to think that SIL is silly to want a home birth??

[catinboots]

I know I'm probably going to get a flaming - so let me first clarify that I am not anti home-birthing !!

SIL is 41, single and expecting her DC1 this year. She has stated she is going to request a home birth. Am I right in thinking she is a bit bonkers - due to both her age and the fact it's her first baby. Surely both these factors put her in a higher risk group?? She just keeps quoting caesarean rates and says she definatley knows that nothing will go wrong because she has a positive outlook!!! She said that health professionals are scare-mongers.

I have several friends who have had very successful home births. It is also something I would consider if I ever had a DC3.

Maybe my opinion in coloured - my mum had a full-term stillborn baby, and my DS1 was born in hospital after a very long labour and various forms of intervention. DS2 was also born in hospital - but the experience was very positive.

SIL currently lives with MIL (who is not keen on the idea either). She is 30 minutes drive from the hospital.

At least half my friends have ended up having an ECS, whether that was the fault of the hospitals or not I've no idea. I don't recall any one of my friends going in to those labours intending to have an ECS, in fact most of them had done their NCT homework and were positively evangelical about their planned natural births beforehand.

Maybe I just attract ECS 'victims' (and the latest one ended up having an ECS after two natural, problem-free births), but the worryingly high percentage of people I know whose births have gone tits up is enough to make me petty sure that hospital is the place to be for me.

I think people really demonise hospitals and seem to think that hospital staff are hell bent on causing problems during labour. YANBU to be concerned for your SIL, but I wouldn't say anything - I hope I'm sure she's been advised of the risks.

here

Just been off to have a think, and I retract my statement about 'at least half'... about ten people popped up in my mind who had had ECS and I could only think of about seven or eight friends who had had vaginal births. On reflection, I've suddenly thought of loads more who have had straightforward births so excuse me for spouting shit my confusion. I'd actually put my badly formed estimate to be about a quarter of my friends have had ECS.

Still a statistic to consider though .

The "HB triples risk for baby" article is being discussed here. From what I can gather, the study is being criticised for not considering the qualifications of the carers that are present for the birth. In particular, a lot of HBs in the USA are either unattended or not attended by a MW (often due to legal circumstances) yet a lot of these births were included. If the data is restricted to those cases where qualified carers are present (which includes most planned HBs in the UK), my understanding is that there's no significant difference in risk for the baby between home or hospital.

I don't think that hospital staff are hell bent on causing problems, but I do think that its a lot harder to fight against hospital policy if you don't agree with it once you're admitted, in labour and then having to try and have a rational discussion with people in white coats (who we've been brought up to trust and not question, and who often act accordingly). A straightforward labour is better for mother and baby, but lots of little things ("having" to lie on your back because you "have" to have a VE, having to talk to HCP's and discuss things again because there's been a shift change...) can interrupt what could have been straightforward.

Why is it foolish to have a HB for your 1st baby? Why is a non-progressive labour at home (if its monitored by a MW, as it would be with a planned HB) more likely to result in a medical emergency than the same labour in hospital? As an alternative, I know an extremely experienced and well respected MW who felt that 1st babies were ideal candidates for HBs are things tended to happen more slowly and so there was more time to react and get to hospital if necessary. Being 41 might increase risks, but if those risks don't tend to apply during the birth and/or would be handled in exactly the same way regardless of location, why is age an indicator to be in hospital?

Ultimately, you are entitled to think what you like, but as long as your SIL is making an informed choice you might want to consider supporting her rather than slating her. When we were planning a HB for DD1 (also DC1 and breech - dread to think what that's going to make me ) it got so draining defending our decision to everyone who felt that they had the right to try and change our mind, even though they had done a lot less research than we had, that after a while we tended to avoid them.

