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! :)

I have to say we were shocked when having our booking in appointment with the Midwife the other week she was really pushing for a home birth. We have some complications and this is our first we will be lucky to avoid CS and have the type of birth that we want.

Crazy apparently there is a trend towards home births which if you can have one great but it's not for me and I live in a location where its 40 mins to the nearest hospital too much of a risk for us.

StarBall, you're right, I do see the disasters, including the ones who come in from home, which though rare, are always in far worse shape nd have worse outcomes.
I don't dispute your decision for a moment, it was the right choice for you. What worries me is the number of women who choose a home birth who don't understand the risk and think they're just 5 mins from the hospital and so only adding 5 mins to emergency time. If fully informed then of course women should choose whichever option they're most comfortable with.
I had a really good calm birth. If I am lucky enough to have another I'd still go back to hospital.

I am one of the women that magnum is referring to. It turned out I had preclampsia. After my first birth I wouldn't consider a home birth.

If you were not happy with your first birth I would consider looking at different hospitals. I am in the US but the there are differences between the local hospitals. As an example my local hospital as birthing pools, acupunture, a chiropractor and other alternatives available. The other hospital has a midwife led unit and the third hospital is known for their amazing food and continued care.

I'm glad I had one for DD2 (even though I still believe epidurals are one of the best inventions ever!). I felt safer, as I knew there were medical professionals within earshot at all times and actually THERE whenever I wanted them to be.

It's lucky I had a home birth, actually, as otherwise I would have wound up with DH delivering Dd2 in the hospital carpark as it all went pretty quickly.

I found Magnum's minute counting very interesting and helpful as that is the way I also think about things and work things out, except I came out with a different result for me. I had Dd1 in hospital, and hardly ever saw any midwifes or hospital personnel, except right at the end. They stuck their heads in every hour and a half or so and then went away, probably to patients who were in more obvious need. So if something had happened, unless it was obvious to DH and me (blood pouring from every orifice or something - we aren't medical professionals and wouldn't have known), it would have been up to an hour and a half before anyone noticed, then they would have had to get theatre ready and do all the other stuff she listed. Whereas at home, it would have been picked up straight away, then I would have gone straight to hospital in the midwife's car (20 minutes), and by the time I reached the hospital everything would have been ready for me to go straight into theatre as the other midwife would have called ahead and got them ready. (The midwives explained this procedure to me as part of preparing for the birth.)

So this analysis depends on what your local hospital is like, how well-staffed it is and how far away you live.

The most sensible thing I've read about the home birth v hospital birth choice on MN is not that is is a question of more or less risky; it is a question of which SET of risks you choose to take. Except that if you decide to have a hospital birth, no-one sits you down and explains the risks to you as they do if you decide the other way.

What a long post! Eek!

Magnum but the women in the birthplace study ALL had uncomplicated, straightforward pregnancies didn't they?

So it isn't a case of stats being skewed by low risk women choosing a homebirth being compared to high risk women choosing a hospital - it was low risk women choosing a homebirth 'vs' low risk women choosing a hospital birth or choosing a MLU birth. That stops the skewing of figures somewhat. A low risk woman having a second or subsequent baby at home is as or more likely to have a good outcome as a low risk woman choosing a hospital birth.

A high risk woman choosing a homebirth is more than made aware of the extra risks and increased likelihood of a poorer outcome.

Forgot to add that my preclampsia wouldn't have been caught if I had been at home. I was induced in the evening and given the option to stay or go home. The resident did a blood test in the morning after I told him that I opted to stay overnight because I didn't feel right. My blood pressure was in the normal range.

They tried everything to get me to deliver vaginally but I wasn't able to get past 5cm so they did a CS. A home birth wouldn't have caught the preclampsia and there is a good chance it could have gone untreated or I would have been rushed to hospital in a panic.

I had my baby at home, planned water birth and was totally brilliant. Do it, do it! My MW completely reassured me it would be a-ok (was dec so was worried about snow and ice/xmas etc!) that they have done HB in caravans in the wildest of the dales in gales. The privacy, space and comfort was brill and I had two MWs all to myself all through the labour (was 4 hours so very fast which was good as in hospital I think I would have been left to it).

If anything is going wrong it will usually take as long to get ambulanced to hospital as it would for the theatre to be set up so you will not be wasting time.

MW kit in the home is the same for resus as at hospital. They checked the baby's heartbeat with every contraction and if anything had been felt to be amiss we would have gone to hospital before anything serious could have possibly happened.

the www.homebirth.org website was great at allaying any fears I had and making me know that I was making an informed, risk averse decision to have my baby at home (try telling my MIL that though!)

