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! :)

Edgar I am an obstetric anaesthetist, which I think makes me qualified to comment on the topic, don't you?

op actually i was thinking about this, because i like to get all facty figurey about home birth, but really that's not why i chose it first time round. i wasn't that well informed first time round.

I wanted -

privacy
no hassle (convenience wise)
home comforts (telly during early stage, own bed, bath tea facilities)
carpets (to burn a hole in whilst pacing during labour)
my own space

all touchy feely benefits.

I also got - that first time- a moment of purest happiness and joy when my DD1 was born. and my bedroom is the wonderful place where all my children were born.
it isn't just a choice against hospital - all things being equal i'd still choose to give birth at home.

i think if you'd actually read any evidence, such as the Bithplace study the NHS spent £798k producing last year, you'd be aware that home birth is a safe option.

People on this thread are mainly talking about prolonged or obstructed labour. In these cases, transfer to hospital to be sorted out is not urgent, unless there is fetal distress.

My problem is that women in labour are not fully informed of the catastrophic (admittedly rare) things that can happen, and which require immediate obstetric and paediatric intervention.

Childbirth carries a risk, wherever it takes place. This is why I made a will during my pregnancy. The OP has already had a baby and had a negative experience in hospital and is asking for advice about home births as she's considering one this time round; she's a second time mum so I'm sure she is aware of the inherent risks.

i will say it again: according to the best/ most recent / relevant study - home is the safest place for a low risk woman to have her second or subsequent child...

they surveyed 60000+ women. enough rare adverse outcomes to draw a statistically valid conclusion - home still safe.

Edgar the OP asked for opinions and I am giving mine. I don't need multimillion pound studies to tell me what I already know, which is that when the shit hits the fan, the hospital is the place to be.

I'm glad you had easy births. Tell that to the woman brought into my hospital from home with a dead baby recently.

Thanks, Edgar :)

that study also found that there was no significant difference in still birth rates between birth places.

you are allowed to scaremonger. i am allowed to quote the evidence.

the professional bodies of Midwives and Obstetricians alike support home birth as a safe option.

that is, for low risk women.

"I don't need multimillion pound studies to tell me what I already know,"

this is a very dangerous opinion for a medical person to have.

experience is often misleading.

and £798k isn't even one million.

So no babies die in hospital, no mothers?
No babies are saved by midwives at home?

In your job, would you not be most likely to be called when there is a problem during birth?
Do you not think that is likely to skew your view a bit?

I worked in A&E for 6 years (non clinical post). This was before I had a baby. When I became pregnant I was pretty much certain it would end in miscarriage.
Years of seeing women coming in bleeding PV will do that.

tell that to the woman who came into your hosptial with a dead baby recently?
Tell it to the several women I know who lost their babies in hospital or the ones with birth injuries.

I was a 'low risk woman'. If I'd chosen to labour at home, I would have a dead or severely brain damaged child, instead of the perfectly healthy one I have.

You can spout statistics all you like, I know what I see at my work, and I know what my own experience was. For me, that's enough to discourage anyone from risking their health and that of their baby by choosing to be at home, out of reach of immediate medical attention.

Homebirths are safe - when they go according to plan.

Personally, I believe a baby with Shoulder Dystocia has a better chance outcome being born at home (with midwife care) than in hospital. That is why I became even more determined for a homebirth when some things indicated I would be having a big baby.

Equally, I think Shoulder Dystocia is less likely to occur in the first place in a home birth, given some of the risk is due to induction, poor positioning and above all forceps, - all much less likely in a homebirth.

Carrie, - you don't know that. You don't know for certain that your baby wouldn't have presented better in a homebirth.

Place of birth affects positioning, length of labour, hormones and effectiveness of contractions in turning babies.

I'm a hospital doctor (not an obstetrician, a medical doctor) and I have been looking at a lot of the evidence for home births and I'd like to thank Edgar for quoting things both factually and calmly. I think doctors as a group are particularly emotional about the topic of home births, and I don't think your profession necessarily means you think about things more or less logically than the next intelligent person. It's fine for people to have emotional responses and preferences for treatment or labour based on their experiences or beliefs, but I think actual advice to others needs to be based on evidence.

