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! :)

Fair do's but in that situation it'd be unlikely a good outcome no matter the setting.

Of course some problems are caused by being in hospital! It's very naive to think otherwise.

Again, chicken and egg!

"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."

What - you mean the NCT Zealots behind NHS Choices?

"However, when the researchers focused solely on women planning to have their first baby at home, they found they were almost three times more likely to suffer complications than if they went to hospital." (Info on NHS Choices on Place of Birth study 2011).

Maybe you can explain why 13% of healthy, low risk first time mums who book to give birth in a CLU have an emergency c/s rate compared to 6.1% of those who book to give birth in a free-standing midwife led unit?

And why four times as many healthy, low risk women who book to give birth in a CLU end up needing intensive or high dependency care following birth when compared to those giving birth in a freestanding midwife led unit.

Yack - that last one flags up the increased rates of poor outcomes for women having a first baby at home.

Meant to c+p this:

"The chance of receiving caesarean section for these low-risk women was lower in all three non-obstetric unit settings, with the lowest rates seen among women who had planned to deliver at home or at freestanding midwifery unit births.
obstetric unit: 11.1% (95% CI 9.5 to 13.0)
home: 2.8% (95% CI 2.3 to 3.4)
freestanding midwifery unit: 3.5% (95% CI 2.8 to 4.2)
alongside midwifery unit: 4.4% (95% CI 3.5 to 5.5)"

Never the less - the poorer outcomes (for babies, not for mothers) that are seen in first births at home are not also seen in FMU - where mothers ALSO have no access to emergency obstetric care on site. To me that says it's not the problems caused by lack of immediate obstetric input that results in the higher infant morbidity for first time mums delivering at home, but issues surrounding lack of experience of care-givers in that setting, and issues surrounding transfer.

I understand where Carrie is coming from to an extent. As a student MW I have seen my fair share of births going tits up and it colours your view. It puts the fear of god in you and makes you question birth. However, the evidence tells me that for second time mums, home is the safest place for mum and baby by a very small margin. I know those statistics are far more powerful and far more relevant in making a decision on place of birth than are my anecdotal experiences. What's the point of all this good, hard data if the medical profession is just going to discount it?

Re: the point about having access to spinal/epidural for emergency procedures in hospital, I have never heard of giving an epidural for an episiotomy!! And you wouldn't have forceps at home anyway, you would have transferred in for that. Also I have seen ventouse with no anaesthesia (shudder - no way would I allow that on myself) so there's no absolutee guarantee.

I'd not really heard of a cs involving the baby being pulled back up through the birth canal and would have thought it would have a fairly grim outcome as Benedict describes.

Slightly off-topic I know but is there anyway of either trying to avoid sd (eg position during birth) or any reliable predictors it's v likely to occur (eg signs earlier in labour, how big is 'big?' etc). I realise I may be asking the impossible!

Wrt to anastesia -if you needed an episiotomy at home could you not have a local? I appreciate it would be different if you needed forceps but wouldn't you transfer in for that anyway?

Shagmund, I am endlessly fascinated by the differences they found between MLUs and home for first time mothers. I hope they are going to do further investigation into that aspect of the study. I think you may be right that it has to do with better transfer arrangements and higher birth volumes, leading to more experienced care.

Probably because obstetricians are less willing to take risks when the woman is in hospital, or because problems are more easily identified I would imagine. Maybe the 13 - 6.1% would have got away with it - who knows? It's much the same argument as the home birthers who escape unscathed - we will never know.

We put women on ICU/HDU because the option is there.

There is a truism that the length of a woman's birth plan is in direct proportion to the likelihood of her needing intervention.

Carrie, my midwife and consultant both agree that my son had interventions purely because he was born in hospital. He would not have been failed ventouse and forceps if I hadn't have been given syntocin and an epidural.

Maybe if I hadn't been left on my own, scared and in pain for hours and someone had encouraged me in active birth, instead of telling me I couldn't leave my room. Maybe if any of the medical staff had paid me any attention above contempt I would have had different outcomes.

Actually my consultant said problems are identified less quickly in hospital as they become a little complacent and leave it to last minute. At home people would have paid attention to me much sooner and I would have been transferred.

