To home birth or not to home birth?

[Buranda]

Hello all,
I realise there are several posts out there regarding this subject, but I was wondering if there were any women who are due or have just had a home birth and what their experiences were.
I'm currently 32+5 weeks with my first baby and still have 3 weeks to go until I discuss my birth plan with the midwife (who is based in Wandsworth south London). So I'm not sure if I can definitely have one yet.
I've just completed a hypnobirthing course, am practising my relaxation techniques, am really looking forward to meeting the little one and quite relaxed about it all - for now!
I am really keen on the idea of a home birth, mainly because I want to be in my own surroundings, want a water birth, which St George's cannot guarantee, and have the attention of two midwives.
The only slight niggles are things like, will there be a lot of mess to clear up? WHAT IF something is wrong with the baby, or me or I can't cope? My DH wants to be reassured about that particularly ? even though the hospital is only 10 mins away.
I think what hasn't helped is some friends have just looked at me and said I'm mad for even considering it... I've had the general comments: "What no drugs, you're a nutter!"
I should know better than to listen to them really!

Hey Buranda
Good on you for looking into it. I'm 36+2 with my first, and my mw's were round yesterday getting everything ready for my hb.
Firstly - don't listen to anyone else. I'm sure you know already from bitter experience (!) that everyone's got an opinion on everything when you're pg. It's your birth and your baby - they are all individual.
My DH is nervous too. If you're having an hb they will monitor you incessantly and be overcautious. If you're only 10 mins away from the hospital, I doubt it would be any different than actually being in the hospital should, in the very small percentage of cases this happens to, anything go wrong - your treatment in hospital would probably take 10 mins to get to you anyway, iyswim.
Mess - get some big plastic builders sheets from homebase or some shower curtains and use all your old duvets, towels and sheets over them. The mw's take everything away to be incinerated afterwards.
It's entirely your decision - I completely agree with you on being at home, no hospital germs, more relaxed, etc etc. If you can't cope with the pain, you go in - my mw's say it happens all the time and no-one gives a monkey's. It's about keeping you and the LO happy and safe. You can always book in for a hb and then change your mind!
Google Homebirth.org (I'm on my phone so can't link for you, sorry). There is also a first time hb thread on the childbirth topic, come and join us! :)
HTH, good luck with whatever you decide :)

Thanks Jenni
That's so reassuring to know there are other first-timers out there. I agree with you that it would be better to book in for a hb then change my mind than the other way around! I will definitely look at homebirth.org - it will pass the time on a slow day at the office!
I think it I'm just itching to discuss with the MW, so I can get things prepared and sorted.
Good luck to you too! Not long to go now! :)

I had a planned HB for DD1, planned a HB for DD2 (although events made that one go rather awry and it wound up as a hospital induction) and am trying to decide what to plan for DC3.

To take your points in turn:

What if something is wrong with the baby or with me?
In any birth, in any setting there are risks. The risks at home are different to the risks in hospital. If you are in hospital, one of the risks is that they may be very busy and you may not get very much attention while in labour - I have a number of friends with "its a good job I was in hospital or I/my baby would have died!" stories, and every single one of them has the a similar starting point of either the MW not listening to the mother when she said things weren't right, or the MW being over committed and unable to give the mother enough attention to spot a developing problem. In either case, was it lucky they were in hospital so the "emergency" could be resolved before it became a catastrophe? If they had been at home with a dedicated MW, would those issues have been identified and resolved before things reached the "emergency" state? I'm not a MW, I don't know all the details - but all the friends I talked to felt on talking about it that the "emergency" could have been avoided.

That's not to say that obstetric emergencies can't and don't happen. And if you are at home and one of those obstetric emergencies does occur then it could have a bearing on the outcome. It might be worth talking to the MWs and asking how the communication is between a HB MW and the hospital in the eventuality that a transfer is required - in theory the hospital should listen to the MW's assessment and be prepared for what's coming, but I have heard of instances where the hospital wait till the woman is inside their four walls and then start the assessment process again. It would be reassuring to know that you're in an area where the former is more likely!

