In two minds about having a home birth

[ViolaCrayola]

I had a horrible hospital induction 1st time around (have posted about this before), now 31 weeks with DC2.

Have been seriously considering a home water birth - have terrible SPD and water really helps. Plus all the other pros about home comforts, privacy, 1-1 care etc.

But I am very unsure that I actually want to have a baby at home! People seem to often be either very definite about home births one way or another, but I just feel undecided. Has anyone else felt like this? How did you decide eventually? Time is running out! :)

Madly Picking up this point: homebirth can be fine, but women need to be aware that it is sometimes not. I doubt if there is a woman on this thread seeking a homebirth who has not had the risks explained to her. 50 - 60 years ago, that might well have been the case and I think your point would have been more valid.

I would dearly love to see the risks of hospital birth explained to women.

MrsDeVere & Starlight Interestingly enough the RCOG paper linked to this morning doesn't think you have to be middle class to have a home birth.

Snip from section 4.3 Home birth provision should take into account women's individual needs, especially women from socially excluded, disadvantaged and minority backgrounds, as they are less likely to access services or to ask for home births.

As a complete tangential by the by - nothing wrong with some nice homemade yogurt, lentils, or weaving

inductions can be hard and fast I was induced with both mine. second baby was much easier to deliver did what I wanted the second time refused to lie on the bed and delivered standing up. I would never have had a home birth because you cannot predict if baby will become distressed but that is just me you just have to be clear on what you want and you will be more confident this time.

Cacm, home birth babies are monitored in the same way as hospital babies, you wouldn't have a c section after one decel of the fetal heart in hospital, whereas at home, any deviation from the norm ie a deceleration, you'd be advised for transfer to hospital in case of further complications. Midwives are trained to deal with this. Home birth is not about respecting the safety of your baby.

^Too true - 'tis doctors like Carrie that give obstetricians a bad name and, ironically, create the backlash against hospital birth that they constantly moan about.

Any other doctors lurking on this thread? It would be sooooo nice to hear from some non-loony medics who are capable of understanding evidence.^

zoobmeister I posted the other day - a few pages back now I think - I'm not an obstetrician, but I am a medical hospital doctor and I'm having a home birth. I'd like close midwife care not random people in and out of the room, the evidence shows it's as safe, I'd like to maximise my chances of the labour being shorter and easier, I'm keen to avoid unnecessary intervention, and if needed I live 5 mins from the maternity unit, probably faster by ambulance.

I would advise a low-risk woman to have her baby in the environment she felt most relaxed and safe and supported in, as the outcomes are the same. For some (most) women this is definitely hospital. For others it isn't.

I have noticed a real panicky, emotional, gut response to the idea of home births in the medical profession, I still don't really know why this is. I do think dealing with disaster every day does skew your perspective of risk and this is why evidence is important. I thrombolysed an 18 year old with a stroke (!!!) the other week - but I don't go home and worry about my headaches. Human beings (and doctors are human beings) are not very good at intuitively calculating risk. Getting in a car is quite dangerous. Would you RISK putting a baby in a car... well, everyone does.

I have been watching this thread with interest as like the OP I am also debating whether to have a homebirth. The thought of a homebirth hadn't actually occurred to me until my midwife suggested it at my booking in appointment last week.

The difference is that this is my first time, so statistically it is slightly more risky for me than a hospital birth. However, I am slowly coming to the conclusion that any risk is probably mitigated by the fact that I live a 5 minute drive from the hospital. As someone pointed out upthread, I could almost certainly be in hospital quicker than an operating theatre could be ready, so the transfer time seems to hospital is outweighed by the benefits of having 1-1 midwife care.

The outcomes for mothers seem to be much better at home (although I wonder if this is because women are less likely to have a homebirth the first time around, and first labours tend to be the worst?).

One thing which is really pushing me towards HB is that I have heard many stories of people being turned away from my local hospital because it is full, and the thought of a 40 minute drive to the second nearest hospital fills me with dread, especially as my DP doesn't drive so it would be in the back of a taxi.

