Your thoughts on home birth after a bleed at 36 weeks...

[victoriasmith]

Hello

Would just like to know what people think about my situation and whether any of you have had similar experiences. I really would rather not hear negative comments please from people who are against home birth any way though, thank you.

This is my first child and from the beginning of my pregnancy I have been planning for a water birth at home. However at 36 weeks (this monday) I woke to find I was bleeding and was admitted to hospital over night. After being scared to death by one consultant in particular who immediately began talking about us having the baby in the next 48 hours as they would need to induce me and the possibility of a c-section as well, we saw another consultant who reassured us, did an ultrasound scan to check the placenta which was fine, monitored the baby who was fine, and admitted me over night until the bleeding stopped. Overnight the bleeding stopped and by the morning the consultant was happy to discharge me, but not before telling me that a home birth should not be an option any more which was also plastered all over my notes, the usual "advised against home birth". I am having another scan at 38 weeks to check everything is fine and then going to full term but having my sweep a little earlier at 39 weeks dead on to try and get me going into labout a bit before 40 + weeks. The consultant also said they would want to induce me should I get to 40 weeks but to be honest I have instantly discounted this as it seems ridiculous.

In all my boyfriend and I were left slightly traumatised after this experience and it has taken me a long time to calm down. I am not wanting to take unnecessary risks with the health of my child but am also not willing to give up on my dream of a home birth as I feel the stress that I would be under should I go into hospital would affect my labour.

I am seeing my midwife to discuss our options with her next week but would like to hear if anyone else has experienced anything similar.

Apparently if I had had the bleed earlier in my pregnancy then by this point I would still be considered low risk and "allowed" a home birth. I know the decision is ultimately mine and that the NHS have to provide care at home if this is what I choose, I also know that the instant anything happens hospital staff almost have to suggest against a homebirth which is making it very difficult for us to trust anything the midwives and consultants are saying to us.

How much blood did you lose and what is the cause?

What caused the bleed?

From a non-medical point of view - I wouldn't have the sweep. If you're not ready for labour it won't do anything anyway (and if you are ready for labour, it'll happen on its own) and I would be interested to know if the chance of a recurrence of the bleeding would be higher if you had a sweep?

I'd wait for the scan and chat to your MW again. Of course, hospital birth DOES carry a set of risks of it's own (cascade of intervention, babies not being aware they should perform to a timetable etc) but if you're deemed high risk then you should seriously consider it (and I was DESPERATE for a homebirth and devastated that ended up with an induction in hospital)

How far away from the hospital are you? If you're reasonably close then you could always see what happens at the start of labour, and transfer at the sign of any unusual bleeding?

I would want to know the reason - if they found one.
Was it provoked? (as in sex)!
Does the scan show the placenta is ok?

I cant understand why your consultant would want to induce you at 40 weeks either - what reason did he give?
If he was that worried about the bleeding, then he should have induced you then. (or keep you in to monitor)

Hmm...what a shame. I have not experienced what you have but have been involved in a legal case that had similarities (day job!).

Have you tried to Google 'bleeding in pregnancy research'. It always helps to see where the health professionals are coming from then you can make a really informed decision.

I looked on the NICE guidelines for you to see what it says. (NICE isn't anti home birth - pretty evidene based and unbiased). It says women with causes of bleeding like placenta praevia, pregnancy induced hypertension, placental abruption,recurrent antepartum haemorrhage should all give birth in a consultant unit but a single episode after 24 weeks of unknown origin is not an absolute indication but requires individual assessment when planning where to have the baby. I suppose you need to find out what condition they suspect has caused the bleeding.

Might be a silly idea but have you tried one of those decison trees where you write down or think of all the best and worst outcomes if you took the hospital route or the home birth one? I always think that helps me to focus on what is really important - I don't know if it might work for you.

It might help to wait a few days as well because you've had a bit of an upsetting shock and sometimes you need a bit of time to mull it over.

