To have a home birth??

[sarinha2203]

I am six months pregnant with my fourth baby. I would love to be able to birth to my baby at home but not sure of the risks if any? I have never met anyone who has had a homebirth.

I have not yet discussed this with DH but I have a feeling he will be against it...

A planned homebirth for a low risk pregnancy is just as safe as hospital. www.homebirth.org.uk is a great site. I've had 2 hoebirths, both fab :)

yes yes yes yes yes - have it at home

How close are you to a hospital if you needed/wanted to transfer in?

I have had 2 homebirths. I have never given birth with a hoe or any other garden implement.

I'm pregnant with my fourth too, and finally having a homebirth! Yay! Assuming all goes well, of course. Given that you have had three already, if all those labours and deliveries were normal, then you should be considered very low "risk" for a homebirth. My husband was pretty concerned at first when we discussed having a homebirth, but after discussing all the in and outs of it with the midwife he is supportive of my desire to stay home with this one. If you're worried he won't be supportive, do lots of reading first before discussing it with him so you can be armed with some facts and stats. Have you discussed it with your midwife yet? Some are more supportive than others and if your midwife is keen on homebirths she may well be able to reassure your DH...

"I have never given birth with a hoe or any other garden implement."

Thank goodness for that! Could have made for an interesting thread, albeit off topic somewhat...

LOL Indith!

sarinha, if you think your DH will be against it, could you bring him to an antenatal appt and get your midwife to have a chat with him about it? I think a lot of dads fear HB because it's unknown to them. Hearing from a professional that you're not some crazy lady putting yourself and your baby in danger might be just what he needs.

Oh, cross posted with sarahbuff.

oh if I manage to sleep tonight I'm going to have nightmares about babies been born with hoes and gardening implements - although I guess for an avid gardener it could be considered an option

I seem to be incapable of using bold to correct mistakes. Ignore me, having a bad day!

My dh was a bit concerned at first but the statistics speak for themselves really and it was just so lovely to not have to go to hospital and then snuggle up together in bed rather than being separated.

LOL Indith Sarahbluff AND mamottat!!

Very interesting feedback so far...

I have just briefly and casually mentioned it to DH when he phoned me and he said "are you??? you're mad!" lol

Buy him "Fathers homebirth handbook" by Leah Hazard, and make him read that and both have a read of the homebirth ref site if you've not seen it already.

Homebirth can be great for dads as they are on home ground and generally have more to do, less likely to feel like a spare part.

The risks of bad outcomes in the UK are still deemed to be even for home and hospital. The biggest difference is with interventions - hospital birthers are twice as likely to end up with a CS according to one study. Homebirth is a very good choice if you are "low risk" and are up for it.

A lot of people are conditioned from a young age into thinking birth is a dangerous business which would be scary to contemplate doing outside of a hospital. The stats say otherwise, but it can be difficult to change peoples' gut feelings about it, so be prepared for people you know to be negative about it.

Thanks everyone for your comments. I have been doing a bit of reading and am still keen on a HB. DH is not as keen as me but he said we will discuss it in more detail and that it's something to think about. So not a definite "no" as I expected from him.

Moonunitalpha - it would take about 20 mins to get to nearest hospital.

I don't think it is just the time it takes to be transferred, it is whether there is a team ready to help you as well, so it can be a lot longer than 20 minutes. I always wanted a home birth but right before giving birth (luckily) decided against it based on second opinion of independent consultant. I think that my dd would have died if I had had a home birth. Please realise, Netherlands has one of the highest homebirth rates and also the highest infant mortality rate in the Western world (there is a big review going on at the moment) and all these women were supposedly low risk with hospitals truly close, still did not help their babies when it went wrong. I have come to the view that what really matters is a healthy baby and that the rest is nice to have but not essential.