I don't think of myself as hippy dippy in the slightest, this just seems like the most sensible option based on the evidence. I don't see why this would be rejecting the benefits of modern medicine; I would only go ahead with a HB if modern antenatal screening techniques continue to confirm that I am low risk at the time of birth, and I would quite rightly be whisked off to hospital at the first hint of trouble.

Oh and the option of a birthing centre doesn't make sense for me as the nearest one is 40 minutes away in the countryside, and a lot further from a hospital than I would be at home.

This thread has been really helpful to me forming an opinion, so thanks to everyone who's posted (both for and against).

with regards to monitoring,it depends on you and the midwife,i wanted to be left alone during labour unless there was a real reason for intervention,i just wanted someone there in case the baby was born and needed help,i caught them all myself,the midwife came at the pushing stage though,i imagine if a mw wanted to they could force the 15 minute check rule,well they couldnt force you but they could make you feel like you have to have it or they could refuse to be there unless you do,it all depends on what you are comfortable with!

I didnt feel that 15 minute monitoring was forced.... I rather felt that it was part of checking all was well and therefore home plan still good idea. I had HB with second but fully medicalised. I only live 5 minutes from the hospital so figured that by the time they'd prepped theatre I'd be there. It was just a bit like the delivery suite being my lounge. Obviously everyone assesses the risk differently.

FWIW OP I didnt decide till I ended up on labour ward for the 2nd time at 32 weeks. I walked out saying 'I never want to come back!' Luckily I didnt have to.

I think the doctor views are just scary from the calibre of intellect perspective. Thankfully not all doctors are like that!

You could be killed in a car crash on the way to hospital (no-one's mentioned that) although I guess you are lower risk for that too the closer it is!

I think its great if your wishes are listened to cuddler I am glad that you were able to get what you wanted. I wanted the same but just didnt trust I would be assertive enough in that environment.
Big problem I have found is that when you are in hosptial you are infantalized. Infact as soon as you get pregnant (possibly one of the main markers of being a 'grown up') you are treated like a child.

The difference between my home and hospital births were many but the main one was the way I was treated.
It was my home and the HCP treated me with far more respect and I was far more confident. OK, I was caught out by one midwife who did a very painful internal but I learnt from that and it never happened again.

I was able to say what I wanted and I was listened to. I was monitored to a necessary and safe extent but there was no hooking me up to a monitor 'just in case'. The midwives had to rely on their expertise and trust me.

I have spent far to much time in hosptials being treated poorly, ignored, humilitated and fobbed off to want to trust the care of my baby to one. A huge, impersonal machine staffed by over worked and undervalued people. Just another woman having just another baby.

It is very difficult to see someone as just another woman having a baby when you are in her bedroom surrounded by her photos and things and her other children are downstairs playing whilst her partner is making the tea.

brettgirl i wasnt saying they force it,i was saying that if you say you dont want it,then the mw COULD make you feel like you HAVE to have it?Does that make sense?Im just trying to say that with monitoring it depends on how much you want and how much-or how little- the mw feels comfortable with giving.

I think cuddler it just starts to show how different home births can be depending on the woman giving birth. I definitely did want monitoring!!!! I'm actually very risk averse - as dd2 was born in January my main worry was snow!

In my hb, just a fortnight ago, I was the director of operations. I did my own internals for a start.

I was in the pool when the Mws arrived to make it clear they weren't gonna do internals and I told THEM when baby had crowned. I told THEM that i'm not gonna push yet, and then announced that with next push I was gonna pop the head out. I told them that once head is out I'm gonna get off my knees and sit back and deliver forward so if they wanna see it they need to come round to the other side of the pool.

When baby was out I brought him to surface and told them I was staying put with cord uncut until the placenta came out naturally. I told them I was gonna feed before they checked me or weighed baby.

And you know what? They told me that they enjoyed the birth, that it was good to see a woman take control and know her mind. they were fab!

I'm a midwife who has had one hospital and two homebirths, all good safe experiences for me.

I currently work in a midwife led unit within a consultant unit which means that if there are concerns the woman can be moved to the labour ward within a few minutes. We have around a thousand births a year and rarely have to transfer anyone running!

