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!

*4th pregnancy
Previous retained placenta and haemorrhage
Precipitous labours
Age

All risk factors for a further haemorrhage
Add in state of the NHS, lack of on hand childcare, distance from hospital and massive shortages of midwives and I would be recommending a planned induction.

And I say that as a midwife who also had a homebirth with my second.

Good luck with it all, I hope it all goes well*

This. I doubt the hospital will facilitate a home birth given your risk factors, as it isn't safe. Home births are safe for a select population of women only.

They didn't know my boy was back to back til quite late, I had been pushing 5 hours and needed emergency episiotomy and forceps delivery. Its not worth it in my view. You never know what will happen.

@Oftenithinkaboutit

Head. Wall

Do you always struggle with the fact that people are allowed to have different opinions to you or is it just on maternity care?

You do realise that some people specifically have home births because of precipitous labours and distance to hospitals? It can be the safest way to get good midwifery health to them.

Why is it only maternity care where having a second opinion or discussion options is frowned upon?

@LemonPeonies

They didn't know my boy was back to back til quite late, I had been pushing 5 hours and needed emergency episiotomy and forceps delivery. Its not worth it in my view. You never know what will happen.

One of mine was a 10lb8oz back to back baby, born at home and one of my easiest births. However at home I had focused and experienced midwives with me who changed my position to manage a back to back delivery and whose presence kept me able to focus and not worry. My one hospital birth had no real continuity of care - instead a succession of less experienced staff came in and out whilst trying to focus on other women. It was anxious, stressful and ended up with interventions I suspect wouldn't have happened with a more experienced or consistently available team.

BTB is not automatically a contraindicator for HB or a trigger for complications.

And it keeps on coming

@Oftenithinkaboutit

And it keeps on coming

That says it all.

I had middle one at home after hospital induction with first which I found quite traumatic. However I did lose quite a lot of blood, tore, which messed up mattress and new cream carpet and pretty awkward for doctor stitching me up with husband holding bedside light in position at 3.00am💡😬 also started panicking mid labour about what would happen if something went wrong with baby & not having hospital services on hand even though I was only 10 minutes from the hospital. So the next one I had via community midwife at domiciliary unit which basically meant 10 minute car drive in middle of the night and home few hours later. (why is it always middle of the night🤷) would it be possible to stay closer to hospital when you are near due date, perhaps rent for few days to avoid induction & just start naturally?

I absolutely would have a homebirth, but then that would always be my choice of setting baring any major reason not to.
I had 4 out of 5 of my kids at home inc my twins. The 5th was a hospital birth because it was a premature delivery.

Hard one - I had three home birth back in the 90s. For the first there was encouragement or information from the GP or hospital and no internet. Via the Association of Radical Midwives I found the Society to Support Home Confinement and armed with information from them, I got my first one. Got kicked out of my GPs practise for it but ended up in a better one.

Come the second pregnancy HBs were more accepted locally and it was all very straight forward.

The third was more of a challenge as I had gestational diabetes and the fear was a big baby and shoulder distocia (?) and I was persuaded into the midwife led birthing unit, However, I really felt uncomfortable at the thought of a hospital labour - off home territory, the water birth they used as part of the enticement was not necessarily going to be available
and I would have difficulty getting my partner in and my massage professional friend who was the biggest help ever in my previous births.

So I phoned an independent midwife who gave me enough facts to empower me to go for a home birth again. I was going to see her and see if I could scrape the cash together to have her support me at home but the baby came 10 days before the due date.

I phoned the midwives and said that I had a place booked but I was going to have the baby at home. The midwife I spoke to was shocked and told me I couldn't do that. I said I can, and if there's no midwife who can be there with me I'll do it alone. There is a legal obligation on a health authority to provide a midwife for a labouring mother. Anyway, long story short, I got it. A happy and sucessful birth, mostly in my big bath. Quick too, second stage was about 4 pushes. Only negative thing as my daughter could not wake to see her little brother born.

Absolutely no advice from me, but another story, this one of a home birth against advice. I must have been around half an hour away from the hospital. I think I was 39 for the last birth.