I planned a HB for my first and we were (at least) 30 mins from the hospital. We were totally supported by our community midwife, with the proviso that if the risk factors changed so would the plans. Was my midwife a fool? No she was following evidence based practice which said that I was low risk an thus suitable for a planned home birth. As it happened ds was transverse oblique and had to come out by C-section, and I didn't get to labour at home (indeed I didn't get to labour at all).

Second time I had a planned hospital birth, and it was probably the worst experience of my life. Another c-section, but there was at least a 30 mins gap from when that decision was taken and going under the knife, and during that time I had no MW support at all (she buggered off leaving me still strapped up the the syntocin ).

Riven that US study is very problematic. Here is a description from Dr. Michael Klein, an emeritus professor of family practice and pediatrics at the University of British Columbia (Canadian data was used)

"It's a politically motivated study that was motivated by the American College of Obstetrics and Gynecology who is unalterably opposed to home birth, and they probably were quite happy to publish this article because it fits with their political position,"

He went on to say that he thought the study was "crap" using data going back to the 70's, some very very small studies (it's a meta-analysis) that should have been excluded using normal standards for such studies. Plus most of the data was from the US, where home births are not attended by trained midwives (because the doctors have a bit of a stranglehold on a very very medicalised approach to birth).

That's not to say that there are no risks. Of course there are and anyone making this decision should be cognicent of them.

Untested pelvis:

The average first labour is 12 hours. During this time, you expect progress (increase in the intensity of contractions, gradual descent of the baby, and gradual vaginal dilation.

It doesn't happen in a matter of life-threatening minutes all at the end. If something is not right, there are hours to alert others.

Sudden problems, which are very, very unusual, don't have a better outcome when they arise in hospital vs at home (except for the ones that are caused by hospital).

I can't believe the posts about mess and the fact that OP's SIL lives in her MIL's house. But that is where she lives, it is her home too. And as far as mess goes, it's not bad, all she needs is a waterproof sheet on her bed.

MIL does need to be considered though. It is her house afterall.

They must obviously have discussed it.

both my DD's have got stuck on the way out (shoulder dystocia) and with number 1 i was prepped for a c-section and then they got her out with ventouse as the had turned slightly by the time we were in theatre, number 2 was very very quick and she got stuck, MW told DH to press emergency button, 6 doctors and nurses piled in within 30 seconds got me into some posiiton i have been told was called McRoberts and she shot out. i am not sure what would have happened if i had been at home but i was glad both times to be in hospital.

in your SIL's position i wouldn't be considering a home birth but there is no reason why things shouldn't be straightforward for her and to be honest with no 1 i was in labour for about 30 hours so i imagine that after a certain length of time at home the MW would suggest transferring you if things don't seem like they are going to happen without help.

wow scaremongering or what! There isn't that much mess - they catch most of it in those incontinence type bed sheets they put down and anything more amounts to bedsheets like when you normally strip your bed.

My midwives took care of everything while I had a bath and then came back to my bedroom to find it all ready to snuggle up in fresh bed with my new dc. It was lovely.

Poor SIL if she is forced to give birth somewhere she doesn't feel right because it's MIL's home. That will be sooo conducive to a happy birth. NOT.

MIL doesn't want to say anything that may upset SIL and is treading on eggshells. SIL is a bit depressed after splitting with DP. She has come back from living abroad to stay with MIL until she sorts herself out.

Your poor SIL. Her situation would really benefit from a lot of love and support right now. She is very vulnerable.

Maybe you should read Ina May Gaskin's childbirth book for reassurance, lots of problems such as shoulder dystoria mentioned above are easily managable with a good mw, luckily I had read it just before my accidental hb, it helped me stay calm and focused, it had cleared away for me all the horror stories you come across.

Isn't there a happy medium? I had DD2 in a midwife led unit - it was fab, very little intervention but the knowledge that if anything did go wrong I was in safe hands and in close proximity to medical help

Actually a few bad things did happen in it.