I have been to lots of home births and births in out of hospital midwife led units during my career, there have been some slightly worrying moments and I have had to do some transfers but I can honestly say that the most worrying times I have had as a midwife have all been in the labour ward when the doctors have all been in theatre, or when I have had a woman with an abnormal fetal heart rate trace and you are just wondering is that baby going to be ok.

One of the anaesthetists that has posted on here has stated that in the event of a severe emergency happening within the hospital the woman can be in theatre within a few minutes. This is usually the case, but if there is only one theatre she will have to wait until it is free, clean and the staff have sorted out the first woman. It is not always possible to just get on and do a section at the drop of a hat.

I would recommend to any low risk woman to plan a homebirth, if she doesn't want to do it in labour, she can decide to move to hospital. Where as if she books for hospital and then decides at the last minute she wants a home birth, it is more difficult to manage.

lots of great points made on here, i was booked in for a home birth with 4 out of my 5, it didnt happen as i always went overdue, and having got to more than 2wks overdue i got fed up and went in to be induced, despite that i had good birth BUT i had to be very forceful with what i wanted and so did dp to support me.

one example ds3's birth, 18 days overdue and consistently during his labour there was a registrar who KEPT coming into my delivery room and trying to insist i was on my back on the bed for monitering, despite the fact i had had the 20mins of monitering and then was having intermittent monitering as baby was FINE, i was labouring in the bath and then on birth ball etc, in the end i agreed to have another 20min monitering session, but stayed on the birth ball, which he did NOT like, the trace showed baby was fine ,so off came the moniter, but he STILl wanted me on the bed with the moniter on, wouldnt give a reason why! luckily i had my dp to support me, the midwife was lovely but very young and she was obviously intimidated by the registrar, in the end the head midwife who was in charge that night came in, she had i think heard the disagreement! and asked what the issue was, so i explained and the registrar kept insisting that i should be on the moniter! to which the head midiwfie look at the traces, listened to the baby herself and felt his position etc and declared all was fine and told the registrar in no uncertain terms to go away and that he would be called if he was NEEDED!

labour progressed fine, ds3 was born in 3hrs with me kneeling up, 9lb 3oz apgar of 10, all perfect!

the head midwife later explained to me that she had been having to keep an eye on that registrar as it was a quiet night and he was 'looking for something to do' and as i was 18days overdue that made me an 'interesting case' so he wanted to get involved! you know what had he asked politely if he could have sat and observed the birth i would have let him! have had students at some of my births quite happily as long as they sit quietly are polite, hell ihave even let students to internals as they have to learn and i am happy for them to do so. But no he wanted to take over and have me birth his way, well sorry but it is me doing the birthing and i will do it my way, had their been reasons to be concerned then yes i would have had more monitering, no labouring on my back tho, i deliver big babies and need to be upright, in always deliver better that way (learnt that after ds1!) and i strongly suspect had he got his way and i was flat on my back wiht a moniter attached i could well have ended up with other interventions.

similar experience with baby no 5 and a registrar trying to insist i was on my back ont he bed, the midwife disagreed with him this time! i did concede to having a drip sited just in case,put in as technically i was higher risk for pph as it was baby no 5, tho i have never bled heavily after any of my births. but he really tried to put the fear of god into me and did NOT want me having an active labour, sitting on the birth ball or heaven forbid going in the birthing pool!

incidentally the one issue where i needed drs input with my 5th birth and they failed to give it was ant-natally i was taking citalopram (due to pnp after ds4) only a very small dose but it was agreed by the cpn and the mh team and my gp that it was best to stay on a low dose 10mg throughout pregnancy rather than come off it, just to be safe, this was fine but i was referred to a consulatan because of this and my history of pnp, the idea being that they had to check and just as a bit of back up etc.

i was fine to do this but each time i saw the consultant they failed to read my notes and assumed i was there to book in for a c section! their argument was that i was small and dp is tall and i obviously couldnt deliver a baby that was 9lb or more (scans had predicted dd to be at least 9lb) if they had LOOKED at my notes they would have seen that all my babies had been 9lb+ and ds4 was 10lb 13oz and delivered in the birth pool! when i pointed this out i was told i had got lucky and he still thought i should have a section for no 5, despite having delivered 4 big babies easily!

