To ask you to help me make a decision re. home birth?

[user124765]

Posting here for traffic after no response on the Childbirth forum.

I'll try to keep this brief. Fourth child due in January. I'm aged 41.
Because of my age I'm being consultant led throughout this pregnancy. I'm otherwise fit and healthy.
The consultant is urging me to be induced on my due date. I'm not overly keen on this idea, having been induced at 12 days overdue with DC2 and it was a really unpleasant experience.
One of the main reasons, beside being 'geriatric', is that I labour very quickly. My third child was born in the hospital car park after a 40 minute labour. They seem to be getting faster and faster.
Would you have a homebirth in my situation? I'm being told it's too dangerous. Is that really the case though?

I've had a retained placenta and haemorrhage after the induction with DC2, but other than that I've had normal easy births. Just very quick!

No, I wouldnt. It's personal choice but a home birth sounds like something out of Call the Midwife!
You might pop them out easy but childbirth is still risky.
I wouldn't rush to be induced on due date though.

If it were me I wouldn't risk it. Just because the last 3 births followed a pattern doesn't mean this one will be the same.

Will they sign off a home birth if you’re consultant led? Usually they won’t do I wonder if you do truly have the option?

No I wouldn't and I'm a big advocate of home birth. As an older mother you are statistically higher risk.

No I wouldn’t even contemplate one in that position. Not worth the risk.

No, I wouldn't personally. But it's a very personal decision.

No I wouldn't and I don't understand why anyone would take such a risk. On the one hand you have at worst unpleasant but safe hospital birth vs at worst risk you and your baby could come to harm. How would a haemorrhage be managed at home?

As you’ve experienced a haemorrhage once, I’d be very very wary in your position. I also had a very fast labour with DC2 that resulted in a home birth - we already had all the kit ready but it was still stressful due to the circumstances- and I would have been extremely worried if I’d previously had a medical emergency post-birth.

If the consultant is wary of you going over 40 weeks and you labour fast I’d seriously consider the induction, perhaps.

How far are you from the hospital? Do you have adequate childcare plans for the others so you. An drop everything immediately to get to a hospital? All these things might factor in for me.

No. I will admit I’d never choose a home birth anyway.

But I’d bear in mind what the ambulance service looks like right now, what it might look like at the peak of winter and what that might mean if a home birth goes very wrong. Often around here home births are cancelled due to shortage of midwives anyway and people are asked to come in.

If you’ve been consultant led and they’re recommending you don’t, I would listen to them. I’m very pro home birthing btw, but also pro listening to the professionals. If you don’t want to be induced then have a good discussion with you consultant and midwife about this.

No, I wouldn’t - and even less so in the current climate when ambulances and health services are under enormous pressure and taking far longer to deliver even emergency care.

Previous haemorrhage is a risk factor for another haemorrhage. Rapid labours are a risk factor for haemorrhage too. That alone would be enough for me to want to get to hospital

I’d certainly be considering it, taking into account all the information you have, reading the relevant research and guidelines and have a good chat with the homebirth midwives as well.
My consultant offered induction, c section, and recommended hospital birth for my second but was really being ridiculously over cautious and I believe this is because consultants aren’t so familiar with normal deliveries they always see the ones requiring medical intervention and personally believe it gives them a biased view.

I had a haemorrhage with DD and was told I was fine to have a home birth with this current pregnancy if I wanted one, which really surprised me.

I’m not against home births at all, but if you’re being told it’s too dangerous, then I wouldn’t even consider it. However, given your quick labours I’d make sure I did some basic prep for an unplanned home delivery - I just mean finding out what they advise the best thing to do it, is there anything you should have on hand. For me that would a last resort though, and I’d be preparing for it while planning for it not to happen.

If you have previously haemorrhaged after birth I would speak to your midwife and ask for an honest opinion. I wouldn't do it as I think the risk is too high if you have such quick labours. I would also refuse the induction though unless there is a medical need for it, inductions lead to lots of interventions which are quite often unnecessary and simply being an older mum isn't a medical need unless you have poor health etc.

I wouldn’t, I wouldn’t be confident that the ambulance service would be able to quickly respond in an emergency.

I have had two HB, one a HVBAC. That should tell you where I stand on the topic generally. I would be avoiding the induction, but the haemorrhage plus current staffing/ambulance would make me v wary of a HB.

It’s worth remembering that labour is only ever normal in hindsight.

If it were me, I’d certainly want help readily available, just in case.

It's really hard to know what to do. I'm scared that if I allow myself to go in to labour naturally I'll end up just repeating history and deliver this baby somewhere public like a car park or a lay-by. The hospital is 25 minutes away by car.

I wouldn’t. I get why you’d consider it - I had two home births and fast labours were one of the considerations.

However, you’ve already haemorrhaged so are at higher risk, especially as I believe quick labour increases that risk. Plus ambulance services are a disaster at the moment so I’d be too concerned about that.

Plus, having just moved to a completely new area I don't know anyone locally who can help with childcare at the drop of a hat. My DM would have my older three children whilst I give birth, but she lives an hour away so it's not an option, given my precipitous labours.

@user124765

Plus, having just moved to a completely new area I don't know anyone locally who can help with childcare at the drop of a hat. My DM would have my older three children whilst I give birth, but she lives an hour away so it's not an option, given my precipitous labours.

Then I would seriously consider the planned induction.

However you need a plan for if you go into spontaneous labour before that.

No. If it's hard to get to hospital on time, it will be harder still for a midwife to get to you on time.

I'm a big fan of home births, had one myself. But in your circumstances I would have made plans to stay closer to the hospital in the run up to the birth. I stayed a similar distance away, but have family that live much nearer the local hospital.

“The hospital is twenty five minutes by car”

I think that answers your question about whether a home birth is a good idea when you have an identified high risk pregnancy and we are living at a time when all hospital services are stretched to breaking point.

I would, yes. I wouldn’t be having an induction either, just because of a quick labour (sorry if I’ve misunderstood the reason). I’ve had two very quick births and one slow. The slow one being the induction.

Have you met with your home birth team?