And you can indeed change your mind at ANY time during your pg and labour. Wonderful.

good luck!

You're right flisspaps, but it's the level of bad outcome. If my baby was in distress during labour the extra 30 mins would add hugely to the level of injury that child may sustain. At that moment stats won't matter. I'm not saying women shouldn't have the option; it's just my own opinion.
Lisianthus- that's very poor care. It's the sort of reading that is becoming more common and makes me ashamed to work in the nhs. my midwife stayed with me in hospital.
Just a point of note, Home births do take a huge resource, much greater than in hospital and the provision contributes to the hospital teams lagging behind.

just to quickly say as well, that when you go into labour the hospital are informed (by you or the MW) so they take into account your labour as well as those women on the ward when it comes to staffing levels/ they will be ready for you if you need to go in, you won't be 'out of the system' as it were.

And magnum, sorry but there is plenty of evidence that having a HB is less of a strain/resource, certainly financially, which is why the tories love it so. I would agree though that it depends on the committment of your PCT to HB and hospital organisation skills as much as anything.

I'm not very definite, I find the person caring for you to be far more important than location. I've had a bad hospital birth, a great homebirth, an awful homebirth, and a good but difficult hospital birth and I'd say 90%+ of what made them what they were was the midwives and other care staff.

Afterwards, home is my preference, prefer my own food, bed, and it's much easier to ask DH for something. I know some who prefer the hospital particularly those that keep visitors at a minimum. .

Magnum it is very common in hospitals for midwives to leave you to it unless you are near the end. I had my first nine years ago and my dp had to go and find the mw to give me morphine, then find the mw when my baby's heart rate dropped. I am assuming you were in latter stages of labour or they knew you were a doctor. When I arrived at the hospital to give birth to second dc I was 9.5cm on examination do yep she stayed with me.

At the home birth with my third the midwives were with me from the first call out when I was found to be 6cm and then until I gave birth. She checked the heart beat very very regularly and discussed options when my labour slowed off a bit.

Sadly the only person I know in real life who lost a baby was in a hospital hooked up to a monitor. Just no-one checked that monitor for hours and hours.

So for most women one-to-one care is not the norm in the NHS and hasnt been for some time. If it was I think hospital birth would be more attractive.

Sorry for lengthy reply and I actually think the op should only labour at home if she is absolutely comfortable to do so.

I was later to hospital fran, 7cm on arrival, so that's probably why. But if a woman needs to be hooked up to a ctg she shouldn't be left. It's a great shame that people choose a home birth just to get a midwife to stay with them. Neither option is ideal. Hospital just my choice of the lesser of 2 evils, for me.

Franup - in one of my homebirths, the two midwives spent most of their time doing paperwork and making calls in another room, checks were sporadic, and their third stage care risked my life (yanked on the cord repeatedly and violently, while I screamed in agony, until the cord and a piece of placenta came out causing a massive PPH). A home birth does not guarantee a more attentive attendant. I was cared for and was attended far more in my hospital birth for the next DC.

Magnum, how do your reckon that homebirths impact on hospital care and leave it lagging behind? In most areas it is community midwives who cover homebirths - there is no overlap with hospital midwives.

Just a point of note, Home births do take a huge resource, much greater than in hospital and the provision contributes to the hospital teams lagging behind.

I don't think that is the case Magnum. The Place of Birth study that flisspaps quoted showed that even allowing for the one to one midwifery costs of home births, they were cheaper than hospital births.

But to go back to the OP - can you think about why you are undecided? Some common reasons are:
DH is against it - talking to others who have had a homebirth might help you decide.
The mess - I found there wasn't much and the midwife cleared it all up after she had run me a bath, and I was contentedly soaking. That seems to be pretty typical.
Transfer time if you need to transfer in - but you would need to consider how long it would take you to get to hospital if you booked a hospital birth.
Access to waterbirth - presumably you will sort it out at home, but would you be guaranteed a waterbirth in hospital?
Noise, and other people hearing you in labour. You will know whether this is a factor for you or not.
What if it goes wrong - well as has been said here, you need to consider whether you are more likely to be better attended at home or in hospital. I certainly think that Magnum is painting a very rosy picture of the response times of hospital.

I am sure there are more but these might help you in weighing up the balance of risks for each option.

