Homebirth risks!

[StarlightMcKenzie]

I'm almost 38 weeks and due to having to jump through ridiculous beaurocratic hoops have only just been taken on by the local hospital.

Well, I finally get my 'booking in' appointment tomorrow. And then they want to do my 'homebirth assessment' next Friday .

I asked what happened if I went into labour before that. They told me to call triage at that point who would go through my options. I had to point out that as far as I was concerned my 'options' included the homebirth I was having.

The midwife then explained that I wouldn't have had the assessment though.
I asked her what exactly the assessment involved that would discount a homebirth for not having had it.

She said it was to go through the 'risks' of homebirth to make sure I knew them.

FFs! I mean, she was nice enough, but no-one ever insisted I had an assessment/talk to go through the 'risks' of a hospital birth to ensure I understood before I had my other two. Like being 4 times more likely to have to have an emergency c/s for example.

Well my first rubbish birth was in a hospital MLU!

The assessment will be so they can explain to you which women they prefer to have in hospital and which they consider are ok to be at home. They will want to make sure you can't say you weren't informed.

You have clearly done your research but I would guess some women haven't so I can see why they are keen to see you - however I think you are absolutely right with the fact that midwives don't tend to explain the risks of hospital birth to you! I hope it all goes well for you.

the amlu stats were different to free standing.. for some reason my browser won't let me re-load the pdfs at present (so previous stats are as remembered)

but here it is you have to really have a good read as some stuff i thought quite interesting and pertinent wasn't in the summary.

They put all the 20 week scan stuff in your handheld notes here, the variance in maternity care from region to region is ridiculous (it's not perfect where I am but a LOT better than in some other places).

Why can't they just print off another report for you? Seems like they are being obstructive on purpose - is the consultant being petulant because you have gone against their advice? It wouldn't surprise me (HCP :) )

I hope your hb goes well starlight and IF you do have to transfer for any reason, I hope you have much more positive experience this time. My EMCS was actually lovely, it was done under spinal and the theatre team were fantastic, very calm and caring and I felt really safe.

Edless you raise interesting point there and I totally agree about OBEM convos! However just to be awkward, my friend is a MW in a CLU and she would point out that their intervention rates are bound to be higher as they take all the high risk pgs from miles and miles around, so again it isn't really comparing like for like.

What I think would be most helpful is clear criteria about what constitutes low/medium/high risk and the statistics for each group, though the perennial focus on cost is unlikely to make promoting homebirth a particular priority for the NHS as they would prefer not to fund one-to-one care for labouring women.

Thanks for that link Edless. I'll have a look later when I can give it full attention.

Just the other week there was a tragedy in an overstretched hospital. Its unclear whether this baby would have survived in different circumstances but the care was clearly lacking. :(

I may decide to give birth in hospital so that we can have IV antibiotics during labour (GBS) rather than the MLU birth I'd have prefered. Its not a flat choice between one safe and one unsafe option. Its different risks that I have to weigh up with the help of my midwife. Having the antibiotics will decrease the risk of baby getting a GBS infection, but in a hospital baby is more likely to be exposed to antibiotic resistant infection. At the hospital we'll be closer to an NICU if baby is ill, but the distance to hospital means there is a greater risk of having an unattended birth in transit etc etc.

At the moment I'm edging towards the hospital birth (though I'll speak it over with my midwife, consultant and partner more) but its not because its a risk free option. Its just different risks.

Hope you get things sorted out for you Starlight xx

GoldenGreen I would have thought precious few women who ask for a homebirth these days go into it without having done some research, so will be well aware of the balance of risks that they face. Which can't be said for many women going into hospital.

LorraineMatthewHenry I believe that the Place of Birth study found that homebirths were still cheaper even when factoring in the cost of one to one midwifery care. Personally I think one to one care should be a basic entitlement, regardless of the place of birth.

Thank you Edless. Very interesting.

Silly baby turned the right way, but just this morning turned back again. Perhaps there's some obstruction that way.

A midwife just range as apparently I missed a booking in appointment this morning that ai never knew I had . She was really nice but grrrrrrr.