i told him i was there because of my history of pnp, he said well i dont know why and sent me on my way, but what he SHOULD have done was flagged me up to the scbu team as in some rare cases it can cause withdrawl problems for hte baby after birth when a mum takes citalopram in pregnancy, this is VERY rare but the point is if it was on my notes then someone from scbu would have come to her birth and then checked her over and made arrangements for us both to stay in 24hrs post birth so she could be monitered.

however i never knew this so after she was born we were all set to go home, midwife etc thougth it should be fine, very straightforward 3hr labour etc, it was only when the registrar who checked dd at the very end said are you taking any medications and i said yes, again had he READ my notes he would have seen this as it was documented clearly by my midwife and letters were in my notes from cpn/gp etc!! the registrar totally freaked out that i was taking citalopram!! esp as i was bfeeding newborn dd and wanted me to stop bfeedign, i had already had this aspect covered and checked out (no thanks to mnet!) and knew it was fine and told him so. he refused to believe me but it was a sunday afternoon, no-one more senior available, so they phoned numerous people and after many hours to and froing he agreed i could bfeed (how nice of him!) but that i would stay in 24hrs to have dd monitered, i did this and she was fine and a lovely lovely consultant from scbu came in extra early on the monday morning (having been informed of the commotion) and checked dd and said we were fine to go. she also told me i MUST complain to PALS as it was clearly written on my notes that i was taking citalopram and it should have been flagged up to scbu by the consultant that i saw in pregnancy (the one who was more interested in wanting me to have a section!) she was really cross and said it shouldnt have happened they have very simple protocols and this consultant failed to follow them.

i was hugely annoyed that what should have been a lovely cuddly, peaceful time with my newborn dd was ruined by that snotty registrar who at one point started talking about informing ss (because i was bfeeding and had been planning to go straight home after the birth) all that could have been avoided HAd the consultant done his job and flagged me up to scbu who would have checked me over and explained the protocol of checking baby at birth and monitering for 24hrs, also knowing i was going to be staying in would have meant i would have been better prepared both mentally (as i dont like hospitals)a nd in practical terms for stuff for me, baby and also childcare etc for my other 4 children at home!

thankfully the staff on the post natal ward were lovely they had heard about the issue and were aghast at the registrar telling me not to bfeed, they also sorted me out a supply of nappies, pads for me etc as i only had a few, not enough for an overnight stay.

anyway that is a bit of an essay! yes hospitals are great and they can save lives but they also make cock ups and yes there are drs out there who want to intervene 'just for fun' and had i not been strong minded and had a good supportive partner then i may well have ended up doing what they wanted.

overall i am happy with my experience i have 5 amazing children and have met many many lovely midwifes and even some lovely drs! but the times i was made to feel like a silly child and spoken down to etc were annoying and patronising, there are plenty more that i havent mentioned, ie when preg with ds1 i had spd so bad i had to be admitted, and the dr telling me 'i was supposed to be uncomfortable i was pregnant' and the ones suprised at how well dp and i were coping with the birht of ds2, as we were young and it was unusual to see a young couple cope so well and be focused and calm etc! ( i think that was 'meant' as a compliment!)

anway op i agree book in for a homebirth you can always change your mind and even if you do end up at hospital you can still have a great birth, i would say tho you need to be prepared and so does you partner, to stand your groudn, dont hesitate to get a second opinion and to get them to explain to you why they want to do things and the risk etc, they may not warm to you for doing this, but so what they have a duty of care, make them stick to it!

EdgarAllen you said explained this three times .

"0.9% is not three times 0.5% - those are the figures for 'serious adverse outcomes' for first timers in the study."

This is not the proper comparison because this included the high risk group that were transfered to consultant care - so not fair to the obstetric group.

For comparable groups the study showed home birth is roughly 2.8 - 4.6 times as risky for first time mums.