I had lunch with a friend who is a neonatal paediatrician today. She said she would never have a home birth, that people all believe that if things go wrong it will happen slowly and there will
be time to get to hospital and that whilst that's true for ae things it's total rubbish in relation to other problems, and that unless you live next to a hospital you are taking a risk with your baby's life. She was preaching to the choir with me, we have friends whose baby died after a failed home birth last year, so I would never have gone down that route anyway. My friends' story isn't for me to recount online but the extensive inquiry afterwards confirmed that there would have been a good chance of saving their daughter if they had been in hospital when her acute distress was spotted, rather than at home.

sarinha - I doubt it would even take that long if you were to be blue lighted there. It was 20 minutes for us in the car.

You have to remember of course that sadly babies die in botched (and even not botched - just very sad circumstances) hospital births too.

dikkertjedap: Yes, Netherlands has one of the highest homebirth rates and also the highest perinatal mortality rate in Europe. However, this doesn't mean that one causes the other. Statistical analysis of data for home and hospital birth in the Netherlands actually showed no difference in perinatal death risk between home and hospital as planned place of birth. It will be interesting to see the results of the review mentioned and whether it pinpoints any likely causes of the high perinatal death rate.

Being in hospital for birth in the UK doesn't guarantee instant action on problems as many people imagine.

In terms of 1:1 care, monitoring and quick initiation of emergency action, you may actually be at least as well off at home.

Bear in mind that in a hospital setting, the same midwife may be splitting her attention between 4-5 other women at the same time as you, making it easier to miss potential problems. At home you will have the full attention of a midwife who can raise the alarm immediately if necessary.

Also remember that there isn't a 24 hour operating theatre on standby in every maternity unit, especially not for those catering for low risk births. At night there doesn't even have to be a consultant ob on the premises. (Interestingly, a recent study highlighted the increase in negative birth outcomes at night. This is one of the possible influencing factors.)

If a midwife at home recognises a problem which needs emergency medical attention, she phones in and the hospital can begin preparing while you are in transit.

In the event that you move from a low risk labour to an emergency situation at night in hospital, the on-call ob (and potentially the surgical team) would have to be brought in.

RCOG recommends that EMCS are carried out within 30 mins but many do not meet this target. You can see how this might happen in either hospital or home situations.

EmmaKateWH: anecdotal evidence is interesting but isn't the same thing as fact or logic.

I know someone whose baby died at birth in hospital a few weeks ago. This doesn't make hospital birth unsafe. It was a tragic accident (an infection wasn't spotted).

I also have a consultant friend who specialises in critical neonatal care. Like your friend, she would never have a homebirth ina a million years. However, she also admits that this is because she is influenced at a human level by the awful cases she has seen. She does not have access to any additional evidence or data which supports her position. It's all subjective. Having a medical title and a white coat doesn't turn someone into an oracle.

I was at a lovely home birth this evening. My client had a traumatic birth in hospital with her first. After giving birth in the pool, she was snuggled up on the sofa with her husband, having a glass of champagne while I cooked a casserole.
Her baby was breastfeeding (last time she had lots of problems with this) and she was relaxed and laughing and proud of herself.
Selina x

Interesting point you raised, togarama, that neonatal paeds in particular generally only become involved in cases where something has gone wrong during labour and/or birth, and so the vast majority of their work is dealing with difficult and potentially tragic circumstances. Those cases are a tiny minority of the total number of healthy normal births that occur each day, so these health professionals will understandably be influenced to see birth as potentially dangerous and therefore be inclined to have a bias towards hospital births. On the flipside, if you speak to an experienced community midwife who has attended a high number of homebirths, she will undoubtedly be supportive of homebirth although aware of the risks and possible need to transfer to hospital. Another thing to point out is that although the current statistic for first time mothers planning a homebirths that end in transfer to hospital is something like 40% (I think), most of those cases are because Mum needs more pain relief (i.e. epidural or pethidine). Or because the labour is long and non-progressive and the midwife feels that there might be some underlying reason and Mum and baby would be safer in hospital. It is important to remember that midwives are health professionals, and their ultimate goal is always a healthy birth whatever the cost, not a homebirth whatever the cost. Another thing that makes me feel a little bit safer at home is that midwives attending homebirths have to be above a certain level of experience, so are likely to be more competent than many on the labour wards. My first baby was delivered by a student midwife who had not yet qualified! Given that she walked in the room as his head was crowning and is pulling on her gloves telling me this, and was that ok, it seemed a bit late to say no thanks could you send someone else! In the end it was fine, except that the first push when I thought I was pushing out a baby was to break my waters since she was too nervous to nick them with his head just underneath. That was less than entirely pleasant...

