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! :)

being in a hospital setting is no guarantee of adequate appropriate or timely medical care

I knew this thread would go this way!

Carrie, dd and I were much safer at home being closely monitored by an experienced midwife than we would have been being ignored in hospital or fobbed off on the phone.

It just seems like a huge risk to take for very little benefit.
I had a huge unexpected placental abruption with ds1 just before transition, even with the best hospital treatment, he was still in special care for 2 days and I was in HCU.
Why risk it?

You work in a hospital. That isnt the 'real world'. It is a place where people tend to go because they are having difficulties.
We all live in the real world.
I work in a specialist children's centre. Quite a few of the children are under us because of birth injury.
Born in hospital.

I dont think that makes hospitals dangerous.
Why doesnt the same logic apply when talking about HBs

Even with all the statistics to back them up as safe?

Its not a huge risk though.

I am really sorry you had such a trumatic time with your baby Karo. That happened in hospital. You really cannot say what would have happened if you were at home. I hope he is well now.

I see a lot of posts along the lines of 'we would have died if we had been at home'
This may be true in some cases but for many it isnt the case or there is no way of telling if it would be.

I have had loads of women tell me 'my baby had the cord wrapped round him, he would have died' I know that some babies do very sadly die due to cord complications but in many cases the cord is removed, this is done at home too.
DC5 had the cord wrapped round him several times.

When I tell them that they are astounded. A lot of the fear is down to just not understanding how things happen.

If we accept that a) childbirth is inherently risky & b) that we have good medical care in the Western world (vs developing world) so we should use it as arguments against homebirth, isn't that also an argument against any woman being left to labour naturally, give birth vaginally and 'allowed' to go over EDD by even 1 day? Taken to extremes, which is the only place these incredibly rare but dangerous complications can be said to be, this means EVERY women should have an ELCS regardless so that all control is within the doctors hands. But then, all control isn't possible is it?!! Afterall, doctors are known to fuck up make mistakes....

Whilst I appreciate that every woman is a product of their experiences, and for some, this will be a very scary, dangerous situation in labour/birth, and this will colour one's opinion, I don't think it is helpful to scaremonger or imply that home birth is dangerous. Statistics can 'prove' anything but that doesn't mean it isn't shit when you are the 1 in a 100/1000/1000000 or whatever, but if we spent our whole lives saying its too risky to do x, we'd have to curl up in a ball in the centre of our bed & not do anything, ever, again. All things carry risk, we have to use the evidence we have to judge what risks are acceptable to us. Why else would people still smoke, drink alcohol, take drugs, drive cars, use chain saws etc??!!!

Karoleann - a friend lost a baby due to a placental abruption - it happened at about 34 weeks, so of itself being booked for a hospital birth didn't save the baby. I don't know whether better ante-natal care would have identified a problem or not.

Carrie370 being an obstetric anaesthetist makes you qualified to talk about anaesthetics but not necessarily any better informed than the rest of us to talk about birth.

I chose hospital births because I though it would be nice if somebody else washed the sheets...

However, my hospital birth could have been at home - couple of paracetamol as labour too advanced for anything other than gas and air which I hate, so I probably had a more basic birthing experience than I would have had with a planned home birth. (which was fine).

Maamaa makes an interesting point about mlu's - my midwife said that people suffering complications in a posh private hospital would also end up being transferred to an NHS hospital, and 40 mins seems a long time in an emergency, but those birthing options seem to be far less questioned?

Hmmm, I think you have to go with your instinct in the end. Which will you feel safer with. You could do what I did second time round.....decided to stay at home as long as possible as didn't want to do the to and fro the hospital that I did first time round.

So....I laboured on my own mostly at home for about 2 and half hours and then everything sped up majorly and I knew the baby was coming SOON, so DH whizzed me to the hospital (about 2 minutes drive away), and even this was not really soon enough- think baby was crowning as I stepped out of front door, swore very very loudly and all the neighbours came to see what was going on!- So... DD was BBA, in the car just outside the maternity wing, midwife just got there to catch her really. It was rather out of control, rather funny, a bit scary, but all ok, phew! I was recommended to have a home birth for no. 3 should I have a no. 3, which we are not. I much preferred labouring on my own at home, didn't have any pain relief, but at that last minute I wanted to be at the hospital- DH offered to phone the paramedics but I knew they would take longer than it would take for him to take me there!

Sorry, couldn't resist telling my story. My sister is a doctor and she could never recommend a home birth, but she did tell me that's because she's seen too much of what can happen when it all goes wrong....

Really interesting thread. I'm also deciding whether or not to plan a home birth for DC2.

Think Mayhew's point that you can book it and then change your mind is a very good one and that is the way I'm swaying at the moment. Also share the concern expressed by others that as a second time low risk mum in reality I would not get much attention in hospital. In addition, I just really love the idea of being in my own environment with my own comforts around me.

Still have a couple of nagging doubts though. I too have "pushed out a big boy with a big head" and really hope that this bodes well for next time. I just worry though that if this DC is significantly bigger (DS was 9lb 2oz) that this could result in problems at a late stage. I'd be really interested to know if there are any statistics in relation to outcomes for those who transfer in during a hb compared to those who labour in hospital rather than comparing outcomes of actually giving birth at home to giving birth in hospital iyswim.

LaVolcan I have been at thousands of births in a professional role. You have only been at your own deliveries. So yes, I am better informed about you to talk about birth.

