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.

We are all entitled to our idealistic views though - the tricky thing is seeing them through with conviction when the going gets tough, and pre birth, I don't think anyone can quite percive what exactly you have to go through both mentally and emtionally during childbirth.

All the reading cannot prepare you for this, so it's a matter of personal confidence.

Angel how terribly, terribly and how beautifully, beautifully put.

Thanks BikeRunSki (please see my previous post if you haven't already read it - pg 5) x

I do think its reasonable to talk to your SIL - but I think it needs to be done from an informed position (the homebirth website is a very good starting point) and supportively. In particular, if your MIL has concerns about a HB in her house (rather than her daughter having a HB) she should be able to discuss these.

But I also think CarmenSanDiego has a valid point - your SIL's MWs won't have said "you'd like a HB, OK we'll see you there" unless they're totally negligent. They'll be talking about what could happen and how that would be handled, circumstances where they'd need to recommend a transfer to hospital and how long that's likely to take, what could go wrong and what the worst case scenarios could be. Even if your SIL is being romantic right now, her MWs will be working on informing her.

Its also worth remembering that CMW's who do a lot of HBs are much more used to having to deal with situations than their hospital counterparts. Not all MWs would consider footling breech a reason to go to emergency CS, although that's probably hospital policy in most places and MWs with strong skills in vaginal breech birth are getting fewer and farther between.

My choices to HB had nothing to do with my rights, and everything to do with my responsibility, as I saw it, to my children.

With DS2, I had a severe asthma attack and was hospitalised at 41 weeks. The doctor proposed an induction. I asked him how the hell he thought I would be able to push a 9lb baby out when I couldn't even breathe to eat properly. He said, oh, we can help you if you have trouble. Right. Never mind that I was full of salbutamol - a drug that is used to stop labour - and running a temp of 39, never mind that I was already exhausted - I had passed his magic cut off of term + 10, therefore I had to be induced.

We went on to have a good, drug free, safe HB. No need for interventions, no need at all but protocol. To follow that doctor's orders would not have been to follow my responsibility to my unborn child.

It's such a pity that things can't change allowing women to have better hospital experiences. Mine with my 1st was just horrible, whereas although my HB was unplanned it was still great.

BigWeeHag that's so impressive, well done there for standing up for yourself and your dc.

catinboots, then share the info from the HB website wiith your SIL, if you can do so without her feeling you are interfering. I certainly didn't have a romanticised idea of a HB. I doggedly pursued my MW team on every "what if" scenario until I felt I had satisfactory answers. I knew where ambulances would be dispatched from. I checked the resus equipment, I looked at the IV kits in my HB pack, I discussed where the ambulance would pull up to in our driveway (!) if one was needed.

I was acutely aware of the devastating outcomes of some HBs, and I hope Riven doesn't mind my saying so, but her experience with her gorgeous dd was never far from my mind. I'm grateful to her for being so open about what happened, and think she shows great generosity, strength and dignity in allowing others insight into her painful HB outcome. It certainly has helped ensure I asked some very important questions when making my decision.

I think I expressed that clumsily. I hope you understand what I was trying to say there, Riven.

But in the end I weighed up the risks and pre-emptively discussed the contingency plans, and then made my decision - which I felt was right for me and for my baby.

seashore, I definitely agree about improving the hospital experience.

If hospital experience were improved, the raison d'etre for a home birth would melt away.

However you dress it up, if there is a problem with the baby, and not all problems can be detected in good time, it is better to be 5 mins from the theatre than 30 mins. The risk might be low but the difference of a few minutes catastrophic.

There is an OB in California who is fundraising to build the first birth centre with an operating theatre attached. This would be an incredible compromise, although I suspect for political reasons it may sadly never happen.

I'm not convinced that improving the hospital experience would completely remove the desire for a home birth. There will always be some women who simply feel more comfortable and safe at home and want their baby to be born into that environment.

But it's irrelevant - the hospital experience should be better anyway. In an ideal world, women would all be properly informed, allowed to make informed choices and have those choices respected and supported. The hospital environment would be calm, welcoming, clean and relaxing. They would be well monitored by alert, professional staff who follow evidence based protocols.

I campaign fiercely in the US to improve the frankly hideous hospital procedures but it mostly falls on deaf ears The US has hospitals which appear beautiful cosmetically, with private rooms and restaurant menus but their procedures are stuck in the 1960s and throw evidence and research out of the window.