Sorry but i am with Magnumicecreamaddict yes this is a physiological process and not necessarily a medical condition, but I think we should do well to remember how the hospitalisation of women in labour has reduced the maternal and child death rates over time, and unlike the days when home births Were common place there is no obstetric flying squad to help you or the baby if there Are unexpected complications these days.... I am also of the slightly cynical opinion that it is only being pushed to women as a great idea because if you choose not to be monitored and things go wrong, then it is difficult to file a law suit against the healthcare trust for continuing care for birth injury. Additionally, I am constantly amazed by the poor training in neonatal care that midwives receive ....if that baby has a problem, in hospital you will get the most senior paediatric doctor on site with you in minutes... At home, you have the skills of the person in front of you alone... Dealing with mum and baby who might have problems at the same time....) Just because you had a bad delivery in hospital won't guarantee a good one at home...make sure whatever your decision you are in the right place for that little person to be cared for!

In the case of a woman who is likely to give birth to a large baby and could be at increased risk of shoulder dystocia there is the option to cannulate during labour.
The way they do in hospital.

If a professional is on hand when things start going wrong the procedure you describe is probable.
However if you are one of the many women left alone for many hours I can assure you that it can take a lot longer than a few minutes to summon help and it is a matter of repeatedly pressing a button until someone responds.
Emergency protocols only work if there are enough staff to follow them and there is a well documented shortage of midwives.

I am about as far from a yogurt knitting NcTer as you are likely to meet.
Throwing that stereotype about does nothing for your argument and merely reinforces the ones that have built up around medical professionals.

Promoting the fear of birth is incredibly damaging to women.
My friend was present at a birth last week. All went well. It was in a MLU because the hospital had told the mother their was no space.
My friend has spent all her life terrified of birth, utterly terrified.
She finally got to see another woman giving birth and she is now transformed.
She is also angry about how she has been made to feel by her own mum and HCP. She can't have anymore children because she was sterilised in her mid 20s.
Her story is fairly typical of the women round here. None of them are in the nct, none of them have HB, the majority have CSS and none of them have had good birth experiences.
In this part of east London birth is something to be feared and there are no choices, you do as you are told.

"Maybe you can explain why 13% of healthy, low risk first time mums who book to give birth in a CLU have an emergency c/s rate compared to 6.1% of those who book to give birth in a free-standing midwife led unit?"

As far as I am aware, our local Midwife-led unit won't take you if you are showing ANY signs of things not going according to plan. My friend was booked into our local one, and she would definitely have had on her notes that she was low risk. On the day before she went into labour she had a very small bleed. She was told by the MLU that she could no longer go to them because of this. She had her baby without any drama or intervention at the hospital.

If you reject patients, who have already been booked in as low risk, at the first sign of potential trouble then of course you are going to have a lower CS rate. It's a bit like saying that grammar schools must have better teachers than comprehensives because the exam results are better.

It took me a lot longer than a minute to alert staff when I knew things weren't right. Because I was left totally alone.

It isn't just hospitals that save women, it is better antenatal care, scans, blood tests etc . Most women who have better outcomes than they would have years ago are diagnosed by midwife at antenatal appointments.

BalloonSlayer The Place of Birth study excluded anyone who wasn't low risk to make as sure as possible that they were comparing like with like - so that the results weren't skewed. This study then found that for multiparous women MLUs/homebirths made no difference to the baby but were better for the women in terms of needing interventions.

Xanderpask, I think you have a misunderstanding about home births. Home birth women are not left to their own devices and allowed to labour unmonitored by anyone, women are monitored exactly the same way they would be in hospital if they had a low risk pregnancy. Auscultating the fetal heart every 15 minutes and regular maternal obs, the idea that women who choose home births are less cared for is laughable. Also when I put a call out for a paediatrician I get the paediatric SHO, who could be pretty much fresh out of med school. I have personally had to stop some very dangerous practices from over enthusiastic SHO's, take over when their knowledge and experience is clearly not sufficient and wrestle pink screaming babies from them that they are determined to resus 'just in case'!

not true here. My first birth had a one page plan. Wen't very wrong.

2'd birth plan was so long it had a contents page. Very right. Gist was don't touch me and keep me the hell away from the doctors.