PlumPie delivering large babies is inherently more risky - shoulder dystocia (when the head is delivered but the shoulders are wedged under the pelvic rim) is an obstetric emergency which can be rapidly fatal if the baby is not delivered swiftly. It is often not predictable, but large babies are more at risk.

Carrie Wow, thousands of births, that is quite a few !
Nevertheless your experiences go to make up your viewpoint just as mine give me my one

I think posts like Carrie's show that evidence based medicine hasn't made it to all corners of the NHS yet.

(Unless Carrie's not from the UK)

Carrie - the outcomes for babies booked for homebirth are as good as for those booked for a hospital birth.

The only group for which this is not true is the babies of first-time mothers, but this is not necessarily to do with not having immediate access to medical care: babies born to first time mums in free-standing birth centres have just as good outcomes as babies born in CLU's.

And of course the outcomes for women are MUCH better.

And probably a good proportion of the disasters you've seen at work are iatrogenic in origin. How do you feel about that? That mothers put themselves at increased risk of all the possible dangers that come with emergency surgery just by walking through the doors of your hospital?

Carrie how many low risk straight forward births have you attended? Births where everything goes right, the way it should do? If everything you see is birth going tits up it's understandable that your view of birth is as something that is dangerous and fraught with complications that are just waiting to happen to unsuspecting women and midwives when in reality, most births are not like that.

I freely admit my exerience is skewed. I attend the births where things are going 'tits up', not the 'normal' deliveries. But I have seen enough of them (and they are pretty common) to know that I would never recommend a home birth to any one I know. Going tits up is not predictable. You can call it 'scaremongering' or whatever you like, I am just putting forward my point of view.

Obstetricians do not intervene sugically on a whim, they do so because in their professional opinion it is the right thing to do at the time. We are in danger of forgetting that the majority of babies are born in hospital, and the proportion of higher risk mothers is greater, so of course we are going to see more iatrogenic problems/birth injuries/traumatised mothers in this population.

I suppose it boils down to an individual's attitude to risk. I can only say that a home birth is not a risk I would be willing to take or recommend to anyone I know. Most doctors who have worked on a delivery suite would say the same. I would not want to be hosing blood from a 3rd degree tear at home, while my placenta still hadn't delivered and my midwife was distracted trying to resuscitate my flat baby. It happens.

Carrie - shoulder dystcocia is something I am particularly concerned about. The info on homebirth.org however suggests that the manoevers that would be used to deal with it in the UK could just as easily be done at home as in hospital. I also wonder if there is potentially a higher incidence in hosptial due to increased chance of not having an active labour although I accept that I might be completely wrong about that.

What would be the specific advantages of being in hosptial rather than at home if it did occur given it would be too late for a cs?

You do know ther ate two midwives at a HB don't you?
So whilst one is attending to the placenta rh eorher would be recus'ing the baby whilst a paramedic was on the way.

I don't know about you but I have spent many many months on hospital wards and pressing a button does not guarantee a swift response.
Particularly on a over stretched labour ward.

This is just a musing really because I don't know the answer but midwives see just as many complicated births as obstetricians, I wonder why it is that doctors have that fear of birth as a normal process that midwives don't have?

PlumPie the problem is that the manoeuvres you mention do not always work, even in skilled hands. Because the head is delivered, the risk is of cord compression by the presenting shoulders - this is potentially very serious. A section is possible, by pulling the baby backwards by the feet up through the incision.

MrsDeVere I do know that, but when you have a patient in haemorrhagic shock, with no IV cannula, and a flat baby, even they would struggle, I think.

We have a system for obstetric emergencies; a 'crash bleep', which summons anaesthetist, obstetrician, paedatrician, physician, porters and the labour ward manager immediately. It is not left to someone gathering everyone by phone, or the random pressing of a button.

Just a quick note, HB midwives can and do cannulate and start fluids.

Midwives are not particularly good at cannulating, especially when the patient is shocked (medically speaking) and shut-down, with collapsed veins. Even anaesthetists struggle in that situation.

PlumPie, the other thing to mention about being in hospital is that you have immediate access to anaesthetic intervention, so that things you might not otherwise tolerate (forceps, episiotomy) can be done with a spinal or general anaesthetic (if the obstetrician doesn't think the situation is urgent enough to warrant a LSCS).

Carrie, another thing (sorry I'm not picking on you) although what you say about doing an emcs in case of a shoulder dystocia is true, it's hardly as simple as pulling up on the feet and getting the baby out, of the obstetricians I work with very few have ever seen The zavanelli manoeuvre in real life much less performed one, the action of reversing the rotation and flexion of the head is far more complex than you explained above. Emcs in the case of shoulder dystocia often results in hypoxia or death, it really isn't as simple as oh well if you had a shoulders in hospital we'd just do a section and you'd have a much better outcome than you would have at home.

Carrie - the proof of the pudding and all that.

There is no denying the truth of what you say about emergencies in labour.

Yet the outcomes for babies are comparable across birth settings; the outcomes for women giving birth in out of hospital settings are BETTER.

You need to go away and think about that.

You also need to take on board that many of the problems you see are CAUSED by being in hospital.

And you need to go away and think about that too.

No, Benedicts, I accept that, I just meant that it was an option in hospital (although a last-ditch one) that obviously isn't available in the HB situation.

Shagmund, I think you have been listening to too many 'knit-your-own yogurt' NCT zealots when you make the statement about problems being caused by being in hospital.

I am just contributing to the debate, with my knowledge from my own professional experience. That is all.