However you play it, strong birthing vibes to you. A thought about the retained placenta. This sometimes happens with the injection they give to close the womb quickly. I always turned that down. First two births the midwives insisted on controlled cord traction and I wasn't really aware of what was going on then, but for my third I did achieve a fully natural third stage which was brilliant.

One of the reasons I decided on home birth was because I was having twins, the hospital were very anti me even trying a vaginal delivery even though there was no reason not to at least try, I had an easy, relaxed Labour at home. Twins were born naturally 15 mins apart, no tearing, no significant blood loss.
My second was born at home after a 5 hour labour. Again no tearing etc
Third was my premature delivery at 30 weeks. And was an awful Labour for reasons unrelated to her being prem. I wasn’t allowed to move around, and it was the only time I tore during a delivery despite her being smaller by 3lb than any of my others. Longest Labour too.

No4 and no5 were both under an hour from start to end. No tear. Midwife only just arrived in time to scoop up no4.

@LemonPeonies

They didn't know my boy was back to back til quite late, I had been pushing 5 hours and needed emergency episiotomy and forceps delivery. Its not worth it in my view. You never know what will happen.

In a home birth if you weren’t progressing they would have transferred you in (if that was your choice) and done exactly what they did. Lots of people transfer in in Labour for whatever reason. Usually because they want more pain relief or because things aren’t moving. It’s very unusual for there to be any emergency reason to need to go in, as signs are usually apparent before then and they will discuss going in with you

Well it doesn’t really but ok

Op, please don’t be swayed by anonymous mumsnetters. Read their experiences but ignore those suggesting you ignore your consultant.

Y

No on is suggesting she ignore her consultant. They are merely pointing out that her consultant is a consultant - as you say, an expert - but he is also therefore well versed in worst case scenarios and would far prefer it if the op took the "least risky" option from a mortality and morbidity point of view, regardless of the actual likelihood of that extremely severe risk Vs the extremely likely but from the consultant's perspective unimportant risks of booking in an induction.

Such as: the risk that the OP is one of the many who do not respond swiftly to induction so end up in hospital for days just trying to get labour going (all the while separated from her other children); that when she does respond her uterus is hyperstimulated leading to very frequent and intensely painful contractions; that the necessity for close monitoring during induction due to the risk it presents to the health of mother and foetus make it difficult or impossible for the mother to utilise various natural pain management strategies like movement, varying position, and water. Pressure to remain static and in lithotomy position for the sake of monitoring increases risk of baby adopting a B2B position which can stall labour and increase pain. That if this intense, painful labour without the ability to access natural pain mgmt is prolonged, it increases her likelihood of using increasingly potent and disabling pain relief, often culminating in epidural, which comes with a raft of its own risks including paralysis and long term neuropathy. Moreover increases the likelihood of eventual Caesarean, a major surgery, due to mother's inability to move and follow body's cues to progress labour. Increased likelihood of tearing and birth trauma. None of these risks really signify to the consultant. What he has to do is make sure they don't die, and the simplest way for him to ensure that is to push for an induction as then the OP won't have an unexpected BBA and potentially a PPH without medical attendants (her highest risk of dying). The fact that even taking into account her risk factors, that risk is still very very small, is not part of his calculation. It will however be part of the OP's as she will be the one who has to go through it.

I think it's telling you say "a life" is at stake here. And while I'm sure you'd deny it, is lay money on it that when you wrote that the life you were referring to was not the OP's.

I would never have a hospital birth unless there was zero other options. Much more likely to die or have complications in hospital than at home. This is a statistical fact. You get a much better level of care at home. 2 midwifes exclusively for you. I also have precipitatious labours (under 2 hour births). Induction can be very dangerous and intense if you labour quick. You won't get good advice here though, just nonsense like "I wOuLd HaVe DiEd If I hAd TrIeD a HoMeBiRtH". Join a Facebook group called something like Home Birth UK support group. For actual evidence based help not hysteria.

