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.

Right. I actually agree with a fair bit of what's being said here, particularly that homebirths and hospital births both have their own, different, risks and that, for low risk pregnancies both are reasonable choices.
But, for those posters commenting that people saying their own deliveries would have had a disastrous outcome had they been at home are wrong or just don't know, please don't make so many assumptions.
I am a doctor, I've completed an obs and gynae job so do know a bit about this. I, and my baby, might have survived had I chosen the home birth I was offered. I also think there is a very good chance we might not have survived. I developed sepsis in labour - very suddenly - and received iv antibiotics followed by emergency section and multiple transfusions within 20 minutes of the first symptoms - no other early warning signs to trigger transfer. We live 25 miles from hospital so at home this speed of response would simply not have been possible. I lost 7 litres of blood, my daughter had an apgar of 2 and required resuscitation. I am far from certain that we had an extra 20 minutes or so for a hospital transfer to happen.
I find it extremely irritating that posters here choose to dismiss my experience, and others', by implying that everything would have been fine at home as well - or might even not have happened.
Now, my experience was incredibly rare. And statistics suggest that in many ways a home birth is safer. But please don't ignore the fact that hospitals can do some people good as well as harm.

I'm really surprised that its time for yet another thread on this topic, tbh.

I've had three homebirths and one hospital birth. It was entirely due to my hospital birth experience that I had the following at home.

I've supported a friend in a homebirth with a breech baby with no (conventional) pain relief. He was her first and mother and baby were fine.

I've supported a young mum with a posterier presenting baby through homebirth (again, no (conventional) pain relief) and both mother and baby were fine.

I've been fortunate enough to be invited to several other birthings and each and every one was an enriching, enjoyable, empowering experience for the mothers and the midwives in attendance were amazing, grounded women.

I, personally, have yet to speak with anyone who can say the same of their hospital birth experiences and most I've met who have birthed in hospital have suffered negatively in one way or another. Birth should not be that way!

Regarding the 'risks' of homebirth? Birth is 'risky' no matter where it takes place...but without the structured spiral of intervention favoured in hospitals I, personally, have found it to be far less so.

Smiley, no one is saying a tragedy couldn't happen in a transfer... But a tragedy, sadly, can always happen in birth. I was left alone for 2 hours in hospital with an epi sited on a syntocin drip, that woman in Leicester gave birth in a waiting room, I have two friends who had unassisted labours as hospital refused to accept they were in labour with ctx 3 mins or less apart. Any of these situations would have led to tragedy in your situation. If you could guarantee me adequate NICE guideline compliant care in hospital, I would be in in a shot. I want monitoring every 15 mins and one to one care and I know as a second timer with a previous vb there is a fair chance I won't get that in hospital but I will at home. The biggest issue for me is that if a tragedy occurs in a transfer, it will be perceived as something I chose but if it happened because of poor hospital care it would be one of those things...

Giving birth is risky wherever you give birth.

This document shows the various perinatal death rates in 2004

whqlibdoc.who.int/publications/2007/9789241596145_eng.pdf

The netherlands have a lot of homebirths yet they have a better record than the US. However there are lot of factors that affect infant mortality. It is hard to make sense of stastics.

There is a huge difference between being attended by a NHS midwife in a clean house and a traditional birth assistant in muddy hut.

I have no doult that hospitals can provide good care, but its not always the case. Giving birth is very bit as normal as having sex. Being pregnant is not a disease.

Sometimes doctors do upset the natural process and hospitals are run for the doctors convience rather than the patients.

ReallyTired

Katiemiddleton

on OBEM there are quite alot of crash sections and panic situs, yes edited - chosen - but still there, happening, to be shown.

if the c section people are busy - who does it?

re leaving you at home - i am sure they dont!! but if the mat ward is full and closed - where do you go?

That is such a good point about no one sitting you down and telling you "well, you're a low risk woman on your second birth, you've chosen a consultant-led unit, let me tell about the risks of that birth choice, are you sure you don't want a homebirth or a midwife-led unit". Wow. What a different system we'd have if that was the case.

