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...

wow this has turned very negative!

Yes there are deaths both at home and hospital. There are also benefits from both and many happy stories of both.

You need to do what you really want to do. Tell your dp to chat to your midwife about home births, mine did and he was very much reassured. I've had two and looking forward to another in March.

My first was a hospital birth and we had one midwife shared around several women.

My home births have been attended by 2 midwives, one also had a student. They carry the necessary resuc equipment, and like others have said the journey to hospital if needed could be the same as waiting for a surgeon to become available for you in hospital.

There are studies to show and my births are agreeable, that a woman has a higher chance of labouring naturally at home. Stepping into a clinical environment like a hospital can and is often enough to slow down contractions. My babies have all been born within a couple of hours at home, and i truly believe if i'd had to make a car journey and settle into hospital the whole thing could've taken longer.

My personal reason for home birth, as well as the comfort of your own home, is that i'm well away from unnecessary intervention which hospitals can all too quickly use as soon as birh isn't following the text book.

Best of luck whatever you choose x

Yes, there are risks with both options. Yes, there are have been flawed studies published on both sides of the debate.

dikkertjedap correctly identifies one flaw in certain data sets. In certain other data sets which were alleged to demonstrate the greater safety of hospital births, unplanned and/or unassisted home births were included in the homebirth category. Sometimes on both sides of the debate researchers seem to start out with a prejudice and cherry pick or massage the data to support it.

Recent studies which show the same risk of perinatal death for home and hospital births, compare planned rather than actual place of birth. This means that homebirths which transfer to hospital are still considered as homebirths, and accidental homebirths are not.

"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."

Surely this cannot be the case? And if it is, it's just terrible planning. In most countries (including this one) the hospital team would know that a woman was being transferred and be ready for her as soon as she arrived. In fact, isn't the ambulance service usually informed about home births, so they'll know in advance that one might be needed?

I think it depends on where you live in the Netherlands. When my friend was transferred (she lives very close to a reasonably big regional hospital), she was transferred on a Saturday night (around 3.00h) when she arrived there wasn't a team present to carry out the emergency CS because there was only one anaesthetist and she was in another operating theatre. She had to wait over half a hour before they located another anaesthetist. There have been very big changes in the Dutch health care system during the last 10 years. I think that it used to be one of the best.

Surely only one anaesthetist would be a problem regardless of whether you transferred from home or were already at the hospital?

Just found this page and thought of this thread. Its well summarised at the end of the article.

Some of the conclusions are a bit bizarre though:

"babies born at home were less likely to be premature, less likely to be of low birthweight, and less likely to require assisted ventilation."

Hang on, this makes it sound as if you go into premature labour because you are already at hospital (for some other reason, presumably). Surely the only reason to be at hospital is because you are either in labour or have serious health concerns (which may then cause premature labour)? Healthy women do not spend their entire pregnancies at the hospital and then go into labour in week 35 from the stress of it. In other words, there is no way you could say hospitals are a causal factor in premature labour. Any more than you can say that A&E cause broken bones.

Same with low birthweight: if the baby is known to be IUGR, you are far more likely to be encouraged to have a hospital birth and quite likely to be induced before your due date.

It is well known that hospitals may contribute to more intervention in labour- but how to premature labour? By that stage, unless there is a problem, you are nowhere near the hospital.

That is a bizarre conclusion, agreed.

What really stood out for me was:

"It is also important to highlight that when the analysis only looked at homebirths that had been attended by a certified midwife, there was no difference in risk of neonatal mortality compared to hospital births."

Well, obviously! I dare say that if you gave birth in a room in hospital with no qualified midwife present, there would be a greater risk.

So, they should be reporting that unattended homebirths carry a greater risk of neonatal mortality, right? Bad reporting all round, I think.

The inclusion of US data in any study is a bit of a red light for me in terms of its relevance to pregnancy and birth in Europe.

In a number of US states, midwifery is illegal and/or not integrated with the regular health infrastructure. This means that studies which consist of cross-US data often include cases from states where midwives are operating illegally, without qualifications, without medical back-up or all three. In some of these states the perinatal death rate is around 6 times higher than in hospital.

It annoys me that the NHS site describes this as a "high-quality" study. No, it isn't. It's mixing eggs and cabbages by amalgamating data from countries with incomparably different maternal health and birth support systems. But you need to read the whole study and know something of the background to the data to see this.