@Draineddraineddrained

Read the post immediate aftermath yours for example

@Cosmois

I would never have a hospital birth unless there was zero other options. Much more likely to die or have complications in hospital than at home. This is a statistical fact. You get a much better level of care at home. 2 midwifes exclusively for you. I also have precipitatious labours (under 2 hour births). Induction can be very dangerous and intense if you labour quick. You won't get good advice here though, just nonsense like "I wOuLd HaVe DiEd If I hAd TrIeD a HoMeBiRtH". Join a Facebook group called something like Home Birth UK support group. For actual evidence based help not hysteria.

Is that true? The stats do show less intervention at home but I don't think it's "much more likely" to die in hospital? Or is that because anyone with complications at home have then been transferred to hospital and consequently died?

As I said upthread I'm an advocate of home birth. I tried it with my first but did eventually end up in hospital. I'm due again in a few weeks and will try for homebirth again. So I'm deffo not against homebirths but since the op has had issues before, I think it's too risky..

Nowhere in that post does she say "ignore your consultant". She says she wouldn't have a hospital birth unless she had to, not opining on whether the OP "has to" or not.so precisely the sort of post you approved actually.

Different people have different attitudes to risk. Some people would be cautious regarding mortality/morbidity (perhaps more so if you have other children as well). Different complications also mean different things to different people. Discuss the pros and cons of the different options with consultant and midwife.

Do you think you would want further children after this one? Consider an elective C section as an option in addition to induction, hospital and home birth. Ambulance wait times and childcare issues are also good things to consider as PP have suggested. My personal preference would be elective c section (if consultant didn’t thing pph risk too high) - to reduce risk of instrumental delivery and also because I don’t think I’d want further babies.

I would speak to your consultant and midwife and not listen to a bunch of randoms on Mumsnet.

I had a home birth for my second as I labour fast and I didn’t not want to risk giving birth without medical assistance at the side of the road/in the hospital car park.

MN is generally very anti home birth.

@parttimemary

What a waste of a consultant. He could have been treating someone who would actually listen to his expertise

Where did she say the consultant was a man?

Yes, quite. The consultant was a woman, and very good at her job she is too. I did of course listen to her....but I'm still in two minds! My last birth was textbook and she was born in a car park. It would have been so much nicer if I'd just stayed home.

There are alternatives to being induced on week 40. You can ask for extra monitoring instead from week 40. Check with your midwife.

I did go for the inducement but largely due to all the advice from the consultant. I couldn't face increasing any risks for my baby

OP in your situation I would think seriously about a planned c-section. I agree with you - the risks of negative side effects of an induction are too high for me.

I think a home birth would be ideal in your situation (and less risky than trying to get to hospital and not making it in time) but given the risk of severe bleeding I’m not sure I’d go for that option this time and would instead look into the planned section. Everyone I know who’s had a planned section has had a pleasant experience and a good recovery.

@Cosmois

I would never have a hospital birth unless there was zero other options. Much more likely to die or have complications in hospital than at home. This is a statistical fact. You get a much better level of care at home. 2 midwifes exclusively for you. I also have precipitatious labours (under 2 hour births). Induction can be very dangerous and intense if you labour quick. You won't get good advice here though, just nonsense like "I wOuLd HaVe DiEd If I hAd TrIeD a HoMeBiRtH". Join a Facebook group called something like Home Birth UK support group. For actual evidence based help not hysteria.

Women who aren’t consultant led are more likely to die in a NHS hospital birth because the hospital staff are less likely to prioritise them. Women who are consultant led like OP are more likely to come home undamaged and with a baby at hospital.

@Draineddraineddrained

I do think it's interest that the only time you've had a haemorrhage was when you were induced,but everyone is using that as a reason to be induced

I think you are between a rock and a hard place and I'm sorry! I'd want to be in the hospital given your history but I wouldn't want to be induced, since left to itself your body seems to labour well whereas on the one occasion you've had intervention you've had subsequent dangerous complications.

Maybe put it to your consultant that you would like to labour in hospital but do not want to be induced due to your history and see what they say? Would balloon induction potentially be worth considering?

Thank you! Great response and exactly why I'm concerned about induction.

No way don’t do it , if I’d of had a home birth me and my baby would of died , I never thought that things would go so horribly wrong either. What if you hemmoraged again?