Actually, having said that, for my planned homebirth, I found the meeting at home with a midwife very useful. She didn't just list loads of "risks" - she sensibly talked through the different scenarios, as well as telling me what equipment they needed (eg a bucket for the placenta!!), answering all my questions and so on. So when you finally get this meeting OP, I hope it's actually useful!

I think it's less that you shouldn't have a talk about risks when you are planning a homebirth, when you don't with a hospital birth; more that women should be told about the risks / benefits of every birth place choice.

I agree with others that if you go into labour before the visit, you just need to tell them that you are giving birth at home (I assume you have actually done all the reading up, and know what kind of stuff / equipment it would be useful to have?). www.homebirth.org.uk is very very useful if you haven't already read all the stuff on there.

elizaregina - well, there's no difference between a woman having a homebirth needing extra intervention, and a woman already in hospital needing extra intervention. In both cases the hospital has to manage the resources / staff they have to prioritise patients. It's not really about homebirth vs hospital birth.

And as others have said up thread, the midwives attending you at a homebirth are (a) there observing you all the time, unlike in hospital where you are very likely to be left alone (b) experienced midwives, as they don't send newbies by themselves to homebirths (c) because of (a) and (b) very likely to pick up on any problems waaaay before they have turned into an emergency, and advise you to transfer you to hospital way before it's a crisis situation. This is what I was told my my midwife. In her experience, there is hardly ever a situation where the birth seems to be going fine and then instantly turns into an emergency. There is almost always some notice that the birth isn't going perfectly and therefore time to transfer you to hospital.

Did you know the main reason for transfer to hospital, for planned homebirths, is "failure to progress", and that even when woman are transferred, a significant proportion (can't remember the exact figure, but it's all on www.homebirth.org.uk) don't actually need any futher intervention and deliver normally anyway.

Starlight - I honesty think there has been some nscommunication here, or poor explanation. Generally when home assessments are done it isn't to provide any evidence regarding the hospital's acceptance of liability for the homebirth.
It's to do with logistics and planning things like is there a good light source where any suturing or resus is required. Can a midwife carry equipment up any stairs safely is the address easy to find, can others gain quick access if needs be, any potential issues with pets, allergies (I couldn't delivery anyone with horsey stuff about I am horribly allergic) and all sorts of stuff Like that.

So I think this is a trust and safe practice issue and It's geared at making sure things are alright on the night in the absence of a dress rehearsal.

Re: the crash section thing, my midwives said that it typically takes 30 mins to prep a theatre for section anyway. At the second the decision to transfer is made, the midwife will make a call and if it is an ultra-emergency e.g. cord prolapse they can also call for police back up to speed up the convoy and block parts of the route! In practice, she says this has never happened and in 10 years, there has never been a maternal or foetal death in transfer in our area.

Realistically, every time we get in a car with our kids, the odds are much higher that they will be injured or killed than in a situation in which there has been no deaths in 10 years. That doesn't mean that at any moment in time you could be that first person and that's a risk that I find hard, but having weighed up both options, I feel it's LESS likely that I will have a negative outcome at home than if I am in a situation where I am denied access to hospital or left alone in labour.

My decision to homebirth has purely been on wanting to choose the less risky birth for me. I have no strong feelings about birthing at home, we plan to move in a year or so and I will be leaving this place behind, I'm not looking for an ultimate birth experience or anything "woo" and if I have to transfer and end up with an emcs or it turns out I can't have a homebirth for any reason e.g. have meconium in the liquor or premature rupture of membranes, I will happily give birth in a hospital. I just feel that the science seems to suggest that if you are low risk and having your second baby that a homebirth with continuous care is actually SAFER than being in hospital. This seems backed up by my friend's experiences.

Also, when you think about a second-timer, many births are really quite fast with several of my friends who had planned hospital births arriving at the hospital and delivering within an hour. If the hospital was closed, they are technically in the same situation although perhaps slightly worse off as they won't necessarily have been assessed by a midwife who says they need urgent assistance and someone else may be prioritised ahead of them.

I think its really sad women have to make alot of these choices based on fear of in adequate care.,

I hope everyone on here has signed the downing street petition for more midwives and writing to mp's about fears.