3rd was similar with similar outcome.

From what i have read the redusction in maternal and infant death is more to do with the introduction of antenatal care rather than the introduction of hospitals for childbirth?

lavolcan I understand that. What I am saying is that a low risk patient can be booked in at a MLU, but then turned away because of a minor complication at the very last minute. If that then went on to be a c-section that would be a c-section on the CLU's statistics, wouldn't it?

So basically on paper they are like-tor-like, but in practice, the MLU pushes any potential problems straight back at ths CLU (which I am sure they should). I think my friend was still marked as low risk by the CLU, but she wasn't low risk enough for the MLU.

I am not sure I am making sense now so I concede the point anyway

Thinking about it, when I had my DS1, I would probably have been classified as a low-risk birth. Yet I knew I wasn't . . . I was terrified that I wouldn't get my DS's massive head out, as indeed I didn't. Everyone whom I tried to talk to about it was "oh it'll be fine, you'll be fine!" I do wonder if I might have been allowed to have a home birth if I had asked for one. But I wouldn't have asked because I KNEW I was going to have problems, despite the midwives and doctors telling me I probably wouldn't.

So I was one first time low-risk mother who definitely opted for hospital birth because I knew in my heart it was not going to be a low-risk birth for me or my baby. So I do think that also skews results - I reckon there are plenty of mothers like me who knew they were going to struggle and thus wouldn't even consider a home birth, or even a MLU birth, and whose statistics end up being used against hospitals in a "you had an emergency c-section because you were in hospital and had the cascade of interventions" way, instead of, in my case an "I made sure I was in hospital because I knew I was going to need a cascade of interventions to get that giant headed kid out of me" way.

Not sure that makes sense either, sorry.

BalloonSlayer it's some months since I read the Place of Birth study but as far as I am aware they looked at the initial place of booking and then where the woman started her labour. I know that women who were deemed low risk but then e.g. were induced for being overdue were taken out of the study. Those in the study who started at the MLU/homebirth and then had to be transferred to the CLU went down as MLUs/homebirths stats. The study was doing its best to make a comparison of like with like.

I don't remember whether the study mentioned categories where a women was deemed to be high risk in one place, but low risk in another or what it did with women booked for a homebirth but denied it because there were no staff? In both cases you might think they would have been best ignored from the point of view of the study altogether?

I absolutely agree with you - your instinct told you that you felt you would be better off in a CLU. I do wish they would pay some more attention to what the woman herself feels is right.

Carrie, do you not think that with one to one care throughout labour, any potential problems can be picked up at an earlier stage? You see so many emergency situations in hospital because women are labouring alone and so problems aren't noticed until they are happening.

I'd go with a homebirth, you can always change your mind. I decided I wanted an epidural after all at 8cm. Got dressed, walked down two flights of stairs and into the ambulance no problem. Hospital was not a pleasant or comfortable experience though! And the post-natal ward is something I never wish to go through again.

In my Opinion, if you live very close to a hospital, you should try giving birth at home. Otherwise, it's too risky. My first hospital experience was terrible as well but it would make me feel worse if something will happen to my unborn baby because I was selfish and preferred the comfort of my home

normal drive to local hospital is 7 minutes. ambulance made it in three minutes to save my daughter's life. she came within 'two to three minutes of death', having a pph after a home birth.
i had her in hospital, no complications except those caused by the hospital giving pethidine, which i still can't spell.
my mum gave birth at home and had to be rushed to hospital after pph.

on balance, go to hospital. plan to leave there after a few hours to avoid germs and being bossed about.

I get really pissed off when women are acussed of being selfish for havin home births.
What the hell do you know about my reasons?
Do you imagine you care more about your babies than I do mine?
Comfort?
It would have been a hell of a lot more comfortable if I had an epidural.

Lovebunny.
You say your daughter was saved, HB didn't cause her pph and the emergency protocols worked.
You had a hospital birth with complications, your mother had a sucessful home birth an was treated for pph successfully.

I don't get your reasoning for thinking a hospital birth is safer.

Pph happens t home and I hospital. If it happens at home women are taken to hospital and treated. Everyone who has a HB knows that there is a possibility they will transfer.

On balance it seems better to have a HB and only go to hospital if you need to.