What if I can't cope?
Then you go in. Wrt this point I tend to look at it as I can choose to plan a hospital birth or a home birth. If I plan a hospital birth then they will tell me to stay at home as long as possible, they'll try and diagnose remotely how I'm progressing, and DH and I will have to try and decide when we should go in - late enough that we don't get sent home again but early enough that we'll definitely get there before the baby arrives. If I plan a HB then a MW will come to me, intermittently to keep an eye on things and then staying with me once things start to progress - if I'm struggling to cope the MW can help advise whether it looks like I'm nearing transition (when a lot of women hit a "I can't do this!" phase, which is jus that and will usually pass fairly soon - especially with reassurance) or whether there's a long way to go yet, in which case a transfer might be worth considering. And if I do transfer from a planned HB the MW may well come with me (I've used IMs, who definitely will, but no experience on NHS to compare) and I'll be in an ambulance, so if DC decides to arrive sooner than expected there will be someone with me who knows what to do.

What no drugs?
Well that's just not true! MW's will bring G&A, and should be able to give you pethidine (although you may need to get it prescribed by your GP and have it ready in your fridge in case you want it). The only thing you can't have at home is an epidural. At home its easier to stay calm and relaxed, which helps keep the right hormones running (and you know you can get in a pool if you want to, when you want to ) all of which can help you cope with labour. For what its worth, DD1 was 9lb 12 - I used TENS for the 1st stage, got in a pool for transition and birthed her on dry land with no pain relief (not becuase I'm a masochist, because it didn't hurt). DH got quite confused he'd geared himself for seeing me in pain and trying to help me cope - and then I wasn't in pain and suddenly his self-designated job had gone and he didn't know what to do anymore! Its not a foregone conclusion that labour will be agony - and if it is, you can transfer in.

Mess
MWs are very good at controlling the mess - and if you have a water birth most of the mess will wind up in the pool anyway. We got a big blue cheap tarpaulin from B&Q and had a stack of old towels. The MWs brought masses of IncoPads. Afterwards there wasn't a mark on the carpets.

---------

Ultimately I'd aim to be where I felt my baby and I would be safest. For some women, in some pregnancies that will be home - for some women, in some pregnancies that will be hospital. For some women it might change from one to the other with different pregnancies. All you can do is what's right for you.

Just as an aside - your HCP's may advise you against a HB, but as long as you are a mentally competent adult (ie you haven't been committed under the Mental Health Act) they cannot force you to accept any intervention, including their kind offer that you avail yourself of their hospital facilities for the birth of your child. Also, you can inform your MW at any point that you are planning a HB - you don't have to wait until a designated (by them) point in your pregnancy. You might want to let them know sooner rather than later (by phone if you don't have another appointment), as the sooner you tell them the easier it will be for them to make sure they have sufficient MWs on the rota to cover the likely demand.

Sorry . That's seems to have turned into a bit more than I initially intended. Hope there's something in there of use, and you have a happy and healthy pregnancy leading to the safe arrival of your LO :)

Well, taking the easiest question first, if you want more pain relief (I think that's a more positive way of saying it than 'can't cope'!), you ask to transfer. It's not an emergency ,you just head in. A homebirth can become a hospital one at any time, but not the other way around! The midwives carry gas and air and you can usually have pethidine (although it might need to be prescribed in advance), so it's really only an epidural that you can't have at home.

On problems, most can be dealt with at home. The midwives carry full resus, etc, equipment. If an emergency section were needed, you can probably be in theatre as quickly as if you were on a ward if you are only 10 minutes away. I was told that, given it takes time to prep the theatre, etc, if you are close, there is very little difference . Homebirth UK have good stuff on this too. Also, in central(ish) London, an ambulance can be with you very fast. DH reckons ours took 6-7 minutes (nothing went wrong- DD2 just decided to arrive very fast once I reached active labour and the midwife didn't make it. Thank god I wasn't in a car trying to reach hospital at that point really!).

