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.

Blueshoes, I know that had I been in hospital with DS1, I would have had a section for Failure to Progress (24 hour labour compared to less than 6 for first baby.) As it was, I was at home, it was fine. There was have been no need. Just because hospitals perform 25 sections for every hundred women (and in the US that is more like 40) doesn't mean those women and babies needed them. Hospitals are also very good at making women believe they were saved from a dreadful experience, when hospital protocol may have actually contributed to, or even caused the emergency.

buzzing, my dd was born within 11 minutes of the decision to perform an emcs. It was under GA. She was whisked to NICU straightaway.

Luckily, I was in the hospital at the time.

Of course, you can say most situations would not require such speedy intervention. Low risk, perhaps, but severe consequences.

Bigweehag, I had earlier said that the hospital experience should be improved for women. That includes doing away with unnecessary protocols.

Which would make it safer- but currently, it is not safer than homebirth, they are equal in terms of outcome.

I wonder, as crash c/sections are supposed to be so incredibly rare, why there are so many of us who have had one on Mumsnet!

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

No, the MW's lived closer (there was one in the village that would have been called if needed also- my CM, it was in my notes

There's quite a few of us Riven.

TBH as long as peeople don't try and dicatte to otehr women I don't mind too much what othjer people think- their right to an opinion and all.

Would anyone be in actual favour of banning HB's? If not then it's not an issue is it?

Bigweehag, I am not sure what you mean by equal in terms of outcome. To who? Mother or baby or both? Not to baby, 3x higher risk of morbidity for HB, as per latest study (which I am willing to take with a pinch of salt as I do all studies).

It is not just the risk of the baby dying, it is also long term disability (sorry about your experience, Riven). How do you quantify how bad the outcome is?

I'm wondering, with the crash sections, how many people were left labouring, then checked and all systems go, or whether it was more gradual than that?

Those of you pointing out the rare events which require a crash caesarean are right. Uterine rupture, placental abruption are possibilities and they're pretty terrifying things to happen anywhere, let alone at home. You're right that they are best dealt with in hospital.

However on balance, hospitals cause a huge amount of problems that are very unlikely to occur in a home environment. Some of these cause only mild complications. But there are rare, catastrophic events more generally found in hospital such as MRSA, botched surgery, postsurgical blood clots, amniotic embolism, epidural reactions etc.

There is also a question of monitoring. Often women are left alone for longer periods in hospital meaning problems can go undetected. A woman left alone in hospital for half an hour may be in a worse position than a woman constantly attended at home who is 15 minutes from the hospital.

The point is both locations have their risks. You can die in either place, but of slightly different things. Thankfully the severe risks in either place are very rare but they do happen.

The research shows again and again that there is not really any difference in your or your baby's chance of dying in either place. The studies do however show that most women have fewer complications at home. So actually on a purely statistical view, the average woman would be safer picking a home birth.

Realistically, the only thing anyone can do is look at their own circumstances, their attitude to birth and their caregivers and decide which place suits them best and which set of risks is most acceptable to them.

Let's stop calling women who choose something different to us naive or foolish though.

I would be interested if a new study found the same elevated risk of mornidity in the UK (bearing in mind our different systems) and excluding all non [planned HB's; ideally one that included HB's against advice and one that did not.

Otherwise I simply stand as evidence that HB's should continue to exist as a best ase scenario option for women who are outside the box, even if people would prefer rnot to choose one themselves.

Blueshoes, there is no 'latest study' - the recent media scrum has been about a meta-analysis on existing data - much of which is decades old or was collected retrospectively. It also considers unassisted births to be home births. More here

A home birth IS as safe as a hospital birth for a baby. The largest, most controlled studies show this consistently.

Carmen, I make no comment on what you wrote on a statistical basis, as I have not gone into the studies in detail.

I will however assert that a home birth is NOT as safe as a hospital birth in the rare circumstance of a "uterine rupture, placental abruption" and any other reasons which necessitate a crash section and swift transfer to NICU/SCBU.

As I said before, low risk but potential for very severe consequences to the baby. It is fine to choose HB if based on an informed decision about this.

I do wonder whether or not I would have needed an ECS in different circumstances but I suppose I'll never really know.

When my waters broke it was just a trickle, the hospital said I was fine and sent me home. 24 hours later, I was still trickling at which point they put me on a monitor and said I was having contractions. That seemed bizarre to me as I couldn't feel a thing! They then decided the contractions weren't strong enough so stuck me on a drip and started to induce. They wanted me lying on the bed during this, as the monitoring equipment was plugged and said I wasn't able to walk around. I refused and pointed out a plug at the other side of the room which would let me wander fairly freely, so with much huffing and puffing, they relented.

I was left alone with DH for hours and coping brilliantly with just TENS and gas and air. The problem was my waters hadn't really broken properly, so DS was pushing up against a huge sac of water and getting nowhere.

Eventually a Dr was summoned, who burst my water sack (and filled his wellies in the process) but by this time both DS and myself were exhausted (or so they said). They were insisting I had an epidural and I refused time and again. I wonder if I had then I might have avoided the ECS? My fear was they wanted to cut me and use ventouse etc to hurry things along and I really didn't want that.

I might have been wrong, in hindsight, I guess I'll never know. It is something that haunts me. I do blame myself for DS's traumatic birth, the seperation we had to suffer through SCBU and my subsequent PND, difficulty bonding etc.

