a huge difference in how the birth goes and how soon things are picked up and dealt with

there's more space to position yourself better on your own double bed or area set up for the birth than a hospital.bed.

I very nearly gave birth alone in.hospital. had dp not been there I would have.

they also didn't notice the bleeding despite me telling them my waters had a bloody tinge to them way befire.

but you know, an alarm would have gone off if they'd been a problem and id get checked on eventually

emergency team on site

would that be the staff member who turned up after dd had been born with a "I'm here to examine you....oh...." ?

Spare - there is no such thing as 'allowed' when it comes to choosing a homebirth. Doctors and midwives can advise, but they can't force a mother to come to hospital.

And why is it particularly risky for her to have another baby at home? Second births are the most suited to homebirths - there is no evidence they are more risky for a low risk mother.

I really hope you are trying to hide your judgy attitude from your 'friend' who you clearly blame for her first child's problems and see as irresponsible.

OP I am sorry for your previous experience. As others have said a debriefing could be really helpful.

Knowledge, so often is the key and I would suggest researching the facts carefully. Hospital birth is not definitively safer than home birth for the Mother or the baby, and even if a hospital has a NICU there is no guarantee that a cot will be available when needed, and a transfer to another unit may still be required.

What you and any future children need is good care during labour. Please don't allow your misconceptions, however understandable they are, to get in the way of informed decision making.

FWIW I have had 3 births, the last and best at home. I am also a Health Professional.

mini
She has written a blog post about how she will always carry the guilt of knowing her decision to have a home birth is the reason her son has the problems he has
If he had been born in a hospital, he wouldn't have those problems.
Of course, there is nothing to say he wouldn't have had other problems from a hospital birth but it is highly unlikely.

She doesn't need me or anyone else to point out her choice of a homebirth caused his issues. She has freely admitted it, and you'd be an idiot to try and argue otherwise.

Why don't I think a 2nd attempt at a homebirth is particularly wise? She has found out the hard way that she lives too far from a hospital to be transferred there quickly enough if things start to go wrong. She, ironically, has a high enough pain threshold that she was able to give everyone the impression she was managing well and therefore wasn't monitored particularly closely, which meant they found out too late that the baby was in severe distress. And there is no guarantee at all that subsequent births will be straightforward, so to gamble with your baby's health to that degree is a tad irresponsible in my personal view.
But her body, her baby, her choice...

I was booked in for a home birth if I went into labour at night. Kit was delivered etc. Luckily for me I went into labour during the day. Shoulder dystocia,4th degree tear,baby grunting/ nose flairing rushed to scbu and off I went for surgery. So like you I was in the right place. But 1000s of women do have lovely home births and with that I guess there is a small risk. Each to their own.
Sorry for what happened to you.

And what's the hospital like?

doesn't matter what facilities are available if the staff don't bother checking on people much or.talkimg to the women etc.

what use is a world renowned midwife of she's covering so many women she can't fully attend to any of them.

I was ignored despite my notes and pregnancy complications.

rushed down when they realised

then they all fucked off again.

I may as well have been out on the street the level.of care I received. the only person who really even spoke.to me til some.print out deemed me. worthy of attention was the sodding cleaner.

it's all very well saying she should have been I'm hospital. but you need to realise that hospital isn't some amazing place swarming with staff there to bring your baby into.the world and make.you as comfy as possible. it's cold and clinical and nobody tells you anything.

OP, you've had a terrible time by the sound of it, but you can't worry about others and their desires. You must concentrate on you and your baby

Fwiw I wanted a home birth, no intervention, with candles and nice music etc and ended up before labour even started having a emcs. Next baby I was never away from the hospital just in case.

When much younger I was invited to Sunday lunch with some neighbours. I admired the indoor paddling pool ( I had no idea, being childless and v young:). and was informed that was actually the home built birth pool and here was the baby, born that very morning! All had gone well, but it was a huge risk- it was a remote location. 30 mins for an ambulance to turn up.

Some people do live in remote locations - and yet they have to get to hospital under their own steam and just trust that it all goes OK whilst they are getting there. They are very very rarely told that they ought to move nearer to the hospital 'just in case'. There was one example on MN of someone on a Scottish island, where she was told just that because they weren't prepared to offer any sort of maternity care where she was. I can't remember how she resolved the situation.

SparklyTinselTits
But those who are advised by medical professionals against home birth, but choose to do it anyway because it's their "plan" are morons. I've seen it. A friend of my sister's planned a home birth from the start. She is a rather large lady, and was told her risk for complications was automatically higher due to her weight. On top of that, she went overdue, and refused an induction. She eventually went into spontaneous labour, but still refused to go to the hospital hmm
Beyond stupid.