I can't see your point Ushy - it was supposed to be a study of low risk cases. It seems perfectly legitimate to exclude those who are found to be high risk.
In the same way, (if I remember correctly) that those who went on to inductions were no longer deemed to be low risk and were excluded - even though some of those would be inductions due to a date on the calendar rather than a genuine assessment of risk.

La Volcan

The point is that the obstetric units had the extra high risk cases but the other birth places didn't.

Obviously, if you are doing any kind of study you need to ensure the groups you are comparing are equally matched. That is why they then compared again, removing the group that had complications which is where the 2.8-4.6 times risk comes in.

However, this is ONLY for first time mums.

Having suffered a dreadful miscarriage on a labour ward once, and lost an incredible amount of blood, I mean incredible, great puddles on the floor, with no medical care apparent at the time because they had buggered off when it happened, I would not trust a hospital to see to a PPH any better than a couple of midwives with their injections and access to a phone to call an ambulance.

My son'a heart rate was distressed for ages before anyone did anything. At home I would have been transferred immediately.

I was one of those high risk women who laboured in hospital hooked up to a machine. It didn't mean there were actually staff in the room watching that machine for most of the time; they popped in now and then when they had a moment to spare from the other labouring women.

During my second labour, there was such a shortage of beds (actual beds, not just staff) that women were labouring up on the ante-natal ward and in the corridors.

During my first labour, when the fire alarm went off and the building was swarming with fire men, noone came to see that I was all right or if I needed help to get out: we made our way to the exit point and back after an hour or so; the midwives didn't even seem to have missed us. If I'd been at home and the fire alarm had gone, my HB midwife would have known what became of me.

I was happy to give birth in hospital and that would always have been my choice, but I do think Carrie is a bit unfair, comparing the risks that could happen at home with the idea of what ought to be happening in hospital (which isn't necessarily what does happen).

Boffinmum I think what you have said is true.

"Having suffered a dreadful miscarriage on a labour ward once, and lost an incredible amount of blood, I mean incredible, great puddles on the floor, with no medical care apparent at the time because they had buggered off when it happened, I would not trust a hospital to see to a PPH any better than a couple of midwives with their injections and access to a phone to call an ambulance."

But you could equally argue that your treatment would have been better if there had been doctors around. This is what really me.

Care is so crap in hospitals that you'd be just as well off with a midwife??????

Hello? No, personally I would like BETTER care in hospital......

Just as a small point re the midwife not enforcing the 15 minute fetal heart checks, it is very very unfair to ask a midwife not to do this unless fully discussed beforehand, that midwife is accountable not just to you but her managers, supervisor and ultimately the NMC. 15 minutely auscultation is best practice for ensuring your babies safety (progressing to 5 minutely auscultation in the second stage) if you are asking your midwife not to do this ie not to monitor your baby to the best of her ability then you really need to clarify this before labour and agree to take responsibility for the fact that the midwife may as a result miss early signs of distress in your baby. I fully subscribe to the your baby, your body, your choice mantra and am a huge woman's advocate but I think if you wish a midwife to attend to you in labour she should be free to do her job in order to make labour and birth a safe experience for you and your baby.

If you want to have care which goes against the midwives' recommendations it's a good idea to very clearly write it all down and discuss it with the midwives first. Allow them to explain to you why they recommend what they do, and then make your decision.

If you are clear that for examply you don't want monitoring every 15 minutes write a clear birth plan with this in it, saying you understand that it goes against guidelines but it is nonetheless your decision, and send a few copies of that birth plan to the midwives looking after you (or who might be on call) well before the birth. Then you won't have to be having that discussion while you're contracting.

It is absolutely your right to have a homebirth and to choose or decline whichever aspects of care you want, but it is important that those involved in your care can know that you are aware of the risks and benefits of your choices. If they don't have that discussion then they are not doing their job properly. If they don't adhere to your choices, even if they disagree with them, they are not doing their job properly. I personally might include something along the lines of 'while it is my choice not to be monitored every 15 minutes I will of course be happy to change this if it appears my baby's health is at risk' or whatever, but that's up to you. Labour can change in seconds so it's always good to be flexible, but make it very clear that everything should be discussed with you first.