"What worries me is the number of women who choose a home birth who don't understand the risk"

the post-corrected data for babies of low risk women in Clu vs low-risk women at home (additional correction for other risk factor differences between two groups) found actually a 0.1% reduction in 'severe adverse outcome' for babies from women commencing their labour at home.

in terms of lower-level adverse outcomes (neo-natal admission, feeding troubles) these were much higher amongst those choosing CLu to begin delivery.

in terms of maternal outcomes -

EMCS - 11% vs 2.8% HB
Forceps - 8% vs 2.3% HB

according to the best, most recent study data available -

home is the safest place for a low-risk woman to have her second or subsequent child.

i gave birth at home for the fourth time on Sunday night -

the hospital was so busy they were stalling people from coming in with the inevitable consequence that women were giving birth at home by accident, the ward was rammed...

my birth took 2 hours (the average homebirth labour takes 2 hours less than woman in CLU) - i would have been unlikely to have two midwives with me in hospital on that night. Did at home though....

What edgar and flisspaps said.

It is misleading - not to mention highly unscientific - to state that home birth is equally and unequivocally 'dangerous' or 'safe' for everyone. Research shows that it depends on the individual woman, her history and circumstances.

I always thought doctors should be expressing opinions on the basis of evidence not gut feel and anecdote, but hey, maybe I'm expecting too much

ViolaCrayola, remember that if your birth is very straightforward you could be home from hospital within a few hours if you want to be.

I enjoyed having my DC in hospital as I would have hated to clear up the mess we left behind us (one of my DC decided to test out their bowel and bladder immediately at the birth!).

This is one of the most interesting homebirth v hospital birth threads I've read on MN. Just one point, which Mouldy raises, and which i know is an aspect that puts some people off re tidying up afterwards. Our experience was that the midwives did the most brilliant job of tidying away. They put sheets and hospital squares down and bundled everything in a bag afterwards. You would never have known, within about half an hour afterwards, that a baby had just been born on our sitting room floor .

OP, I didn't have really strong feelings one way or the other and only decided on a homebirth at around 36 weeks. Like a couple of others posters have said, I had my hospital bag ready and was quite prepared to transfer if need be. I decided on a homebirth in the end because I knew I could change my mind at any point during the first stage, but the reverse would not be the case.

It all worked out very well for me in the end, with a long but comfortable first stage. Second stage took around two hours, and the lead MW told me that I only had a short while before she would have to call for an ambulance, but I felt that everything was very much under control, and had she had a moment's concern that the baby wasn't coping I know she wouldn't have hestitated to have me taken in. I felt, at 10 mins from the hospital, very safe as I was being so closely monitored.

Good luck with whichever option you choose. I loved my homebirth - still think of it very fondly - but I know it's not for everyone.

This is really interesting. DH is a doctor and is unsure about a homebirth for DC3. He's read the relevant studies (okay - he's read the summaries. I rarely meet doctors who read the ENTIRE study front to back! ;)) and he admits that his worries are entirely counter to the evidence, and based on powerful anecdote i.e. his own experiences.

Magnum, hospital birth was right for you. But the evidence against homebirth is NOT strong. There are weaknesses in the evidence against hospital birth too, but in my opinion they are fewer. It is a relatively difficult thing to study. Is your usual practice based on the best available epidemiological evidence (and relevant guidance from the Royal Colleges)? If so, why not your opinions about place of birth?

Some random points:

I spent most of my home birth in the downstairs loo, which was really grim before we had it done up! I kept muttering about fecking hating it!

Floor was covered with groundsheet from homebase, midwives were great at tidying away.

I got tucked up in my own bed that night.

We only lived 5 mins from the hospital with nee naws on.

I was told I had to go into hospital in early labour by the consultant, even though the ward was closed so would have had to drive 45 mins to next nearest one...I refused!

I felt in control..As much as was possible, in my own home after an emerg c-section 1st time round.

Good luck with your decision.

Hello. I had one baby at home and one in the hospital. Hospital birth much less painful and I felt safer. If you have a home birth make sure you've got people with you who are experienced. If you are at all anxious make sure they stay with you overnight after the birth when the midwife has gone home.
Little know fact is that midwives can't do internal stitches at a home birth. Senior registrars can though.

I am having a home birth this time. For ds I was left on my own, at one point for 6 hours. I was scared and alone. Ds was forceps after his heart rate dropped, but that I think was due to the syntocin and epidural I had to hurry me along.

Throughout the whole thing no one told me what was going on, I was given an episiotomoy without my knowledge and shouted at by a consultant.

If they hadn't been so neglectful in their care I may have had a different outcome. Sometimes hospitals are to blame for problems.

i had stitches done at home for a 2nd degree tear. they can transfer you after birth for them too, if necessary. this does differ trust to trust though.

a survey of women found they reported lower levels of experienced pain at home, the usage of analgesia is lower for a reason (i don't believe women giving birth at home are any tougher than those choosing CLU)

do you think that post-discharge you should have 'experienced' people with you?
or just after a home birth ? why?