I also think it's sad we have a shortage of midwives and some people's hospital experience is so poor and sometimes more un-monitored than it should be. I don't think that should be a reason for picking a home birth and I wish it wasn't so, but I have to say two experienced midwives at home monitoring with plenty of time to anticipate problems and transfer to a hospital sounds a lot safer than labouring with a student or mostly alone in a hospital. It depends how far from a hospital you live, of course.

Anecdotally, I monitored a lady throughout her labour and delivered her baby for 10 hours when I was a medical student with exactly 1 week of obstetric experience. The midwife put her head in once, she was very busy. I remember it as an amazing experience, but I don't think that should be happening. (Mum still sends me pictures of birthdays all these years later!)

I was much more relaxed being in hospital and not having to worry. The nice thing is that when it is your second you can concentrate on the baby, at home you have to pay attention to the older one. You are hardly in for long anyway.

Oh, give me strength! Starlight your obstetrician needs to explain a few things to you!

My work here is done.

What work is that Carrie, to give people more faith in the protocols and procedures within hospital? To reassure people that medical decisions are made using sound evidence?

exotic I had my second in a stand alone MLU for that reason. My house was too messy and my eldest has ASD. I wanted to get AWAY from home to concentrate on labour and birth and have some bonding time before having to deal with the fall out with DS.

I had this feeling too. I booked a hb because I could change my mind. In the end I went to hospital. For me I was worry about a fast labour, didn't want to get caught out so I wasn't choosing a hb as such. I just didn't want an accidental one. As it turned out I did well at home and arrived at hospital and gave birth half an hour later .

I defo felt better feeling like I was in control of where it would happen.

Carrie370 You say "I have seen placental abruptions, cord prolapses, amniotic fluid embolisms, major haemorrhages - all treatable when medical attention is at hand, but easily fatal for mother/baby in the living room of your house." are you also saying that none of these occurrances within a hospital are easily fatal within a hosptial? Have you never lost a mother on the operating table? Do all cord prolapses that occur at home mean dead mother/baby?

You might be an obstetric anaesthetist and mother, but that does not mean that you should make a comment like "I would go as far as to say that anyone contemplating home birth needs a reality check. We are in the 21st century now - why would anyone deliberately jeopardise the well-being of their baby" - as it is very obvious that science and hospitals cannot save all babys and their mothers, hosptial is not "safer" for all. I and many others don't need a reality check regarding homebirth.

I could make a statement such as encouraging hospital births is just increasing your workload, that would not make it categorically true, despite the increased use of epidurals that lead to the knock on effect of other inteventions.... Please don't let your extreme experience lead to more women requiring your services. Your statements are inflammatory and not an accurate reflection of what happens in the real world.

Inflammatory and unprofessional.

Anyway,
the siblings issue - I actually relaxed much more at home because I didnt have to worry about the other kids.
I had a day and a night birth and the DCs were easily managed and nothing will beat seeing their little faces when they came in and saw their mum with a baby in her arms.
My DS2 also has ASD starlight but in our case I found the lack of disruption for him, helped me to feel less stressed IYSWIM.

My OH is disabled and I was not confident that he would be treated well in a hospital environment. I didnt want to have to worry about him.

It was nice having him close by at home but he didnt come in until the end because I am better on my own.

I couldnt have asked for more. I cant see how my HB were more expensive than me going into hospital. Surely two midwives for a couple of hours cant be more expensive than hours and hours in hosptial with all the added costs of electricity, cleaning, heating, etc?

No, of course I'm not saying that, Willitbe! I'm simply saying that if a labouring mother is unlucky enough to experience an unanticipated obstetric emergency, the outcome is obviously going to be better if she is already within a hospital setting. Maternal death is catastrophic, but fortunately rare in this country, due to modern medicine - in the third world this is sadly not the case. Why would anyone choose not to avail themselves of it?

The epidural question is chicken-and-egg. Properly managed epidural anaesthesia should not lead to added intervention - the fact is that women who have epidurals are often the same ones who are experiencing prolonged labour, can no longer cope with the pain, and are going to end up with some sort of assisted delivery anyway.

I work in the real world, so I think I have quite an accurate take on what happens there!

my hb 2 weeks ago had midwives there for 9 mins of it.