I had DD2 at home, and wish I'd gone for it with no. 1. The care I had in a busy London hospital was useless - you got the pure medical, but none of the support to help you through it. I partly blame that for ending up with syntocinon and an epidural then forceps. DD2, I had no pain relief at all other than a pool and positioning techniques. It was bloody brilliant!

Amazing points Tangle and Secondtime. I think I will call the midwife next week and mention that I am considering a hb. You're right, as there's not much point waiting 3 weeks, if they can start helping me prepare and I can let them know asap. I'm starting to understand all aspects of hb, from the pain relief to the transfers, and I do believe the pros far outweigh the cons at this point in time. Oooh it's quite exciting!

I think I just have to get my head around the fact that whatever happens, as long as DC and I are fine, it will be okay. I would rather be at home for most of the labour anyway. To have DH at home would be the ideal, but if we have to be transfered then so be it.

I am also 32+5 today with my first, and planning a home birth.

I have known id like a homebirth for years and years and have mentioned it at every appt since 9 weeks, each time being told "its too early to think about yet", until my last midwife appt, a week ago at 31+5.

It is now on my notes "Wahoo"

Also I am a good 45 mins from the hospital, and i doubt that even an ambulence could get me there in less than half an hour from the call.

I too am planning to hypnobirth and have my pool ready (birth pool in a box) and love the idea of 2 experianced midwives all to myself, not sharing a potentially newly qualified midwife with the person in the next room.

The way i look at it, is the at home is the safest place for me to have my baby. As a low risk person (which so far I am) Both me and baby are less likely to die, than if i chose to go to the hospital.
I am also much less likely to get an infection, baby is likely to have a higher apgar score.
Im much less likely to need intervention by being at home.

As for painrelief I have the same options as if i went to the local midwife led unit, which is about half way between here and hospital, so I can have my TENS, gas and air and there will be pethidine here, although i plan not to use it, it will be avaliable if i change my mind. I also garantee having a pool avaliable.

Being comfortable in my own setting, where i am relaxed will be much better for me than making the journey as a passenger (My father was born start to finish in 45 mins) and also a planned homebirth is SO much safer than baby being born in the car... By being relaxed and happy i can allow my body to take over, and let the good hormones and endorphines do their job, rather than over riding them with stress, therefor increasing need for drugs and increasing likely hood of intervention, and taking that downward spiral.

At any point I can change my mind and transfer either to midwife unit or hospital. Planning a home birth doesnt mean you have to decide to stay at home... you can change your mind at any point.

People have looked at me like im insane too, and i too have had the lectures about how dangerouse it is, ESPECIALLY with a first Needless to say no one who has told me this has done any research at all, whatsoever, and quite simply they dont know what they are talking about.

The way i look at it, is i am choosing the SAFEST environment for my baby to be born, and if at the time it becomes necessary to go to hospital then fine, of course I'll go, but if I dont need to go, then i dont see any reason to increase the risks for me and baby unnecessarily.

I am very very lucky to have a wonderful community midwife. I have seen her at all but 2 appts (when she was on holiday and saw another community midwife in her team (of 5)) My community midwife, who i have a great relationship with, has told me herself that she will make a real effort to be avaliable to attend my birth, which i would love, but of course nothing can be garentee'd as we have no idea when i will give birth, and what else she will be doing at that time!

I think Go for it, and being just 1 mins from the hospital if theres a problem you can still get there very very quickly! (Much much quicker than i can!)

Of course as well as being safer, i have the advantage of sleeping in my bed, having my own nice clean shower, kitchen and food avaliable to me and OH 24/7, TV, DVD's etc etc.