As you say, the most important thing is that you and the baby are ok. Ultimately, the decision is yours - I really hope it goes well for you.

I don't know whether this will help (and sorry of it is not positive enough for you) but here goes:

With my DC1 I had had some bleeding very early in pregnancy. I wanted a homebirth and so at 36 weeks I was at the hospital waiting to see the consultant so I could be "signed off" as suitable.

I started bleeding in the waiting room. Not much but enough for the consultant to ask me to go straight up to labour ward. There I was examined, the bleeding was not heavy (period like I suppose) and I was scanned and they could find no reason for the bleed. However my consultant was cautious and I was induced.

Following my DD's delivery I had a massive PPH. I only survived because of the expertise of the senior MW who recognised what was going on early enough and teh Drs that were immediately on hand.

It was very frightening. The Drs never discovered the cause of the bleeding and whilst I was disappointed not to have a homebirth I know absolutely we were in the right place.

Hi - hope you're feeling better, just wanted to add my own experience, absolutely in no way negative, just honest and supportive!

I was due to have a water birth at home with my first - went into labour two days before I was due and all seemed fine. But after 16 hours I had a massive bleed (I thought my waters had broken, there was a literal 'pop'!) and had only progressed to 1cm, so midwife felt it was best to go in.

TBH, I was very pleased I did. Everything suddenly got very, very painful and they midwife seemed to think the baby had turned back to back. There was no way I could have handled that at home, and I needed an epidural very quickly. Long story short - 36 hours later and at barely 8cm I had to have an ECS. Am cool with it, our babies come the way they come!

Please, please do not think I am implying that this will happen to you, I am honestly not trying to scare you - I was so set on having a home birth, and I think they are incredible, I think I'm just saying don't write off having to go in - I had no idea there was was so much post-natal care and advice to consider, I don't think I would have had any where near that amount of help if at home.

I'm with Fliss - start at home and see how you go, but from someone who started at home and then transferred, it was actually a really lovely, positive experience!!

Wishing you lots of luck and love!

I'm a massive fan of HBs, but I'd be considering going in a likely option given its a bleed so late in pregnancy. Unless they can catagorically tell you what it was and why, I think you really should consider other options I'm afraid.

Make sure your midwife knows how much you want to give birth in a home environment. What facilities can they offer you? Is there a birthing suite which can provide you with more relaxed, comfortable surroundings? What can you bring in, and all being well, how soon can you get out?

Without wanting to sound negative, you kind of have to trust either the midwives or the consultant. A hospital birth isn't a negative experience, and you have time to get your head around that.

My first was a hospital birth, I was very clued up, had excellent birthing partners and was very sure I did not want to be on the hospital conveyor belt of intervention ("two hours pushing, MsOFFS, time for the forceps"). I had a really, really good birth because of this, and it paved the way for three subsequent homebirths.

Speak to your MW, explore your options fully and keep an open mind. Be prepared to do whatever is necessary to get your baby into the World safetly, and don't beat yourself up if its not exactly as you dreamed it would be.
Good luck

Can I just say, I am not advising you to stay at home and see how you get on, merely suggesting it as something you might feel comfortable with rather than agreeing out and out to go to hospital straight away!

Nancy - I had a pph after dd3. Nothing as scary as you but I remember the sound of the blood pouring out of me (sorry folks) and dh goes a funny colour when it's mentioned and it has made me more cautious about homebirth if contraindicated. So often we don't know why women bleed and we don't know they will (I had no problems with either of my other births or antenatally). I was in hospital and went home after a few hours, had I been at home I damn well I would have ended up there anyway after that!

For me, it wouldn't be worth the risk, so I would probably go into hospital. I had bleeding on and off through my entire pregnancy and suffered with really bad blood loss after my EMCS.