You can read up on SD and homebirth here. The nuts and bolts are that, apart from 2 very drastic options that are performed extremely rarely, everything that can be done in hospital to try and resolve SD can be done at home. And SD is less likely to occur when a woman is free to move around and change position as she feels is appropriate, and where labour progresses naturally - both of which are more likely to happen in a home environment.

Has anyone talked to your SIL about why she wants a HB and do you know why your MIL isn't keen? My IL's were very dubious, but once we started talking they realised that most of their instinctive reactions were not supported by the data and that our decision was well considered. The vibes coming off them became much more sympathetic after that! I can sympathise with both your MIL and SIL - but if everyone is approaching SIL with the view that she is silly and bonkers by even considering HB its not going to make it easy to understand where she's coming from and won't encourage her to listen to alternative points of view...

that is v interesting Tangle. i didn't mean to scaremonger but that is my genuine experience.

Her childbirth book is a record, it's not sugar-coated, it is an account of real women giving birth, just because they are not in hospital doesn't mean it's all lovely and nice, I hate this patronising attitude people often have about hb's, it is the only book where I read for instance that when baby crowns you will feel a burning sensation, so when that happened I knew it was meant to, I understood what was happening.

All I mean is that if the op were to read it she might understand more where her sil is coming from.

I had a hospital birth that caused problems for DD and for me - an induction. It was traumatic and completely unnecessary. We avoided a C section by the skin of our teeth - and actually only because people were being incompetent, had they been paying attention, it would have happened.

Subsequently have had 2 home births, that became "high risk" because I have long pregnancies (the shortest one went to 40 +12, longest was 42+3). I did my research and decided that for me and my baby, home birth was safer. Of course there was risk involved, but for us, there was more risk involved in going to hospital.

It wasn't some kind of "birth experience overriding outcome" obsession. I genuinely believe that in our case, hospital birth carries far more risk than home birth.

I didn't tell all that to everyone I met. If people I knew weren't terribly informed started in on me about "risk" etc, I did what your SIL was doing - Smile, It Will ALl Be Fine, thanks for your concern.

Bad things happen at home, bad things also happen in hospital, we must all weigh up the risks and make the decision as best we can with the information available to us.

Home biths can be the safest options for some- had I not had a booked one with ds4 he'd ahve been born somewhere aorund Tesco csarpralk ;there simply was not time to get to hospital. A birrth lasting 35 minutes.

So it clearly isn't rtrue that HB are always less safe- warm, home, with birthing apck and MW clearly better than roadside on a cold night in April.

OTOH my first biurth with ds1 was pretty rough and an unduction saved us so i;d be wary about a first birth but you knowm support her decisions as theya re.

Loads of first births startw ith induction anwyay, ther are no guarantees.

Oh and there weas no mess at all with my HB- I pit some pampers care mays down that we had in the shed and it was fine. MW been and gone in 2 hours, MN Doula in attendance....

Yes, same here SMA, no mess at all. Well, there was, but it was on bed mats, and whipped away in seconds.

Wubbly, I'm sorry you had such an odd experience and your baby was in the NICU. Sometimes it can be nice to get notes to find out what happened - especially if you're thinking of having any more. But I hope you have some peace with it.

The untested pelvis is such nonsense. It happens but it is very, very, very rare to have true cephalopelvic disproportion (baby's head too big for the pelvis).

I was diagnosed with this for my first birth which ended in a EMCS. Third baby was the same size, delivered at home... and not even a tear.

Yes, first births can be slower, can stall and babies can seem 'stuck' - there are a lot of reasons for this but An active delivery - lots of walking, stairclimbing etc. during labour can really make a difference to the baby's position. If things really aren't going well due to the baby being 'stuck' it generally happens very slowly, not in a big blue light emergency.

Re: The Guardian article. This is based on a very dodgy interpretation which was released primarily for political reasons. If you actually look at the largest, most controlled, recent studies (such as the CMAJ one), they unanimously find home birth very safe.