Homebirth for high risk... tell me everything!

[BabyDubsEverywhere]

I am 24 weeks with my 3rd, and no doubt last, baby. I would love a homebirth this time. I am happy to transfer to hospital, (about 15 minues away max) if there were complications. Dh is worried about not being in a hospital setting but would go with whatever i want if it came to it.

I am 'high risk' due to my weight (a size 20, no idea actual weight) and mental health. I have Bipolar, amongst other things, and the meds i was taking until we discovered the pregnancy have a lovely side effect of weight gain and buggering your metabolism to boot.

I was induced with DS as they weren't sure on due date, started on tuesday, had him on friday! ended up on drip and pushing for three hours, he was back to back and a vontouse delivery in the end, but completely fine. DD came on her due date, no probs at all mobile labour on G&A, 5 minutes pushing, no complications at all.

What are my chances of getting a home birth? I know this sounds weak, but I dont want to even ask the midwife about it until I am clued up tbh. I know if theres something i'm not sure about i would just crumple if challenged.

Sorry this is long, i wanted to put as much down as i thought could possibly be relevant in the hope you can help me :) TIA

Have a look here: www.homebirth.org.uk/

It is your right to have a homebirth, even if you're advised against it. It's less clear on whether you'll be attended by a midwife though if they felt they wouldn't be able to practise safely.

Yes you do have factors that make you a higher risk case but I'm sure that you would be able to find a supportive midwife; as long as you are sensible and agree to transfer to hospital if need be.

Don't ask your midwife for a homebirth. Just say you want to have one. She can then tell you of the risks and when you make your informed choice to go ahead with the homebirth she just documents that she explained the risks to you.

Have you thought about getting a doula to support you during your homebirth?

Wish I could afford one tbh, but theres no chance of that. Tbh with my DD birth i was left alone for the whole labour with DH and the midwife barely made it back in in time to catch DD! I only want a midwife to be about to have a cuppa with...perhaps if I sell it like that

Thanks for the link, will have a look now.

Well, first thing to say is that a homebirth or not is your choice. While your midwife or consultant may try to encourage you down a specific route, the choice is yours. They are obliged to discuss all the risks with you and then abide by your decision.

Personally, I was advised at my booking in appt, when I first mentioned it, that they would 'not recommend' a homebirth due to a higher BMI (think it was around 37/38 at my booking in appt). I have to have growth scans, a GTT and see a consultant so I'm just working on the basis that if I can tick off all the boxes as I go (so far at 27+4 scans okay, blood pressure okay, GTT passed and consultant happy) and all they are left with as an objection is my size then I will probably request a homebirth.

At this stage, I may be considered 'higher' risk due to size but I don't think I can be 'high' risk, if you see what I mean. I don't know how mental health issues would impact an assessment of risk.

From what I understand, if everything else is well, my elevated risks due to size are probably around PPH or shoulder dystocia. From my investigation so far (and there will be more) my chances of a severe PPH are very small and I'm confident that shoulder dystocia can be managed with the appropriate birthing position except in the most challenging of situations. Unless something changes, these are risks that myself and my DH are most likely to be comfortable with and as such would request a homebirth and expect the midwife support that is appropriate to that.

Good luck getting the birth you want.

I'm sorry I know its important to feel you have a choice and for your birth to be as natural an experience if possible but I think it would be dangerous to ignore the risks involved here.

Seconds are precious if you have complications during delivery and a 15 minute drive to a hospital could be a catastrophic delay if you had difficulties which obviously you had in your previous delivery if you required instrumental assistance.

I'm sorry to sound dramatic and I appreciate it is a personal choice. I do think its very important to be fully aware of the risks involved before committing yourself to the idea.

Good luck though and I hope the rest of your pregnancy goes well and you can come up with a birth plan that you are comfortable with.

Just thought I'd comment on the transfer to hospital side, completely ignoring any weight or bipolar issues. At my antenatal class in hospital with 3 midwives present (including the lead mw) I was the only lady out of 7 who was planning a home birth & like you I'm about 15 minutes away. One of the other ladies asked about safety & the midwife said you probably get transferred faster with a hb as they don't wait to see how things go as they're not willing to take any risks. Whereas In the mwlu attached to the hospital they often monitor for longer to see how things pan out as they know its only 2 mins to theatre if needed.

As your last birth was normal & if nothing untoward shows up in tests & scans I don't see why you shouldn't get to have a hb, but always good to discuss any thoughts you have with you mw - that's what they're there for! Good luck :)

Thank you for all the replies, much food for thought

I think I am going to ask the midwife about it at my next appointment, (I'll be 28 weeks then, is that too late to ask?) Can't hurt to ask, don't think I'm brave enough to go against advice too much, couldn't live with myself if anything happend.

My first birth was medicalised from the start, induced, epidural, stuck on my back with tubes coming out my arms, hadnt eaten more than a cheese sarni for three days and was exhausted! I do wonder how it would have gone if nature had been allowed to tke its course...spose thats normal though.

I really dont quite understand what Bipolar has to do with homebirth but last time i was dismissed quite quickly with "no, you're high risk due to your weight and mental health" I left it thinking that was it then.