Being comfortable during labour etc is important but being somewhere with emergency help seconds away is more important if there are risk factors, in my opinion. Labour and birth really are such a small part of being a mother (for me, I know they can have a big impact on some) that I would personally take the opinion of the qualified consultant who I would generally assume is best placed to judge the risks.

northern It is 6+ years since DD's birth, we're about to have DC4, and DH still can't talk about her arrival.

I think what was most frightening is that before DD was delivered (even whilst in labour) I wasn't showing any signs of being unwell and the fact that I had been scanned was sort of reassuring: You assume (or at least I did) that if there is no reason for the bleed then it can't be anything serious.

Oh and I am really pro HB and would love to have one, I just think it's also important to remember that the 1000 years these docs spend at med school do teach them some pretty important stuff!

I'd have loved a homebirth, and am still very pro them, but after we lost our first baby (anencephaly) I was too paranoid throughout the pg to contemplate not being in hospital - I also thought I'd find the hospital environment stressful and difficult, but wanted to reassure you that it can, in fact, be really lovely and supportive, so that if you do have to go down that route, the birth of your child can still be a really lovely experience in hospital.

A friend of mine had a massive PPH after her first baby (was just fine after 2nd one) - her partner said he'd never seen so much blood. And he's a GP!

Anyway, OP, what I'm saying is that I do sympathise - I was born at home and imagined that my children would arrive in the same way. But if my rather complicated pregnancy history has taught me anything, it's that things can still turn out wonderfully in the end, even if you have to say goodbye to many of your original plans and dreams.

After having two children and two not so ideal births I would like to share my experience with you:-

• After you have had your child, whether you had a homebirth or not will not seem important anymore.

• The important thing is that you are not so traumatised by your birth experience that it puts you off having another one (I am sure a homebirth going wrong can be just as awful as a hospital birth).

• Starting labour at home and taking a wait and see approach could be an option I take it?

• Lastly, hospitals talk a lot but when it comes down to it they are usually so busy that half the things they say in the appointments are ignored when you are actually in hospital. With DS2 I ended up having the birth mostly as I wanted because the medical staff didn't believe I was in labour (even though my contractions were 3 minutes apart).

I'm sorry that you have had to re-evaluate your plans. I'm not in your position, but know how it feels not to get the birth you've planned for with your first. If you've gone down the NCT / natural birth / yoga type route (which I very much had with DC1) it is easy to get seduced by the idea of a lovely home / natural birth. In my experience, some of these organisations have quite a "them and us" approach to the medical profession as well, and can lead you to believe that consultants / hospital midwives will try their hardest to scupper your plans for a gentle delivery and medicalise your birth without justification.

In reality, most consultants will recommend what they feel is the safest course of action. You should feel free to really question them as to what they are suggesting and why, and make sure it is fully explained to you. Personally though, both with regard to DC1's birth and in my current pregnancy, I have had to accept that, ultimately, consultants are experts in their field, who are very unlikely to be suggesting something which will leave you / your baby at risk. Other organisations are not so expert / give more general advice which is not tailored to individuals.

I am now heading for c-section number 2, which is so far away from the water birth I'd planned for DC1, but at the end of the day, I just want my children to get here safely, and know that I would find it very hard to live with if I went against medical advice and something went wrong.

If you do opt for a hospital birth, as other have suggested, there are lots of ways of making it nice. And once you have your baby, you are unlikely to 'miss' the homebirth that you'd wanted to have.

Is there any possibility of getting another referral to a consultant who is known to be more sympathetic to home births? They do exist. That way, if he or she recommended hospital you would know that you really did need to be in hospital.

thanks everyone for all your replies, it's good to get such a wide and varied range of opinions.

In response to a few particular questions.

1. The placenta was fine and not abrupted.

1. Cause of bleed was never established (we hadn't had sex either)

1. The hospital put in my notes that I lost 200ml or lesss of blood, however much it was it was enough to get down to my toes and all over the floor, but then spilt liquid can look a lot more than it really is.