"If hospital experience were improved, the raison d'etre for a home birth would melt away"

Not for me. Why would I go to a hospital when I can be just as safe at home with an experienced mw who can has delivered cephalic and breech babies and is at the ready for most emergencies?

I personally think lots of people also think hospital births mean fewer problems. It's just not the case. Hospital protocol can interfere with normal active births by making women lie down.

The number of friends I've had who've been left to labour alone for hours and hours in hospital.

Don't say anything to your sil until you've researched thoroughly around the subject and know your stuff.

YOu've no place to say anything until you actually know what you're talking about.

CarmenSanDiego that's true, the hospital experience should be better anyway but a lot of women do choose a HB because of a bad first birth experience there, certainly most of the women I know that have had HBs, that was their main reason.

I believe in HB but I would perfer to see women choose it for other reasons, in my case for instance I had had such a traumatic 1st birth experience in hospital that I believe it contributed to my having an unplanned HB which was precipitous, I didn't get to choose the situation,I think my body just couldn't face hospital again.

The OP's SIL mentions her fears of winding up with a C section should she go to hospital, expecting a poor hospital experience is colouring her decision.

Seahorse, agree with you again that women should not have to choose HB only because they have been let down by a hospital birth or heard of women who were.

I agree that for some women, they will always choose HB and I am fine with that so long as it is an informed choice.

But a lot of the reason why women choose HB is because they think the first alternative (hospital) would lead to a poorer result due to the way they will be expected to labour and the management of birth. Like OP's SIL.

That is not ideal because there are increased risks to the baby if something unexpected is detected or happens quickly.

I was always interested in a HB as my biggest fear was of having the situation taken out of my control (not because of a medical emergency, but more of a "well we can't admit you till we've done a VE", "we need to do another VE to check how you're getting along", "we're a bit worried because you're not dilating fast enough - we'll see how it goes but we may need to give you a hand"...) I don't work in a medical environment and I find that an awful lot of conditioning kicks in when I get there so I didn't expect it to be easy to fight my corner.

When we started talking to our CMW about HB (and this is all before we knew DD was breech) she was not supportive. To start with it was a pretty frank rejection (although nicely phrased "much better to see how your 1st goes and have a HB next time round") and after that every possible thing that could go wrong was discussed in detail, along with all the gaps in her practice (water birth, fitting a cannula) where I'd need to "hope the other MW knew how to do it" .

So we wound up with IMs, who didn't say "of course everything will be fine", but also didn't continually try and discourage me. Looking back, other things that turned out to be hugely important included:

• being able to labour without having to worry about when to get in the car
• knowing who was going to come when we called
• already having a trusting relationship with the MWs who were going to come when we called
• having already discussed "what ifs..." so the MWs didn't need to try and make me engage in a discussion while in labour
• not hearing other women screaming while I was in earlier labour
• winding up with unnecessary medical intervention (up to and including CS) because I "failed" to labour according to the NHS's approved plan.

DD1 was born pretty easily after a 7 1/2 hour labour. I went almost completely silent for the last few hours - not unresponsive but a little bit disengaged. The MWs were very happy to follow my lead and didn't try and get me to talk about anything. I did wind up needing to transfer in for a slow PPH (from a tear), but it was no where near needing blue lights.

All of this was a big contrast to DD2, where I had to have a hospital induction. The background was very different and it was never going to be as easy a birth - but it was NOT helped by a number of factors including:

• shift changes, so not having continuity of care
• having to give consent for everything they wanted to do every time (which meant I had to focus enough every time to listen, ask questions, nod or say yes...)
• having assorted other medical team members appear on minimal notice wanting to have a feel / ask questions / change things

Basically all my concerns about the situation being out of my control came pretty true.

The "One Mother, One Midwife" campaign would be a very good start. But even with that, I'm not sure how much its possible to change away from the feeling of the hospital being in control - and for me, that's the deal breaker. I don't want to ignore all research, or override all hospital policy - but I do want a bit of common sense applied such that I'm not held up to ideals and averages. Given most interventions make things more risky for both mum and baby, to me the most responsible thing to do is to try and minimise the chances of intervention happening.

