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!

@JustLyra

And as you well know the statistical fact is that you are more likely to have complications in hospital.

It's also a fact that home births are only going to be supported if they are low risk.

So of course hospital births are more likely to have complications! All the high risk pregnancies end up there.

You won't get good advice here though, just nonsense like "I wOuLd HaVe DiEd If I hAd TrIeD a HoMeBiRtH".

Wow, so rude and dismissive of people who could have died.

OP, I wouldn't take advice from people like that, if I were you.
And I wouldn't risk a home birth in your situation.

@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.

Please give us the source and actual probabilities for that statistical fact you mention.

@JudgementalCactus

According to the above poster… the very fact this poster says That it is a “statistical fact” means that, well it definitely is!

Yeah, I'd be veeeery surprised if such a statistic exists and the correlation it not explained by a series of covariates.

But I don't want to dismiss it without assessing the actual study.

@FluffyBooBoo I’ve made that point several times.

It’s a fact that you’re more likely to end up with interventions and complications in hospital - which is an entirely understandable fact give there are vastly more births in hospital and vastly more hospitals births.

It’s why the OP should speak to her midwifery team about her pregnancy if she wants a second opinion on the obstetricians view.

[quote Oftenithinkaboutit]@JudgementalCactus

According to the above poster… the very fact this poster says That it is a “statistical fact” means that, well it definitely is! [/quote]
Its amusing you’re demanding facts and figures from people yet have given nothing to back up your assertion that obs will have experienced “many” failed home births that require life saving surgery…

@JustLyra ummm I wasn't the one to make that assertion

[quote JudgementalCactus]@JustLyra ummm I wasn't the one to make that assertion [/quote]
Ummm I didn’t reply to you…

You and your baby are safer at home. If you labour fast that’s even more reason to stay at home rather than risk giving birth in the car.
It is 100% your decision.

I'd have loved a home birth but had a high risk pregnancy due to multiple factors but like you including age and previous history of complications. It's not just you at high risk - your baby is at high risk from a home birth as well. I think you need to consider that carefully and put your baby's safety first. That doesn't mean you have to agree to induction though, you could request frequent Doppler scans instead. But honestly if I were you I'd go with what the consultant says, they're experts in weighing up the balance of risk.

@JudgementalCactus

Yeah, I'd be veeeery surprised if such a statistic exists and the correlation it not explained by a series of covariates.

But I don't want to dismiss it without assessing the actual study.

Exactly I would just like to see where the poster is pulling the statistical fact from I’ve not denied it I just want to know what the stat is and the source But it would seem….

High risk pregnancies have a higher infant mortality or mobility than in hospital.

Speak to your health team - the medical professionals.

Given your history it sounds like you are high risk or at least high risk factors. If this is correct, then you will put your baby at higher risk of a negative outcome than in the hospital setting. There are plenty of global studies regarding this online.

If this was a low risk pregnancy with no risk factors, I would suggest to consider a home birth, before any posters come at me.

No, and I’d be requesting an induction at 40 weeks if I hadn’t gone into labour naturally by then. But I’m extremely risk averse.

If you've been told it's dangerous and you're 25 minutes away from the hospital, I wouldn't even consider it. Being induced was horrific for me too, but I would still rather go through that than risk mine and my baby's lives.

How is stating a statistical fact denigrating?

Well quite. And it is simply the case that at home you have sole care from an experienced, primary midwife and a secondary to join for part of the time. It is unsurprising that women in the sole care of experienced midwives have better outcomes than women sharing a midwife with others giving birth and with less experienced medics.

My awful first birth was in hospital and largely a consequence of mismanagement due to inexperienced and overstretched staff. It was that which drove me to dig into the research and have my subsequent births at home.

Would I have gone for home births if I lived on a remote island 100 miles from the nearest emergency help or if I had placenta previa or similar? No of course not. But the endless pressure and propaganda that its always best in hospital is simply not true.

Anyone prone to very rapid labours is at particularly at risk if they give birth en route compared to either giving birth at home or in hospital.