As for mess i have a massive non slip plastic floor mat thing for the front room. I have 3 waterproof bed sheets with terry towel cover which can go on the sofas (and can be binned if necessary)
Midwifes are used to clearing up and OH will be able to help too

I will also use a portable black out blind for the window to give me darkness and extra privacy throughout

Hi Buranda, I have a lovely healthy 11 month old who was born at home. I used a tens until the midwife arrived and I was 7cm so hopped (or rather lurched!) into the birthpool we'd hired (born in water-very good!). I stayed there for I think about 4 hours and then flopped out again for the last 10 mins or so as she wasn't coming around the bend so to speak! I had no drugs but I had got pethidine and an anti-nausea drug from my GP ready if I needed it. I was offered gas and air but I wanted to wait until I was desperate, and I never was. The midwives were fab and let me listen to my body and follow my instincts. The mess was all cleared up with old towels and pads from the mws. Worst bit was the stitches, bloody agony even with a local. I would def have a HB again, no contest. I live in a rural area and most births are handled at a midwife led unit which would have no more emergency equipment than the MWs brought with them. In an emergency in either case it would have been a 40 min transfer, so that was an added incentive to push hard!-didn't fancy labour in an ambulance!

You sound like the ideal candidate for a homebirth , especially being so close to hospital.

Mess: the MWs bring masses of inco pads (mine said they'd have 30!) and friends who've had homebirths say it really wasn't that messy. I can't see how it's more messy than a hospital birth since the MWs clear it all up at home too!

Can't cope: do remember you have loads of pain relief options available at home - all the hypno techniques etc you are learning, TENS, water, gas and air (once the midwives arrive) and even pethidine if you arrange in advance.

And as others have said - it's a lot easier to plan a homebirth, but then decide to transfer to hospital, than the other way round. My birth plan for a homebirth said that I reserved the right to change my mind during the labour about going into hospital if I wanted to! And that should be fine with your midwives.

Need to transfer for health of you or baby: you are v v close to the hospital. MWs attending homebirths are trained to monitor you carefully (even just by observing you) to pick up on any potential problems well before they become emergencies. I was very reassured by a midwive who said that very few problems in childbirth happen instantly and there is usually some kind of warning (eg baby's heartbeat dropping over the course of several contractions). Bear in mind though that around 40% of first time mothers having a homebirth transfer to hospital at some point during or after the birth. But hardly any of these transfers are real "blue light" life and death type transfers. Quite a large proportion are things like "failure to progress" where the woman doesn't even end up having additional intervention even in hospital. Much more info (eg a breakdown of the reasons for transfer,, by percentage) and the scientific research on this on the homebirth website below.

(Only c.10% of second and subsequent time mothers transfer btw.)

You say you would like to labour at home for as much as possible of your labour - most hospitals won't let you come in until you are contracting every 5 mins or so, with contractions lasting about 50 seconds (ie very established labour), so you will probably have to labour at home whether you wanted to or not, even if you were planning a hospital birth. For example, with DD1 (born in a midwife led unit attached to a hospital), I was at home for 7 hours of my labour, and in hospital for 3 hours.

Have you looked through www.homebirth.org.uk? Loads of helpful info/ research / stats as well as annecdotal information (eg birth stories).

By the way, I planned a homebirth for DD2 (born this May) but ended up having her in hospital due to staff shortages at the point I rang them (when I was in extrememly established labour). So worth asking your midwife what the chances of staff shortages are.

Hope this all helps and good luck planning it all!

Hello, firt timer..

i had my first at home. very wise choice! they wouldn't believe i was in labour, so at the point where i was definitely in labour, instead of having to transfer in whilst in deep labour - the midwife came to me! fantastic. it was calm, relaxed, all i had to do was give birth in the privacy and comfort of my own home, with my own tea and biscuits.

mess - i was conscious of none. it all vanished into a big black sack with the midwife.

risks - i view hospital as equally risky, in terms of mortality, and much more risky in terms of other lesser adverse outcomes.

in our area, thecommunity MW still attends the births of HBirthers who were booked in if they end up hospital birthing anyway - if possible.

so far as i have read on here, in the event of staff shortages., if you put your foot down you will most likely still get a MW sent out to you.