Lorraine in the study being referred to (the birthplace study in the BMJ) only low risk women were included. So they were comparing like for like, as best they could. Of course there could be something intrinsically or systematically different about women who choose homebirth compared to those who choose CLU and this type of bias could only be overcome by doing a study that involved randomising women to place of birth (which would never happen as no one would ever agree to it).
A follow up study found homebirth was the most cost effective place to give birth and recommended it be promoted more widely (to save the NHS money).
Good luck starlight I've been following your posts. I've just booked my second homebirth (am now 34 weeks) and I apparently don't need any home visits or for anyone to read me the risks of my choices. Nor to check out parking as the midwives all come out in taxis. They bring all the equipment with them on the day so don't need to drop anything in advance. They won't administer pethidine at home here (in case the baby is affected and needs paeds assistance after the birth). It's mad for your trust to put all that bureaucracy in place when it doesn't need to be there.
I second using the stuck record technique when on the phone. But get someone else to do it for you. I thought I was going into labour with my first (in Dec 2009) when there was snow and ice everywhere. The hospital said homebirth service was suspended. I cried but got my friend to ring back and she did the stuck record thing and eventually they said they would send someone if I needed it. I didn't go into proper labour for another 10 days! But I found out afterwards that if they are short of midwives to attend homebirths they call a supervisor of midwives out of their bed to go and attend one.

So sorry they are making things so difficult and stressful for you Starlight.

'Risks of homebirth'. I'm with you, I wish someone had sat me down and warned me the risks of hospital birth before DD1. (Nothing like your story, but traumatic in its own way). I hate the fact that such emotive language is used for one and not the other. And comments like those by the GP are just uninformed. Who needs evidence based medicine eh? I have a relative who is a GP, and she made similar comments about my homebirth. It was before the place or birth study or I would have waved it at her.

You are getting there though. Inch by inch. If StarBaby decides to come before the meeting I think you just need your doula briefed and put it out of your mind. IME most doulas seem to have a good line in forcing the midwives to come out - though normally through staffing issues than bad booking in - without being confrontational about it.

Lorraine - as has been pointed out, the study was only low risk women. I genuinely think that, when the technology is there, there is a temptation to use it. If I had been labouring slowly at home, it would have been a big decision to transfer me in for a syntocinon drip and the midwives would have tried anything else first. As it was it was "if you aren't four/five centimetres in another two hours we'll get the drip set up", which led to epidural, both of which combined to result in forceps.

I am booked for a homebirth.

I think when this comes up people often say things like "my baby would have died if I was having a homebirth" but statistically that really isn't true or likely or believe me, we would all hear a LOT more about it. There have also been reputable studies to back this up.

I wouldn't have tried a homebirth for my first as there are potentially increased risks, but for a subsequent baby a homebirth is as safe and perhaps safer than a hospital birth.

Where am I getting this info? It's what we were told at our NHS hospital antenatal class! I went to a consultant to discuss it further as I am very risk averse and the obstetric consultant recommended it.

At home, you have 2:1 midwifery care throughout and there is a strict policy on transferring in. They won't take any chances, they will move you as soon as they think there is a SLIVER of a chance of a problem and there are quite a variety of circumstances where they will advise against a homebirth if risk status changes and I would never go against any of their advice.

Of course yes, there will be circumstances where tragedies occur as there are with all births. The place of birth is not always a major factor. I have sadly had two friends lose babies in labour, both in major Teaching Hospitals, one had inadequate care/poor decision making as a factor, the other was a shoulder dystocia situation which occurred two and a half hours after pushing began. If my friend with shoulder dystocia had been at home, they would have transferred her after half an hour of second stage labour with no descent and the transfer time here is 15-20 minutes, which is around the same as it is from most MLU's to CU's nationally so in no way would her planned place of birth impacted on the tragic outcome.

Anyway, as others have said, that's not what this thread is about.

Incidentally, my major reason for choosing homebirth is that I am terrified of not being admitted to a labour ward as ours closes regularly and/or being sent home or not believed if I am in labour and in pain and not being allowed access to the hospital. I want to be in a situation where I can get on with the business of labouring, basically, without having to fight to be assessed or seen or monitored.

I think the most recent study showed a statistically poorer outcome for 3 babies in a thousand for first time mothers compared to the outcome in hospital (and no difference for subsequent births, although I read the study a while ago). I think MN must be populated almost entirely by that 3/1000 given the number of times I have read on here "we would have died if I had had a homebirth"....

I hope you get the birth you want Starlight.

The thing with all this 'I'd have died if I'd had a homebirth' stuff is you quite simply cannot say that. You might have but that isnt the same thing.

My friend had a PPH and baby born blue, needing rescusitating. it scared me but the midwife was really reassuring about the procedures in place. After all isnt potential double emergency why there are 2 midwives?