The monitoring point is very pertinent though. I do wonder that if water sac had addressed earlier, perhaps I might have delivered without any of the shit that happened.

Ultimately, I'm very grateful that DS is alive and well but I remain totally confused as to whether the hospital contributed to the problems or saved the day?

wubbly; the membranes thing sounds strange to me although I don't have any details to back it up and obviously every case can be different.

But when DD was born the membranes didn't burst till she was crowning. Head delivered, waters went fully, baby out with a bit of a gush that made her look really clean in comparison to pics of newborns I've seen.

I do know that having the intact membrane sac offers more protection to the cervix which means the cycle of pressure/oxytocin release/stronger contractions/more pressure isn't as obvious - perhaps why your contractions weren't noticable to you at first. I spent 3 days wandering about in early labour, noticable but only a few contractions strong enough to be seriously painful.

There are actually 2 layers of membrane, the outer bag can go while the inner bag remains intact. NICE guidelines suggest that if labour has not started within 24 of pre-labour rupture of membranes then induction can be appropriate. Without knowing the exact circumstances no-one but your care-givers can say - but I would question if they have the right implementation of the guidelines? If you were having contractions, then you had started labour. The fact it was a slow labour might not have been an indication that augmentation of labour with a drip was needed.

However - the NICE guidelines do say that if there is delay in the first stage of labour they should have offered to rupture the membranes BEFORE offering you the drip.
And of course - that only takes into account the medicalised idea that progress in labour occurs fairly uniformly when it doesn't always.

I don't know if that information helps you any?

blueshoes, most emc/s as you are aware, is not conducted under GA. most babies who are taken to NICU make full recovery. using some exceptions to prove your point is weakening yor argument.

have you been debriefed on the reasons behind your need for a crash section?

"I'm wondering, with the crash sections, how many people were left labouring, then checked and all systems go, or whether it was more gradual than that?"

this was certainly the scenario that evolved after I was blue lighted to hospital w/ PE. Midwives were complacent busy that night, pretty much ignored me and a few hrs later, they were 'saving' me from a set of circumstances which was slowly developing right there in hospital.

this incident doesn't mean that anyone ought to rate it more that my anecdotal but it left me with PTSD and PND for the first year of dd's life.

Thank you anastasia, that does help to make a little more sense of everything.

I think the argument for inducement was because my waters had been leaking for around 36 hours and they felt this might increase the risk of infection, does that sound feasible?

Having told me I was having contractions, they were also concerned that, after monitoring for sometime, that they weren't strong enough so again an argument for inducement I suppose.

The problems started once I was fully dilated and they wanted me on the bed in stirrups to be examined. At this point they established that the waters were trapped around DS's head. The Dr was called to burst the membranes and DS changed his mind and shot back inside. At this point they started pushing me to have an epidural but I didn't see the point and there was no explanation given as to how it would help.

The next thing the Dr popped his head back in and called for ECS. I understand that his heart rate was slowing and they told me later the cord was around his neck which might have caused him to retract back inside, but I think this was only established during the procedure.

It really doesn't matter now, I have a wonderful healthy little boy and that's what matters ultimately, I just wish I hadn't blamed myself for failing him during the birthing process.

Once pregnant though it's best to have an open mind as anything can happen. All the books I read always carried pictures and information about c sections, so although that would certainly not be on my wish list, it is something to mentally prepare for - on the opposite end of the spectrum though is precipitous birth, I never came across one single mention of it. Had I not a certain belief in HBs and knowledge of positive outcomes from it I might have panicked and things might have turned out differently for myself and ds.

A HB can happen even when it is not planned so it it best to be informed and open minded about them.

OP if you wish to be of support to your SIL, reads some books, check the link provided earlier. One thing that is clear from this thread when you look at everybodies experiences is that your SIL needs support and understanding now.

At least drop the 'bonkers' from your post.

YABU. You have to fulfil a lot of criteria to be a allowed a home birth. We had two lots of questioning, where we had to fulfil each condition. Then had to agree to come into hospital if anything in a long, long list happened. The midwife went through everything in detail.

Buzzing, I have made it clear that the circumstances of a true crash cs are rare. I have stated it as it is.

You on the other hand are determined to paint me as clutching at straws. That I would call denial. If you decided to have a HB without considering all the risks, then I feel sorry for you and your baby.

I am considering a homebirth, this is my first pregnancy and I will be 39 when it happens (assuming pregnancy proceeds well).

One of the reasons is that I attended the birth of my godchild, and the mother was frequently abandoned by the midwives ; she had her pain dismissed by midwives ("people feel pain differently"); they didn't realise she was in established labour until staff changeover, and nor did they realise how close she was to birth, as MW was off 'doing paperwork' as she snapped at me when I called for her, saying my friend desperate to push. They didn't monitor the baby, even though labour was induced. My god daughter has significant learning difficulties and will probably never lead an independent life.

I live less than a mile from my hospital, and I would like a midwife present and totally focussed on me throughout my labour, not dealing with paperwork or other people. My local hospital has a higher than average percentage of emergency ceasarians, so I need to bear that in mind when deciding.

I haven't made my mind up yet, but for me it will be what I think is safest for me and the baby; whether I have faith in my London hospital having sufficient staffing and not whether I would prefer to have someone else to blame (ie hospital) if something goes wrong, rather than blaming myself if something went wrong at home.