If the induction was linked to the haemorrhaging then, as I said upthread this needs following up to understand likelihood of it happening again if induced. The key question is were they related and are they relevant to the current risk assessment.

I was in a fairly similar position, but can't comment on your haemorrhage. Second baby due when I was 39 years old, first baby arrived fairly quickly without any complications or stitches, so I was concerned second baby would be born in the car on the ring road.
I was then advised induction as diagnosed with gestational diabetes, but I did my research and felt home birth was still the best option for me. It was - baby's head arrived at the same time as the midwife in my lounge - so he would definitely have been born in the car if I'd gone to hospital!
My advice, get a doula if you can afford one - she was able to get to my house much earlier than the midwives. See if you can speak to the consultant midwife at the hospital. Mine seemed much more balanced than the obstetrician consultant, who sounded like she wanted ALL women to be induced.
Do your research - eg excellent book "Why Induction Matters" by Rachel Reed about induction and it's related risks.
Ask for compromise. Agree to hospital birth on a midwife led ward if possible. Ask to wait for induction until 41 weeks instead of 40.
Maternity care should be individual-led, not just looking at blanket statistics. Read the excellent "Give Birth Like a Feminist" by Milli Hill

Statistics from The Lancet www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30063-8/fulltext

[quote PfizerMinnelli]Statistics from The Lancet www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30063-8/fulltext[/quote]
The first 4 words are significant to OP.

Also

“Findings of the study suggest that low risk….”

So not a “statistical fact”

I think that OP should investigate the nature of her own 'high risk' status before anything else. OP, speak to your obstetrician and ask for your relative risk (eg, twice the risk of previous pregnancy) and absolute risk (eg, 1 in 1000 similar births) of adverse outcome. Ask what specific adverse outcomes it is that you have an elevated risk of. Only then can you know if you have a sensible choice to make. If the increased risks are still low in absolute terms, and relate to adverse outcomes that aren't lifethreatening, then you're in a position to investigate the other relevant factors, like transfer time, etc...

Good luck for a happy outcome for you and your family. 🍀🤞

@Oftenithinkaboutit

Also

“Findings of the study suggest that low risk….”

So not a “statistical fact”

The opening from the link:

Findings

16 studies provided data from ~500,000 intended home births for the meta-analyses. There were no reported maternal deaths. When controlling for parity in well-integrated settings we found women intending to give birth at home compared to hospital were less likely to experience: caesarean section OR 0.58(0.44,0.77); operative vaginal birth OR 0.42(0.23,0.76); epidural analgesia OR 0.30(0.24,0.38); episiotomy OR 0.45(0.28,0.73); 3rd or 4th degree tear OR 0.57(0.43,0.75); oxytocin augmentation OR 0.37(0.26,0.51) and maternal infection OR 0.23(0.15,0.35). Pooled results for postpartum haemorrhage showed women intending home births were either less likely or did not differ from those intending hospital birth [OR 0.66(0.54,0.80) and RR 1.30(0.79,2.13) from 2 studies that could not be pooled with the others]. Similar results were found when data were stratified by parity and by degree of integration into health systems.

Point taken about planned home births not being the higher risk births but note that they say When controlling for parity in well-integrated settings so that has been taken into account in the meta analysis.

“Findings of the study suggest that…”

A direct quote from the conclusion of the report

i would definitely consider it if you labour quickly and your previous births were straight forward. There is a really supportive Fb group "Home Birth UK" which is great for advice. I had lovely experiences with my births and trust my community midwives. If anything concerns them during labour they would transfer you immediately.

In general, people have been horrified to hear I have had homebirths; attitude towards it are incredibly negative and I've had to put their opinions to one side. I would expect you'll be told a lot that the risk is too great, it's irresponsible, do you think you're a hippie etc. ultimately it seems so sensible to consider since you labour quickly - I'd definitely prefer to be at home where help can get to me under safe circumstances and an ambulance could reach and transfer me safely if needed than taking a car journey. All the best and whatever you choose I hope you are well supported in your decision x