To want a home birth?

[InMemoryOfSleep]

I’m not pregnant (yet), but chatting to my mum and some friends recently I mentioned I’d like a home birth next time. Their reactions weren’t positive, to say the least - despite me explaining that, for a 2nd baby, home birth is as safe as an MLU, and both are safer than a hospital. They’ve made me really doubt myself - having read the research and stats I was convinced it’s the best option, but am I missing something?!

@VioletteValentia
I would consider one because I had a waterbirth with my first, which was great. However it was sheer chance that I got the one birth pool room available for all labouring women in my entire city! Having found how well it worked for me I would like to be able to ensure a pool for my second.
This means my options are a stand alone MLU in a small town about an hour away from me with a significant hospital transfer time or my house with a probably 15 minute hospital transfer time assuming ambulance is available etc etc.
Given that statistically if I have a low risk pregnancy it is as safe for me to birth at home this time I would seriously consider doing so.
It actually makes childcare a pain, I don’t want my mum staying with us to look after DS if im having a homebirth and I’m not sure who he knows well enough nearby to send him to.

I had to get signed off by my consultant for a home birth due to my cervical cancer. We went through everything thoroughly. My first labour was perfect 6 hours long, no issues at all. Consultant examined my cervix (there was talk of having a stitch at one point if my cervical length wasn't enough which would of ruled put a home birth), we talked pros and cons. He was more than happy to sign off on my home birth and the care I got from the home birth team was amazing. Like I have said before on here I had to be transferred in as I lost a hell of a lot to blood but it wouldn't put me off home births.

Everyone has to make their own decision. You need to weigh up risks and how comfortable you are with them.

Baby and mum benefit from a vaginal birth Violette. It has been shown to be better for the baby's gut and also to establish breastfeeding. It also can be (can be) a wonderful experience. I wouldn't trade any of my 'vaginal births', pain and all, for a c section. Of course I'm also glad that there is an option out there when things don't go to plan.

As to why women do it: I don't like hospital, I hate going to the hospital, the hospital is for sick people and I didn't consider it was the right place for me to give birth in. Also saves me having to worry about when to go to hospital and the risk of being in labour for hours in an hospital room.. Can't think of anything much worse. The only thing I had to worry about with my births was when to call the midwives and even then they could always leave and come back anyway.

Also higher rates of vb are the goal VioletteValentia because they have less complications and risks. Medical interventions have a lot of risks and can cause a lot of complications. The evidence is all out there on the NHS pages. Even pethidine has some serious complications which have caused death in infants due to how it can cause breathing difficulties.

But as I keep saying, everyone has the right to look at the evidence and the stats themselves and make their own choices without being judged unfairly and should be supported in their decision.

Sorry if I'm being super ignorant and repeating what's been said but I think a lot of the negativity surrounding home births comes from people taking their own circumstances and applying them universally if that makes sense? So anyone who has had any kind of complications automatically assumes the worst when as you say, statistics actually show good outcomes- especially for second time births.
It isn't a realistic option for me sadly, but I can totally see the appeal and avoiding the horrors of a hot post natal ward sounds amazing!

To all the posters who believe that they or their babies 'nearly died' in childbirth - were you actually told this outright by a HCP? Only as a midwife, I have only saw this truly happen a few times, all of which were elective sections. Yes I have saw plenty of emergencies, but the appropriate response is always made and so the situation isn't actually life threatening (though would be without the appropriate care). I don't see this as 'nearly died' to be honest. I think people are also confused as to what midwives are capable of managing at a birth - midwives are highly trained in obstetric and neonatal emergencies.

I had planned a HB for my youngest however a last minute complication meant it wasn't a safe choice in the end so I birthed in hospital. Personally I would never accept a section unless absolutely necessary and wouldn't have an epidural or pethedine due to affects on the baby. However does this mean I would judge others who choose these things? Of course not!!!! Women are entitled to make their own choices for themselves and their babies.

When women are in hospital they tend to end up lying on the bed, uncomfortable. This leads to a higher change of needing pain relief which in turn leads to a higher chance of something going wrong. Birthing at home, in her own environment, greatly reduces the chance of this happening. To those who doubt this - take a look at the maternity system in USA and then look at their stats for maternal and infant mortality there.

Well, it wouldn’t have been for me, but then it’s got nothing to do with them has it? It’s fine for them to have an opinion. Your midwife is the best person to advise.

I could have had a home birth for my second pregnancy as it was without complications, as was the birth. However, I didn’t want to. I had him at the hospital and was home for dinner.

@VioletteValentia "I think it’s incredibly selfish personally, because if it all goes wrong, it could be catastrophic. You’ve got no medical equipment there"

Yes, you do have medical equipment there, generally dropped off in advance -- including a resus kit, and midwives trained in coping with emergencies. Just wanted to correct this in case it gives other the wrong impression of what a home birth is.

Well said MissDuke

MagnaWiles well corrected.

I do think that those who choose a home birth do not generally make the choice so flippantly. As I have read on here many times, women look at their own pregnancy and experiences coupled with evidence and what resources are available where they are before they make the decision

I had a hb for many reasons. Mainly being I wouldn’t make it in time. Given my risk profile it was really unnecessary for me to be in hospital. There really was no need.