Riven - it's 20 minutes in the car driving at normal speeds. We do have an ambulance station in this town (just no A&E or Maternity) so it doesn't have to come all the way from the hospital and get back again.

I was left for well over 1/2hr on my own when I was having an induced VBAC with DS2 (at the hospital Sarinha could end up at). But in those long periods during my VBAC anything could have happened. Especially as my pain relief wasn't working so whn they ^were/6 in the room they were asking questions to determine whether it wass a rupture or not (And then buggered off and left me again)

DS3's birth I had someone with me almost all the time - but it was exceptionally quiet on the ward that day so I got lucky.

Riven - I hope you know that my post wasn't a dig at you???? I know there are two sides - and I did say to Sarinha that she'd get the good and the bad.

It's not a risk I would be prepared to take. Obviously it would make for a nicer birth experience, but what if I turned out to be one of a tiny minority like Riven or our friends for whom it all goes wrong? Your baby can get a hypoxic brain injury in a lot less than 20 mins. I think it's way too big a risk to take.

It's not risk-free having a home birth, it's just a different set of risks. OP, check out the homebirth website linked to above and read the research papers on the various risk factors.

Overall, infant and maternal mortality rates aren't any higher for home births but there are a couple of circumstances in which you would be better off in hospital. There are also reasons why you may be better off at home.

My Dsis is a paediatrician and is terrified of having a baby full stop because of the terrible things she has seen at work. She knows she has been influenced by this (who wouldn't be?) but can't shake the idea that having a baby is a terribly dangerous thing to do.

I've decided to have a homebirth because I believe it's a good, safe choice for me. You do need to have your eyes open about what can go wrong though because sadly things sometimes do.

In the Netherlands women were always told that having a homebirth was as safe as going to hospital, however, what until very recently nobody had realised was that it was based on totally flawed figures:

• if a baby was still born at home it was usually not registered as a paediatric death in the homebirth category as it was only officially labelled a still born once they arrived in hospital and hence recorded as a hospital stillborn
• similarly if there were complications during homebirth and the woman was transferred to hospital and the baby later died it was recorded as a death in the hospital birth category and not homebirth
• as a result for many years (until now) many deaths had been recorded in the hospital birth category rather than the homebirth category, this is now corrected, and the figures are now bleak for homebirths. this is a huge issue, because it means that women have been given misleading information to base their decisions on for years. Many women might have made different decisions (possibly saving their baby) if they had known this. So politically this is a bomb.

Furthermore, in the review what is now going on there is a big issue with how women are being classified as low risk, medium risk etc. Doctors are pointing out that this is just not possible to do in a reliable way. You can be low risk when going in labour and then suddenly something happens and you swing to very high risk. The only blessing in the Netherlands is that hospitals are very close. But this problem is that if they are not expecting someone to come in they might not have a team ready when you need them. They are now thinking whether it makes sense to only have a few number of hospitals to transfer women to with fully equipped teams on call 7 days a week 24 hours, but this would mean that transferral takes longer.

Now, with the benefit of hindsight, I cannot even imagine why I wanted a homebirth (and spend lots of money on homebirth classes, a pool, etc etc) in the first place. I really believe that what matters is a healthy baby and a healthy mother and although hospitals are not nice places to be, I do think they increase the chance of a good outcome. But this is just my personal view of course.