1. Hospital is roughly 1 mile away only 5 mins in a car.

Flisspaps that is really interesting what you say about the sweep inducing more bleeding we hadn't even thought of that and I will definitely bring it up with my midwife.

Ushy thankyou for looking up the NICE guidelines that was great of you, will take a look at them and see whether there is any research about all this.

I do think that seeing how we go at home would be a good place to start and then transfering in if necessary. I still don't understand why if the hospital are so concerned about me bleeding out then why they are ok with me labouring at home but would then have to come in to hospital to deliver, surely if it really was that risky they would be recommmending I go running into hospital at the first sign of contractions??????

How can they tell it wasn't a minor abruption? You can't tell from the scans.

The trouble is if you have a haemorrhage then being a mile away from the hospital is unlikely to save you. Sorry to be blunt about it.

In your situation, late bleeding, first birth I would definitely go to hospital. There are some things worth taking a risk for and some not. I would take this as a sign that a home birth is not right for this pregnancy.

And I say that as someone who had her last two children in a birthing pool at home (first two in hospital)

To add my experience - no idea how helpful or not this will be I bled - at low levels - throughout both my pgs.Bleeding was finally diagnosed as cervical erosion (benign & very common)

With ds, my first, he arrived at 36 weeks (all fine, 36 weeks onwards is pretty low risk).
With dd I planned a hb, and my mw was very supportive (despite ongoing low level bleeds again through this pg). But after a couple of days of low level contractions just after 40 weeks, I had a sudden bleed - similar to your experience, a real gush down my legs (sorry if tmi!). Rang the hospital, who said I had to come in.
I ended up having the midwife who had been on call to come out to my hb over the last two nights, so knew what I had wanted. She was completely supportive, and although I gave birth in the hospital, she really let me stay in complete control, and it was the most amazing birth - very fast, very easy.

So, I just wanted to say, don't feel that if you end up going into hospital things have to totally change - you can still be in control and working towards the birth you want (events may conspire against you, of course, but I think feeling like it's still possible is important)

HTH - and good luck for the birth!

I think the reason that the labouring at home is considered acceptable is because most bleeding occurs pp.

I have to add that 5 minutes would have been about 4 minutes too long to save me. Sorry I thought long and hard about posting that but I think you need perspective of what 5 minutes means in those circumstances.

Things happened very quickly. Within seconds of her being delivered I was losing blood, within less than a minute my body was in shock.

Because of circumstances I already had a canula in my arm and hand so was given blood and saline within minutes.

Yes that's the trouble with PPH or placental abruption if it turns bad then it happens very, very quickly. As Nancy says it is most likely that you'll bleed post partum.

Doe your hospital have a bith centre as well as labour ward? Could you push to labour at home, transfer in for delivery andthen if everything is ok get home within 6 hours?

you need to go back and speak to more people tbh because it sounds like you haven't had the reasons for the recommendations explained to you - and you can't make an informed decision without all the facts.
you can ask to speak to the head of midwifery - they are usually very approachable and helpful - as well as the consultant/s. be aware of the difference between the registrar/recently qualified doctor and the senior consultant - usually the more recently qualified doctors will take the option with least chance of them being sued afterwards (imo) - they won't take any chances of their career being wrecked by a decision they might not feel qualified to make - agreeing a hb is always going to put them out on a limb. so imo you need to get the opinion of the people with the most experience and find out why they make their recommendations before you decide what you are going to do

I think you need more information. My placenta was scanned and was fine after a bleed. the scan was however wrong and I did have an abruption. At least ask what the false negative rate of the particular scan is. In my case it was an eye watering 50%

Will definitely ask about the false negative of the scan for the placenta, would be good to know.

Does any one know anything about the risks of PPH for "normal" low risk home births anyway? And what the midwives procedure would be, ie. what could they do to help? I will ofcourse ask my midwife these questions as well when i see her next week.

again thankyou to everyone posting on here it really is very helpful.