Had I at any time been told I was not a good candidate and given valid risks and reasons i probably would not have had one. I might even have elected for a section if the alternative was to try for hospital and birth in the car / at side of road

As always choice is key! And offering hb gives that choice. So do mlu .... as i said previously we need to keep our midwifery skills. Let’s not become America which scares me given the confidence in the NHS being eroded to make way for privatisation. Violette I agree you with 100% on that.

Why are higher rates of vb the goal? Surely the goal is a healthy baby?

Babies born by elcs are more likely to suffer from respiratory distress. Recent research shows that they are more likely to suffer from problems caused by not benefiting from being through the birth canal. They are more likely to have trouble establishing bf.

The mother is more likely to have placenta praevia or worse, accreta in future pregnancies. The risk increases with the number of sections she has, potentially limiting how many children she can have. These issues are serious and carry a high risk of haemorrhage - putting the baby at risk from premature birth, anaemia and intrauterine death.

So there are risks to elcs too - I don't know why you assume that section = healthy baby.

@MissDuke I had a VB for DS and due to a couple of complications and fact he was left in too long he had sepsis at birth which they believe was contracted during the birth. Luckily myself and and dh acted quick on the symptoms and ds is now 1 and thriving. I was induced and my milk took ages to come in and breast feeding was difficult to establish despite a VB. Would myself and baby have benefitted from a c section? I believe so. Despite this I have mixed feeling on kind of birth I’d like for a second dc (if I’m brave enough to have another) but would love the water birth I never got with my first. It’s easy for me to jump straight to wanting an elective but I’m trying not to!

quickly*

In my opinion there are risks with all methods of birth and it just depends what risks you are willing to take over others.

The number of babies at risk of respiratory distress is very low for ELCS. In fact ELCS is one of the safest modes of births (from the POV of the baby), and multiple studies have shown how much safer it is vs. expectant management. It's fairer to compare ELCS vs. expectant management, not vs. uncomplicated vaginal birth as sadly no one can guarantee an uncomplicated vaginal birth.

Secondly vaginal birth carries substantial risks of incontinence and prolapse, which are rarely mentioned. Women should be consented on these as part of the birth process IMO.

www.ncbi.nlm.nih.gov/pubmed/18456074

"modeling the probability of perinatal death among a hypothetical cohort of 2,000,000 women who had uncomplicated pregnancies at 39 weeks, half of whom underwent ECD and half managed expectantly. After taking multiple chance probabilities into account, the model estimated that although neonatal deaths were increased among women delivered by elective cesarean, overall perinatal mortality was increased among women managed expectantly, because of the ongoing risk for fetal death in pregnancies that continue beyond 39 weeks."

journals.lww.com/greenjournal/Fulltext/2011/10000/Pelvic_Floor_Disorders_5_10_Years_After_Vaginal_or.3.aspx

"Compared with cesarean without labor, spontaneous vaginal birth was associated with a significantly greater odds of stress incontinence (odds ratio [OR] 2.9, 95% confidence interval [CI] 1.5–5.5) and prolapse to or beyond the hymen (OR 5.6, 95% CI 2.2–14.7). Operative vaginal birth significantly increased the odds for all pelvic floor disorders, especially prolapse (OR 7.5, 95% CI 2.7–20.9). These results suggest that 6.8 additional operative births or 8.9 spontaneous vaginal births, relative to cesarean births, would lead to one additional case of prolapse…"

There are 2 complications during labour which are unpredictable and need immediate action:

placental abruption
shoulder distocia

Neither is vanishingly rare unfortunately, both are difficult to handle at home.

PasstheStarmix risk of infection and therefore sepsis is a lot lower at home births. Myself and my DS also contracted sepsis during labour; most probably from the constant checking they done up there and how they tried to break my already broken waters and instead cut me on the inside.

You are right though there are risks with all methods of births. But for hospital and home birth for #2 the risk of serious complications and death is exactly the same. So it isn't really weighing up between those risks if they are same level but instead choosing what would suit you the best.

ELCS is incredibly safe, and if there are problems, you can get the baby treated quickly. My son was out in two minutes and in an incubator before I was stitched up.

I don’t think they’re risk free but I think they’re probably safer at the moment, given rubbish staffing and the risks of vb

Secondly vaginal birth carries substantial risks of incontinence and prolapse, which are rarely mentioned. Women should be consented on these as part of the birth process IMO.

Yep. No one talks about this.

Having read a bit more of the thread now, I do think a lot of people underestimate midwives. I had severe pre eclampsia so I doubt whether things would have got serious at a home birth (hypothetically speaking if I hadn't been induced) as I probably would have been transferred to hospital with high BP/headaches. However it was a midwife who delivered my daughter and initially dealt with the pph afterwards and she was great! So even with complications/risks you don't always need to be in a room with a consultant.

Because of my history I've taken the advice to go to the Labour ward and have a cannula in post birth to prevent another big bleed. But just because that's right/safe for me doesn't mean that home birth isn't right or safe for others. Everyone's circumstances are different.

Sorry that was a bit of a ramble. Due in 6 weeks so birth plans etc are at the forefront of my mind!!

TwittleBee I think it was because they went in and broke my waters too after leaving me for hours wondering why things weren’t progressing thinking they’d went after the pess tablet (only part of them had gone.) I guess infection could have been contracted then but they had to do it. A c section would have been better in my case I think. I couldn’t have avoided it with having to be induced.

It’s not to say I wouldn’t try for VB again though but if it’s a choice between induction and c section i’d chose section due to tm experience.

my*