'That is not plenty at all in many instances, my dd's heartbeat dipped extremely swiftly at the end of my labour and I had to have emergency forceps to pull her out, it was the scariest thing I have ever heard,

Something similar happened to me when de;livering ds1

He was high risk; series of cock ups led to them missing pre - eclampsia until it was shown he'd lost somewhere around 1lb in utero. During labour I had a MW 1-1 but couldn't have a c-section as someone else with pre eclampsia had gone into labour at the same time and was in surgery; apparently they had assumed my induciton would take several ddays as they put baby's due date at 13th even though I knew full well it wasn't as DH ahd been ill with flu so it would have ahd to be the immaculate conception. I was induced after being blue ligted in when fiting. Anyway, during labour ds1's heart was dipping dramatically, but anaesthetist was busy and they couldn't give me anything to help as they lost my blood results. I think they feared a syndrome called HELLP.
Luckily (and no way they could have known) I have a endency towards extremely short 2nd stages- longest from 6cm - delivery is uder 20 minutes so the emergency was averted. He is disabled though as we realised some years later and we shall never know if related or not.

DS3 was meant to be a hb (after extremely good MW led unit with ds2, despite him being OP presentation- we travelled a bit to find a MLU near a main unit that wasn't first hospital) but it was cancelled after my blood iron dropped 0.05% and I wasn't savvy enough back then to question it. So when I questioned MW about suitability for HB with the last baby, and she said in her mind it was safest bearing in mind the anomallies of ourr family- DH working away, no family closer than 60 miles, 2 autistic children, previous labour under 3 hours- I was prepared to fight for it and it was a great birth. painful of course, perhaps in my experiences more so because of the sheer speed and related shock, but great nonetheless. And a very few days after the maternity unit at the local hospital was closed to labouring mums becuase it was too dangerous (Royal Gwent, easy enough to google) so I was extra relieved I ahdn't been there to deliver. I went in for iron bloods at 36 weeks, one toilet operational for several wards, blood stained tissues on the stairs, some highly distressed woman being ignored as she carried her crying baby up and down crying out in what sounded like an eastern european language (so nobody could understand but surely someone could have tried to help calm anyway? I've worked in psych / geriactric and done time on a mat ward and would always have tried)....... it's probably much improved now but then, nah. Unless baby in obvious danger not at all for me.

I did however have to sign a form for the Ob saying if issues developed before or during labourr I woulda ccept transfer and help in order for them to send a MW and I was happy to do so.

'If hospital experience were improved, the raison d'etre for a home birth would melt away"

Not really.

I only moved here a fairly short time before my pregnancy so despite all the problems with the hospital I only knew of my one experience there and would not necessarily ahve generalised. I would have transferred there without question had I needed to so would not have been that put off.

The main reasons behind my choice wrere not ones linked to hospital performance: indeed the safety issues came to national notice a few days after delviery.

basically, I didn't want to be alone with my other kids giving birth whilst work tried to contact DH / he tried to get here (labour was shorted than his trip home so would ahve happened)- no family to help. I am pretty shy in RL and was scared of being alone in hospital, DH has always been my rock in labour- in fact being separated from him in labour was my biggest fear, apart from being alone.

In the end we booked a Doula and she would ahve gone in with me. She was someone i;d 'known on MN for a while anyway and someone I genuinely liked.

And as it happneed doula and Dh were well needed: only one MW got here in time, she was chatitng as baby crowned with her abck to me so doula had to grab her attention and take over a little at times (in MW's defence I don't think she expected to walk in and find me 10cm dilated LOL)- DH was running about fixing wrongly set up gas and air canisters and cleaning up / replacing boiwls of water the MW kicked over.

It is a tough one, I would probably be worried too.

My ds was born at home, but I was 27 and had already given birth vaginally. The main reason I chose a HB is because of a horrific hospital experience with dd, which I won't go into, but I felt that I would be safer at home. I was literally across the road from the hospital though, so if there had been issues we could have ran across the road and been there in less than a minute.

I now live in a village that's much further away from the hospital, and don't think I would have a hb again, we have a midwife-led unit which would be a good compromise for me personally.

angel- for you for losing your DD, however I do not think that your experience is an argument against homebirth. Both you and your baby (pre-eclampsia and light-for dates) had underlying conditions which firstly, should have excluded you from a MLU/HB and secondly, may have resulted in death even in hospital. Some babies (and Mums) will die regardless of anything a hospital can do. It sounds negligent to me that neither of these conditions were picked up on antenatally.

re: ambulances- in an emergency an ambulance should reach you within 8 minutes(that is their target). Also most natural labours occur at night/in the early hours when both the ambulance service and the traffic are much quieter. 30 minutes from your home to hospital in your car during the day will mean 10 minutes in an emergency ambulance at night.

quicklook- if you had been at home you would have been transferred for slow progress well before any problems had occcured

shiny- quote from the British Medical Journal- "electronic fetal monitoring lacks precision and tends to overdiagnose fetal asphyxia, only half of abnormal traces being associated with fetal acidosis"

therefore there is a 50/50 chance that there was absolutely nothing wrong with your baby

as I have said before homebirth midwives have forceps to use if need be

blueshoes-but not wanting to adhere to hospital protocols is not just about the Mum's 'experience' it is that these policies increase maternal and neonatal mortality and morbidity

To OP:

Yup, YABU.

neither age or first baby makes her high risk for a HB.