Tbh my mental health seriously deteriorated on the ward as there was no down time, I am typical bipolar and quite all or nothing, so when around people tend to feel like I am performing and takes all my energy, then out of sight wil come a crash where I recoup. Not massively practical but the nature of my disorder, so ho hum! Being on the wards means no time away, so no crash, so when i eventually got home the crash was so much harder to cope with. Surely thats a reason for being at home!

Anyway, i am waffling now, thankyou again for all your help

I would dispute your being classified as high risk. A size 20 doesn't signify a particularly high bmi, unless you are v short. You need to find out what your weight and bmi are.

You are at higher risk of GD but if this doesn't develop then there seems like no reason to not have a hb. Your mh is a reason for hb not against.

I'd second homebirth.org vast amounts of info and support there.

Even a tiny quote of mine

Im 5'5 and was 15 stone at booking in, but I have lost weight since becoming pregnant, although Ive never been petit, my weight is largely due to the side effect of the meds for bipolar, as I cant take them at the minute the weight is coming off on its own, my diet is still the same and so are my activity levels.

I think i would be a good candcidate for home birth, the more i read about it the more sure i am, Im going to really try for this, thanks for spurring me on

BabyDubs I am intending to have a homebirth (38+4 now) for DC2 and am high risk but for different reasons to you (PPH and retained placenta first time round)

I told (didn't ask) the booking-in MW that I intended to have a homebirth, and wrote to the Supervisor of Midwives informing her of that intention, and saying that I had considered the risks pertinent to my situation and still planned to go ahead. I refused consultant care though as there was no new information they could give me, unless something happened in this pregnancy concerning either my health or the baby (I didn't want to see one for something related to my previous birth)

I've seemingly been very lucky with the support I have had from the midwifery team, my decision hasn't been questioned at all. Two of the Supervisors of Midwives have visited me at home (not to do an assessment or anything but to give me paperwork and to chat through the risks to make sure I do understand them) and we've worked together in order to make sure that we can mitigate the risks as far as possible.

If you feel that a homebirth would be right for you then there's no reason not to go for one - having assistance in your first birth (I had forceps) doesn't indicate that there'd be any need for assistance in a second birth. If it's what you want, then I'd write to the Supervisor of Midwives and take it from there. Hopefully you'll find the team more supportive once you do that!

It's never too late by the way, some women go into labour and decide that they are not moving anywhere - and it's FAR FAR easier to book a home birth and change your mind and transfer in than it is to go into hospital in the early stages of labour and then decide you want to go home for the birth itself!

I just wanted to reply to something said up thread about the risks of a homebirth. The recent birth place survey showed that, if you are low risk, home births are just as safe for second and subsequent babies as being in hospital. Being physically close to theatre and all the technology for the whole of labour does not appear to improve outcomes. This could be for a number of reasons, including one to one care and the fact that transfers are advised if in any doubt. There will be odd situation where a problem comes out of nowhere, but many of the stories you hear of women who had 'sudden' problems would not necessarily have been sudden with closer care and a more cautious (less 'wait and see') approach.

Only you can discuss with your doctors what your BMI means in terms of your risk profile. However, i've just put your figures into the NHS calculator and you come out under 35, which someone was saying on a thread the other day was the cut off for being considered 'low risk' for the purposes of getting into a local MLU.

Previous instrumental delivery is not a counter indication on its own against home birth. I had forceps and when I said I was planning a home birth with DD2 the midwives said that was lovely and the instrumental delivery was only ever mentioned when they asked me conversationally whether things had gone smoothly before. A bigger issue seemed to be the 'ooh, are you sure you can cope with the pain if you had an epidural last time' attitude from some midwives (which I did, fine).

Also, if you feel a home birth would be good for your mental health, make that point if mental health is raised as a negative factor again. As others have said, it's your choice but it's nice to have people on side! Even if you gave birth in hospital, remember if it's straightforward that you may well be able to go home from the delivery suite, so the hell of postnatal doesn't necessarily have to happen again. Mind you, there is nothing like snuggling up in your own home with a three hour old baby after a home birth and with everyone gone home .

Good luck!

I'm around the same size and have had 3 homebirths (all at about a size 20 and BMI in the 30-35 range). I've been fully supported by the midwives regardless of my weight. I was told that weight itself is not a risk facter as such, more that it increases the likelihood of other risk factors (such as GD). If any of these had been apparant it may have changed my mind. None of the community midwives seemed to have a problem with my weight at all.

As it was I had excellent NHS care all 3 times and lovely relaxed homebirths - much less stressfull than my first which was (like yours) a very lengthy induction in hospital although not an instrumental delivery.

just checked my notes and it says BMI is 36, I know its high but thats only a point over isnt it, I'm going to call the midwife tomorrow and get an appointment to talk it through. This is what I have wanted since before DC1 and as it may well be my last baby Id like to give it a good shot :) thankyou

Great!

Do bear in mind that, if they are ok with it, probably very little will happen for a while. Round by me they don't book you in for a home birth until quite late. I think it was around 36 weeks, and I think that's quite common. The reason is that obviously complications could arise at any point - like breech, or premature labour, or gestational diabetes, that could unexpectedly change your risk profile and make you change your mind/them advise against. So they don't want to schlep out with birthing packs and home birth visits until they know there is a good chance you are good to go.

Good luck! My first labour was similar to yours, and my second so amazing that I would quite like to do it all again!