Wigeon - DH is a GP and after we had a HB with DD1, he now makes sure that he does tell any pregnant patients for whom it is suitable, that homebirth is a completely valid option. Obviously he wouldn't suggest it to a woman for whom it could be dangerous, but for the vast majority of women he sees for their booking-in appintment, he does now say "Are you aware that HB is a possibility?".

Just for the record, we had planned HB for DD2 but she then arrived early so we had to go into hospital.

"re leaving you at home - i am sure they dont!! but if the mat ward is full and closed - where do you go?"

Where would you go if you were booked into a hospital birth and the labour ward was full?

You are part of the system when you have an NHS homebirth. When the midwife turns up at your door you are technically under the care of the hospital. A nhs homebirth requiring a crash section has as much to the hospital facilites as anyone else.

I imagine a senario where two women SIMULANEOUSLY had a cord prolapse would result in the death of at least one baby even if both women were at the hospital. Thankfully the probablity of that happening is slim.

Would it help to think of a homebirth as being like a hospital birth but in a different location Eliza? I mean in terms of caseloading and management.

When you have a hb where I live it is all managed via the delivery suit at the hospital. You contact them to inform you're in labour. They send the midwives (you get two - the second turns up to take notes and assist if necessary) and you become another patient under their caseload - except you're at home. So the hospital knows they have 9 women in the CLU, 3 in the MLU and 2 at home. They then manage their caseload accordingly. Before anyone mentions the hb taking MWs away from the hospital they are a completely different team. Postnatal care in the community does regularly get shuffled around but while a bit irritating when they cancel at short notice due to a hb I'd rather they went to the woman in labour than come and see me. But I'd really rather have enough MWs for proper care (and enough anaesthetists and other staff for hospitals) but that's a different thread.

Fwiw I can quite see why some people do not want a homebirth. I am lucky I have 2 accute maternity units within 4 miles. I am also lucky to have had normal pregnancies (so far with number two). I think you go where you feel safe. If that's hospital you go to hospital. If it's home then stay at home. Your body is not designed to birth in fight or flight mode so being afraid will not help the natural process of labour.

For me, I know that there are certain things that make me feel tense and so I do not want to have to deal with them in labour: unfamiliar surroundings, strangers, rigid protocols, my mother. All of those are removed (or significantly reduced) from the situation with my hb. I would feel afraid if my baby or I was in real danger so I would transfer straight in at the first sign of trouble because that would make me feel safest. It's about managing the risks. If I can do things to reduce the risks of intervention by being at home that makes sense until that situation changes and I and baby are not safest at home - then the risks are reassessed based on the new situation which is why information and evidenced based information is so, so important. Of course the midwife/wives are calculating and evaluating the risks the whole time because you are never left alone. That makes me feel safest because I have the best medical care available with all the benefits of my safe environment which gives me the best odds to have a straightforward labour and birth.

Homebirths are provided on the NHS EXACTLY because it is the safest option for some women. Some homebirths are completely unplanned.

A homebirth is usually done by the community midwives. They are an important part of the safety net for ALL pregnant women.

If you plan a homebirth you are still under the care of the hospital. Planned homebirths help community midwives keep their skills up. Otherwise it would be very rare for a community midwife to deliver a baby.

Tired old argument, I agree (obviously cos I had 2) with all the homebirthers but to get to the original OP I do think that's a bit weird to breif you on the risks of homebirth and not of a hospital birth - surely if they're doing one they should do both?

FWIW it would just help if all women had direct access to all info regarding both rather than having to hunt for it if you want to consider a HB.

Starlight I don't have any btter advice than what you have already had but hope you get the birth you want - put your foot down and repeat the mantra "I am hvaing a homebirth, when can I expect the midwife"

Good luck and congrats!

Starlight, if you are "low-risk" obstetrically, there shouldn't be too much fuss about agreeing the homebirth when you see them.

If you go into labour before the home visit,, ring delivery suite, tell them you are term and ask for the MW for your planned homebirth. If anyone gets arsey, tell them you are staying at home, its not your fault they haven't done your home visit yet (my HB team sees urgent term referrals within 48hrs, and we're not super well-staffed) and ask for a Supervisor of Midwives to sort it out for you if they can't!

remember, everyone starts their labour at home unless they're being induced?.