"Hang on, this makes it sound as if you go into premature labour because you are already at hospital"

I suppose the number of premature babies being born is increased by things like routine induction at 40wks+10 (where in fact they may have the dates wrong), or induction because of expecting a large baby (with scans being so unreliable for sizing).
Homebirthers may be slightly more resistant to hospital pressure on induction (partly because they wanted to avoid going to hospital at all, so are more likely to question the advice).

n the Uk homebirths are just as safe for baby and mother. if you are giving birth in the UK - that is what you need to consider.

also, aside from mortality, mothers are less likely to experience brthing injuries.

if you consider that epidurals, forceps & c/s all come with risks, the fact fewer people will have these if they commence a planned HB (where these things are less likely to end up being used)shows you why the stats are equal. Also HBs progress faster - so less chance of mother becoming exhausted.

I know a lady who gave birth in hospital to a baby that wasn't breathing - but unattended, the MWs had left her to labour alone. she'd have been better off at home, with the MW there, rather than waiting 2 minutes for them to come back, resuscitate the baby and then having an ambulance transfer anyway (to hospital with SCBU). Such anecdotes flesh out the stats - HBs really aren't more dangerous at all.

I just think that in any case no matter what you would have preferred, you just can't plan anything. Things can go wrong anywhere at anytime, for example you could be 36 weeks and at the supermarket, something might happen that would need a 20 min ambulance transfer to a hospital, even if you were planning a normal hospital birth.
You don't know how long your labour will take, how much pain relief you'll want, which week you'll be in, and even low risk could suddenly turn high risk.
I think statistics show a lot, and personal stories are more likely to sway you either way but don't necessarily show a broad enough picture.
Go with what you think you'll be most comfortable with, whether it's a gut feeling or a practical decision.
You can always plan and book a homebirth then change your mind at the last minute and go for a hospital birth, but you can't vice versa.

Hi, your thread has been very interesting, and has really made me consider a home waterbirth. It would be my first baby. Just out of curiosity, what have you decided?

Riven, wasn't your homebirth a VBAC? Wouldn't the OP be facing a different set of risks?

OP - the Royal College of Gynaecologists and the Royal College of Midwives have released a joint statement in which they say that homebirth is as safe as hospital birth for low risk mothers and that it may confer 'significant benefits'.

As HairyMelons says - you have a different set of risks at both home and hospital. There are babies born at home who would have been better off born in hospital and vice-versa.

"It's not a risk I would be prepared to take. Obviously it would make for a nicer birth experience"

Those of us who have opted for a homebirth felt we weren't taking any additional unnecessary risks with our babies, which is why we were happy to go birth out of hospitals. In my case I chose a homebirth because I actually felt it was safer for me and my baby. I know many other women who've chosen to have their babies at home for the same reason. TBH it's a bit upsetting hearing that people think that we're willing to put our babies at risk in order to have a 'nice experience'.

"babies born at home were less likely to be premature, less likely to be of low birthweight, and less likely to require assisted ventilation."

Unless of course they are comparing groups in terms of intention to give birth at home/hospital. Many studies do this. So some mums who book a homebirth will transfer to hospital care - some before labour because of health problems cropping up at the end of pregnancy. The babies born in hospital whose mothers had originally booked homebirths are often included in the 'homebirth' arm of the study. If you compared outcomes for babies born after planned hospital births with babies born after planned homebirths I think the lower rates of prematurity and IUG in the homebirth arm might be connected to the fact that women who book homebirths are more likely to have care from a midwife they know THROUGHOUT PREGNANCY, where-ever they give birth and it's this that makes a difference to their likelihood of going into labour early and having SFGA baby.

Wow! I didn't expect this thread to have so many comments and some very strong opinions too. I think it has been quite a negative response and it's made me feel a bit scared to be honest!! I haven't made a decision yet, will speak to my MW when I see her end of this month.

We had DS2 at home in pool on front room watching Dirty Dancing!! Very relaxed and easy!!

Also, had 2 midwives in attendance whereas in hospital with DS1 we were ignored completely. I nearly delivered on the loo (!) and only had one midwife in the room!

DH also found that being at home meant he could keep busy and therefore more relaxed.

Not planning any more but if we were, home water birth each time!! Would recommend birth pool on a box!

Good luck x

here

For anyone who'd like to read a comprehensive review of the evidence on the safety of planned homebirth - the paper is listed about halfway down the page.

Whoops sorry, it's the third paper in.