This is me you could be describing. I am far from stupid and find your post and your tone very very offensive. I see you fail to say whether she went on to have any difficulties in labouring? I suspect not as she probably knew her own body better than you and had researched her choices and made a well informed one. Hmmm?

OP - I'm sorry to hear about your traumatic birth. I really do feel for you. But please don't wince. I don't when people tell me they'd like to go to hospital - I would absolutely hate it. My only problem now, years later, is having such an emotional attachment to our home as our babies were both born in the living room and we need to sell sometime soon!

I winced listening to a woman who 'had to' be induced, which ended up as an EMCS and then the wound got infected and she had trouble breastfeeding despite wanting to, but 'couldn't fault the staff'. It was best to say nothing, but I would have loved to have asked whether the induction was really necessary or driven by a date on the calendar, and whether her problems could have been avoided?

TheCatsMeow I am a midwife who does home births (and primary unit births) as well as hospital births. It is understandable that you feel how you feel because of what happened to you. But please consider some facts about your birth:

1. You were definitely NOT a good candidate for home birth, because all your issues during pregnancy.

1. During a home birth, your baby's lack of movement would have been an immediate reason for transfer to hospital.

1. If you were deemed to need continuous CTG monitoring at the time, you would NOT have been eligible for a home birth, regardless of what risk category you were classified in.

And other facts which are often used in these kind of discussions:

"My baby would have died at a home birth", said by a woman who had continuous monitoring (unnecessary), augmentation of labour, hyperstimulation (due to the augmentation), epidural (due to higher pain caused by augmentation), persistent posterior labour (due to lack of mobility, also caused by epidural) and forceps birth (caused by all the above). No, your baby would not have died at home, you simply would have had a chance at a normal birth.

"My doctor saved my baby's life": this is something that your doctors really want you to believe in any case, to save their butt. However, in many occasions, your doctors saved your baby after his/her life was threatened by an unnecessary intervention that often happen in hospital. Kind of like shooting you first and then telling you they've saved your life by taking the bullet out and stitching you up. At other times, if the same emergency had happened at home the HB midwives would have dealt with it and your baby would not have died either. However, it is in the hospital's best interest for you to be grateful and believe they saved your and your baby's life.

"How do you deal with severe bleeding at a home birth?": well, I can tell you how because I have been in that situation, and I have also been at a severe bleeding at hospital. Midwives are trained to deal with bleeding, it is one of the most common emergencies during labour and birth, and sometimes it happens in healthy pregnancies with no risk factors. It is dealt at home exactly the same way as in the hospital (the hospital does not send you to theatre as soon as you bleed... you get treatment from midwives to stop the bleeding first). During the last haemorrhage I attended at a hospital, the woman was treated by me and other midwives for over an hour before she was taken to theatre... as all theatres were busy at the time and we were dealing with it efficiently. The woman who bled at home went to hospital in an ambulance and was in theatre 20 min after the initial bleed. Both women and babies fine today, the woman at hospital though still traumatised by the experience of having the bell constantly ringing and several people running in and out her room. The home birth woman had two midwives with her (me being one of them), there was no panic, we stopped the bleeding and administered her the drugs, by the time the ambulance arrived she was a drip on and was receiving uterotonics IV. If we were not prepared to deal with haemorrhages and other emergencies at home as well as at the hospital, we would not choose to be home birth midwives.

Sparechange - how far is 'too far'?

The Birthplace study found that women who chose free standing birth centres (which have no doctors, no operating theatres, no specialist neonatal help) had outcomes for their babies as good as similar mothers who opted to labour in a consultant led unit. The average transfer of the units in the study was 17 miles.

Your story about your friend now reveals that she wasn't properly monitored in her first labour, implying she had substandard care. You are suggesting that it is this factor - that problems weren't picked up sooner - which is responsible for her child's problems. How is that the fault of her having a homebirth?

As for her having a high pain threshold - please, such rubbish. Midwives have nice mandated protocols around monitoring they are expected to adhere to WHERE EVER they are caring for a mother. How a mother is monitored has nothing to do with her ability to cope with pain and wouldn't be dictated by that.

"Of course, there is nothing to say he wouldn't have had other problems from a hospital birth but it is highly unlikely. "

Why highly unlikely?

Babies experience birth injuries and oxygen starvation that leaves a permanent mark in hospital every day.

Indeed mini. Dd1 has scars on her cheek from the forceps that will never go

Transfer of babies after birth and availability of specialist care for newborns is a separate issue to best place to birth.

I think maybe I'm mixing two issues and what I really want is more availability of NICU and better staffing levels

aurynne that's really interesting, thank you. I did wonder if the doctors often try to cover their mistakes. My debrief is with the person who insisted the movements were fine and I was being silly so we will see...

spare I know someone whose baby has brain damage, likely caused by birth at hospital. Would you recommend a home birth for them next time then?