May I suggest you read up more about what are risks before you express your uninformed opinion.

And yes, some HCPs are scaremongers. I had two do this to me when I was pg with dd2 and only a stern letter to the head of midwifery made them give me grudging professionalism on my birth choice.

Until midwives can safely perform emcs at home and there are no risks of something unexpected being detected or developing at birth, there is no way a home birth is as safe for baby as in a hospital.

In a perfect world, all anomalies would be picked up at the time they should, assuming they can be detected to begin with. But as we all know, that is just an ideal.

Proximity to emergency intervention in emergency situations (that can happen even for seemingly risk free births) is a big factor in prevent morbidity and improving outcomes for baby.

Angel I missed your post initially, so very sorry.

I worked for a little while on a helpline for a charity related to pre-eclamspia (PET) and one thing I did was to edit the birth experience page for the newsletter. I had to edit a great many letters about people who had lost their babies, but never did I come across a mother who had not been diagnosed pre-delvierall (excepting postanatal pre eclampsia which I understand is far mroe rare). It sounds as if you were let down very badly indeed.

However, equally, most baby's born to mums with PET do survive and it could well have been the cord, or a mixture of both (baby already struggling with PET). Nevertheless though, you should not have been delviering at home and the errors amde were by the hospital team. Please, you mustn't blame yourself. I know it's not that easy though. Mum lost several baby's due to a medical condition and she still thinks it's her fault for not resting more / eating differently / etc.

All I can ofer is hugs, I wish tehre was mroe I could do. The lady listed on this site Dawn James (her telephone number is there) is very learned and a great supporter who ahs been there herself hwoever, if that might help.

'Until midwives can safely perform emcs at home and there are no risks of something unexpected being detected or developing at birth, there is no way a home birth is as safe for baby as in a hospital.
'

Please tell me in what way trying to delvier a baby in hospital 30 minutes away whilst awaiitng the return of a DH a minimum of 30 minutes away would ahve been a safer alternative than a planned HB with MW in attendance when the predictable speed of labour was 35 minutes.

The only realistic alternative short of abandoning the boys alone (nope, social services wouldn't help- we asked) was either an unplanned HB, delivery on the road, or an induction I had already asked about and was told was unlikely to be performed for 'social reasons'.

Hospital delivery was not an option. The non existence of a HB system would have meant we could not have delvered ds4 with half the safety of teh birth he actually received.

Cases like mine are not common but theya ren't that rare either and a HB is standard advice here in those cases.

Sancymoany, you are talking about your very specific circumstances about your other dcs and dh. It does not change the risk profile of a home birth.

Yes it does

Precipitous births are nt uncommon

Even if Dh had bundled me into a car and driven me stright there I would not have amde it in time had it taken more than 5 monutes to get boys to childcare / collect bags: that factor is fairly usual fo0r anyone with another child. Even if MIL comes from 3 doors down.

In cases where precipitous labour is expected delviering with a planned HB and MW in attendance is a safer bet than delivering on a roadside or with an unplanned HB. There was nothing that could change those options for me, and similar stories appear on MN frequently enough- Baby's delviered in bathrooms , in cars etc: all known to be riskier than a planned HB.

The DH / boys situation complicated it (and in fact ds4 was born when DH was here having booked off the night before and after a sweep) but it didn;t change the basic logistics of precipitous labour.

Your circumstances were such that you were between a rock and a hard place and you chose the least offensive option.

It was not just precipitous labour. It was the fact of your other dcs and you had to rely on dh to arrive home first than before you could go to hospital.

It would take at least as long for a MW to come to you than for an ambulance to take you to the hospital.

The name emergency CS it misleading. Most of them are actually a CS performed after a complication with a labour in progress.

An emergency c/s regularly take 30 mins, if not more, from the decision made to do one to woman on in surgery.

Ample time to arrive at a hospital in an ambulance and then go straight to theatre.