Buranda a couple of years ago I was in the same position as you, not sure whether to have a home birth or not. I also did hypnobirthing and the birth itself didn't really concern me. I was more bothered about the amount of postnatal help I would get after the birth as the postnatal care in my area was so rubbish! Just 3 visits over the first 10 days and only two of those by a midwife. I think a lot of people focus on the birth but don't think as much about what happens after it.

In the end, I decided to go to a local MLU instead because you can stay a few nights afterwards for help with breastfeeding etc. I wasn't confident around newborns and really struggled with feeding. I was glad I had this time afterwards with a midwife at hand at all times. I hate hospitals and if there wasn't the option of a MLU, I'd have stayed at home and put up with rubbish aftercare. In the MLU I had my own room and it was lovely.

I think all I'm saying is, if you're not confident around newborns, make sure you know how much help you're going to get afterwards, particularly if you plan to breastfeed. If you're not confident you will get enough help and there's a MLU nearby, maybe have a look round? I found the community midwives very reluctant to admit they would only do 3 postnatal visits after a home birth and it took a lot of direct questioning to find this out before the birth.

Please don't worry about problems during the birth. At both home and MLU births, you get a lot of attention and I think any problems would be picked up possibly even sooner than if you were in hospital with a midwife popping in and out.

Good luck whatever you decide. PS I did hypnobirthing and had no drugs apart from a bit of gas and air for the stitches, I'm sure you'll be fine, and if you're not you can always transfer.

I planned a hb with dc1 but had to transfer due to meconium liquor. The transfer was fine. I'm planning a hb again with dc2, due sept. Hopefully i won't transfer this time, but i know it doesn't have to be a big deal if i do. Good luck.

Well after reading all your very helpful comments, I decided to ring the home birth team today and I spoke to the head midwife who quickly arranged to come over to the house and discuss everything with me next week!
MaryLou great point about the postnatal care - I am particularly concerned about that, as I would like help with breastfeeding. I shall make sure I talk to the midwife about that. Unfortunately, the MLU in the hospital only has 2 rooms, and it's on a first come, first serve basis, so no guarantees.

My DH is also on board which is great news, having made up my mind, I feel a whole lot better about it all. THANKS to all of you for helping me decide! :o

as for support with BF - at least at home you can sit half-naked snuggling with your baby and trying differnt things as long as you want and feel realxed about it.

Its a slightly scary realisation that BF support is an incredibly small part of a standard midwifery course - some MWs have taken further training and are fantastic, but many will be falling back on their initial training and (if pertinent) what they were shown when they fed their own babies. HV's can be equally variable in the level of support they are able to provide and the knowledge they have. Its very much the luck of the draw whether the HCP that knocks on your door (or visits your hospital bed) has more than a pretty basic knowledge of BF. You might strike gold, but equally you might not.

If you really want to try and make BF work I'd recommend having a good look around KellyMom and How Breastfeeding Works, which has the numbers for all the UK BF support lines - have a look at them, check the hours they're open and have a printout with all perinent information with you in your labour bag and by your phone (if you do wind up in hospital and feel BF support is lacking, you'll be in a position to phone people who should be able to help). It might be worth getting in conctact with your local NCT (or some of the other groups) and seeing if they run a drop-in support group for mums with bumps and babies that has a BF supporter you can talk to if you have problems, or if they know of anything like that in the area. You might also want to see if there's a post-natal doula or IM in your area that offers BF support (you'd have to pay for these, but the level of support can be phenomenal).

Glad to hear you've made a decision on what to plan for, and that you've got lots of support. Hope it all goes smoothly for you :)