Starrlight - if I remember correctly from another thread, you have recently moved house? I wondered whether you would be made to jump through hoops if you wanted a CLU birth. But having said that, with an increased birth rate, CLUs are heaving at the seams, so you might have got turned away there too.

I hope it all works out OK for you.

I haven't read through all the posts but remember starlight that you were going to have issues when you moved house. I just had my homebirth on 13th May (DC1 - little girl) all went very well and my two MWs were wonderful, but thought I'd copy a previous post to give you the homebirth checklist the mw left with me the reasons for transfer to hospital which are the risks they run through with you to get you to agree to transfer if you/baby requires it (mw's explanation why in brackets). The only other stuff she covered is whether we have hot & cold running water, a toilet & refreshments the MWs can use, do we have suitable fire escapes, all common sense stuff but as usual with NHS the paperwork has to go in the file so they can cover themselves. Anyway here you go, hope it helps:

Prolonged rupture of membranes (ie no contractions after waters break)
Meconium stained waters (possible sign of fetal distress)
Failure to progress in labour
Fetal distress (would be recognised by monitoring heart rate)
Excessive vaginal bleeding (lots of red blood rather than a bloody show)
Further analgesia (pain relief, ie: epidural. I picked up my prescription for Pethidine today from GP )
Retained placenta (can only be removed in theatre)
Neonatal complications (low APGAR score or other issues)
Third degree tear (hard for MW to stitch these without appropriate pain relief and equipment/lighting)
Babies who are below 10th centile (as low birth weight may indicate other issues)

As she kept saying - it's all about keeping you and baby safe! Also, as you are monitored more frequently at home (every 15 mins in active labout after waters broke and every 5 min during transition/pushing stage) they tend to pick up issues more quickly and transfer you faster than waiting to see as they might in hospital.

Ooh, BTW, someone said a hospital would have to take you in if you're in labour. Not ours unless you went to A&E in ambulance with serious complications, they regularly have to close the ward and you get sent to another hospital to have your baby there (nearest is 25 miles away). One of my reasons for homebirth is I really didn't fancy transferring that far with contractions 3-4 mins apart (which is when my hospital "lets" you phone triage to come in!)

All this no room for transfer stuff is just weird. Mine was entirely organised by labour ward and the midwives were ringing in with updates for the board. Surely you'd have the same problem if you were in a delivery suite and needed to go to theatre?

I was amazed at how organised it was. My mum I think expected some hippy midwife to turn up with a rucksack and a couple of towels and was very reassured when I explained the reality.

im a first yr student midwife so dont shoot the messenger when i did my community placement i went to a few homes to do the home assessment. firstly i think there is an element of checking out the home physically and assessing access..even though someone might say i live in bog standard terrace....they have to document if its actually a canal boat/caravan down an unlit path/high rise flat with no lifts or bog standard terrace...this is to ensure that timely access can be made...its not doubting information given but a midwife has to assess and document everything....to ensure that care is planned fully to the letter. there is also i think the time to explain the medication that the mum will need to get a prescription for that has to be kept in the fridge...syntometrine etc. the community midwives i met loved home births...thats why they move into community midwifery, its stepping away from a medicalised birth which may cascade into further interventions/continual monitoring. i didn't attend any home births but they are supposed to be amazing as they are usually calmer and the woman is able to nest more at home (they do use the word 'nest'!). all in all i think unfortunately things have to be documented again and again and everything is based on assessment. i hope you get to have the birth that you want and that you have all the support that you could wish for...good luck...i have a night shift tonight on one of the busiest delivery suites...eek!

Thanks all. Homebirth mw coming in 5 mins.

Apparently the risks thing is simply arse covering for legal reasons.

Booked in last week so all official now. Pool here too. Baby measuring spot on and everything else in order . Not in right place but not

Oh that didn't go to well.......

Tried very hard not to argue.

Glad you didn't go into labour before the visit, Starlight! So you're all set! Now fingers crossed you don't go horrendously overdue or anything.

What did you have to not argue about?