Good luck starlight my homebirth was amazing.

They had Norovirus in hospital at the time

I had a homebirth booking in/assessment which for slightly silly reasons didn't happen until after I was 37 weeks. The slightly silly reasons had actually been resolved before I got to term, and I think my MW had made reassuring noises that if I went into labour before the booking in/assessment they'd still come out to me (can't remember exactly what was said - I was convinced DC would be late, and indeed he was so didn't matter). MW did go through risks of a homebirth at the appointment, and made sure I understood them, but she did also talk about the benefits and certainly wasn't trying to change my mind. Starlight I hope you get everything sorted soon, so you can concentrate on getting ready for baby arriving.

Starlight, I'm not familiar with your story but I wanted to reassure you that after a fairly traumatic hospital birth first time round I had the most amazing homebirth 5 weeks ago with dc2. I had a doula and a lovely mw this time which I'm sure made all the difference. My homebirth assessment consisted of filling in a form at a routine appointment so I'm pretty sure your mw is talking bollocks! I think you'll find that your doula will have plenty of experience in getting mws to come out when you need them but I still think you should speak to the superviser of midwives, at this stage of pregnancy you don't need this stress. Good luck and I really hope you have a lovely experience like mine

The thing with all this 'I'd have died if I'd had a homebirth' stuff is you quite simply cannot say that. You might have but that isnt the same thing.

Quite often followed by 'You were lucky' when you tell people that you had a home birth. When will people see that it probably wasn't just a matter of luck?

Thank you cute. I have had a great second birth with a different PCT. I chose a stand alone MLU because of the dire support for homebirths there. I did start out trying to get one then but they really didn't fill me with confidence.

This time I woukd go back to the same MLU but it really is too far.

the interesting thing is that quite likely the majority of negative foetal outcomes in the Homebirth stats for first timers would have actually occurred in a hospital and some time after transfer (though there is no breakdown of this in the Birthplace stats, previous studies have shown this)

I'd love to get the raw detail and go through for my own evaluation of why there is an uplift in risk for first time deliveries (especially given the rates of intervention are still lower...and neo natal admissions, apgar lower than 7 after 5 mins also lower...)

looking through which negative outcomes were more likely, things like broken bones seemed higher (possibly, given the adjustments) whilst the things associated with forceps deliveries were lower (encephalopathy).... hard to tell because of the way the data is reported (so i might be completely wrong!).

stillbirths alone they couldn't determine any difference between groups, so 'baby would have died' is not likely to have been the case.

I hate the whole "I would have died at a homebirth" thing. Especially when it's followed by a statement like "The baby was born with the cord around its neck!" Oh! Well then, good thing you were in hospital!

As a student m/w I can say that I would choose homebirth for myself, provided everything was low risk and normal. CLUs really are committed to safe care, but just by entering one your chances of having a normal birth decrease, since you are subject to so many questionable guidelines and timelines. Not for me, thanks.

to be fair, maternal death in a low risk mother is rare anywhere

stillbirth happens in all locations, just not more so in any particular one.

Very interesting debate!

I am wondering though like on OBEM, it does seem or though of course it may be edited that things do go wrong very quickly or that someone hadnt noticed - and suddenly its a frantic dash to theatre just down the corridor.

These panics must happen in homebirths....those seconds appear crucial in the program, i would like to know what does happen in a homebirth...also - are the hospitals aware that a woman is labouring at home nad may need an urgent operation?

if your in hosp - are they too aware of it....what if you have a home birth, goes wrong and they cant fit you in?

"if your in hosp - are they too aware of it....what if you have a home birth, goes wrong and they cant fit you in?"

If you have a planned NHS homebirth then you have as much right to the hospital facilites as anyone else. If something goes wrong in the hospital they might be able "to fit you in".

Thankfully the need for crash c sections is rare. The biggest risk is a prolapsed cord and that is rare with head down presentation. It is a major risk if you have a breech baby and why breech babies are delivered by c section.

www.patient.co.uk/doctor/Prolapsed-Cord.htm

Erm, what do you mean if "they can't fit you in"? What do you think happens? They don't leave you at home you know! They take you in and fit you in same as they would for a hospital birth.

However, at home you have one-to-one care and they transfer you in at the first sign of even the slightest problem. That is a big difference between planned homebirths and most hospital births where you are left alone for periods.