Are home births really "safer" for normal subsequent pregnancies?

[propercharlie]

Or are the stats skewed because those who opt for a home birth are less likely to need a c-sec/instrumental delivery anyway?

As a homebirth mw I have been interested in this. The stats are not skewed. The criteria for low-risk was the same for all categories of intention of place of birth. I think the difference is that the closer you are physically to facilities for instrumental/cs, the more likely you are to experience them. All the staff medical and midwifery, want the best outcomes for all the women but they are (in my opinion) unconsciously influenced by the technologies available to them.

On a personal note, many HB candidates even if technically low-risk, have a higher average age and level of education and sometimes bring painful baggage from previous births. What I am saying is sometimes they have a profile that some care givers associate with difficult labours. What seems to help is the amount of personal care in a familiar environment that's possible with HB.

i had a home birth 6 years ago.... it was the best decision i made... so relaxing ( well as relaxing as childbirth can be...) and i had no regrets.... The midwife support is still there.... surely its a personal choice....

That's very helpful thank you! Very interesting point about instruments/cs being available more easily and therefore maybe more likely to be used.

I am seriously considering a HB for my second. I had DS aged 25 and am now 27 and 31 wks pg with DD.

DS was born in a MLU, 8lb15oz, g&a only, no intervention, 11hr from first cx/waters breaking (simultaneous) to delivery. He was b2b but as I say, I coped on g&a only. My MW says I am a good candidate. My mother is totally against it!

There isnt really a MLU option near enough and I am a little apprehensive about going into a normal hospital. I'm leaning towards a HB (5-6 mins transfer time to hosp if needed).

I had my second at home. First was straightforward, in hospital, with a few minor issues regarding epidural, but it was 8 hours and nothing serious happened.

My second took 3 and a half hours. Transfer time was about 45 minutes (maybe 30 with blue lights) and nearly had to be done due to PPH, but it was sorted quickly after some moments of panic. So I didn't have to go in.

I am worried about doing it again as transfer time is so great from here, but the MW is recommending it for my third as she thinks I may not have time to go elsewhere.

They are considering it a low risk for me. I'm 38 btw - had other two at 29 and 33.

I meant to add that if I were you I would definitely go for it as you are minutes away from emergency care if needed.

Home birth for me was far, far better even though it hurt more and I had no pain relief. I hated the bureaucracy of the hospital, not being allowed to do ANYthing with my child, being threatened with formula, not helped when I needed it...it was like a police state. Well that's exaggerating but I felt very very oppressed, and scorned for expressing any opinion that wasn't theirs.

So to be at home helped enormously.

I am having a homebirth (fingers crossed) with DC3 (due in 8 weeks ish) Mother says I am insane, but then she had a lovely 10 days in hospital smoking woodbines laughing and eating pies apparently.... and my (childless) sister says its medieval...

I am taking their opinions on board and then throwing them straight off again! :)

You sound like the ideal homebirther and the proximity to the hospital is reassuring should you need to transfer in for any reason.

Good luck!

This article comes from the other angle, but it is worth a look www.greenmedinfo.com/blog/myth-safer-hospital-birth-low-risk-pregnancies

Had my first in hospital, straight forward, overall a positive experience and I coped with TENS only (plus the marvellous Ju Ju Sundin book!). Like you this raised my confidence to consider a home birth with no.2, something I'd always wanted but didn't feel sure enough about first time around.

DD2 was born at home in March 2011, it was a truly wonderful experience for all of us. Calm, relaxed and quick. I felt much more in control than first time around able to just potter about as and when I wanted, eat and drink as I wanted, pop easily to the loo etc the best part is afterwards when you can climb into your own bed with DH and the new baby and snuggle together.

Talk to your midwife and go for it! We're planning another home birth for DC3 due in Oct.

Had my first in hospital, g&a with no interventions as I wished so I knew I was mentally prepared and capable of dealing with my 2nd at home.

Had a low risk pg, researched and planned my hb and delivered ds as planned at home with no complications. My experience was that although my mw at home appeared to be in the background letting me get on with it, she was actually paying far more attention to how I was doing, checking the heartbeat, etc etc, compared to my hospital mw, as they need to be aware of any signs that may give them cause for concern and which might prompt a transfer in to hospital. Obv you have constant 1-2-1 care at home which is unlikely in hospital and this ensures the mw is much more aware of how you're doing, and therefore any potential issues will be picked up earlier.

If you are comfortable with it all I would say go for it - my hb was an amazing, calm and relaxed experience. I was completely in control and was sat on my sofa bf ds with my tea and choccy biscuits 20 minutes later. (There is also no mess despite what you will hear ) Good luck.

Have to admit I am a bit worried about the mess. I didnt really notice last time tbh but for some reason I am imagining huge gushes of blood and water and gunk!!!!!

What were the logistics of your HBs?? Kneeling on a plastic sheet?? Laying on bed?!!!

I taped a plastic dustsheet to an old duvet and put this inside old duvet cover. MW provided incontinence sheets (about 1m square). I put this on bed and gave birth there. The MW just moved it all when everything was over and took it away with her.
Lots of towels were used and these were in the washer on a hot wash before I moved out of the bedroom.

No mess whatsoever.

Enjoy your homebirth - it's lovely.

(candlelit bath and glass of champagne after everyone had gone - don''t get that on the labour ward)

I have had 2 homebirths, both in a birth pool in my kitchen. We used a liner for the pool which could be chucked afterwards so that caught most of the gunk. The midwives caught the placenta in a dish and cleaned up afterwards so no gunk there. I think both times the final tally of damage was one spot of blood on the carpet. Clearing up the pool would have been a big job but I had a friend round helping out and both times she did it all without me even really noticing (I was snuggling baby on the sofa). I loved my homebirths and could not imagine going to hospital except for a real medical reason.

We bought a huge tarpaulin from Homebase and a couple of waterproof decorating sheets, these went on the sofa and the tarpaulin went on the floor to be covered with an old duvet with cover on.

The MW will have plenty of those super absorbent pads, same as they use in hospital.

We also had to provide a couple of old towels.

There was absolutely no left-over mess. I don't know what happened to most of the stuff, the MW cleared away. We have kept the tarpaulin and decorating sheets. I think one towel was binned.

I started with a vague notion that I'd rather give birth in the living room than anywhere else - more space. Then as it turned out instinct dictated the position I gave birth in; on my knees with my elbows resting on the sofa back to the room. DC2 was out in 3 pushes, 8 min 2nd stage. Prior to that I sat on sofa or paced up and down around the downstairs of our house.

Honestly... I was 40 when i had my homebirth it was all straight forward...My other children were 12 and 16... And NO Mess.... Midwives were fantastic.. You can give birth whichever way suit's you.... it's your birth plan..... And you can change it when the time comes... If things should not be straight forward the midwives will have it all under control and have you in the hospital.. Enjoy... i did... Anad would do it again if only i were 10 years younger... x

Large clear plastic sheet to go on carpet covered with old towels and cushions. Bought those bed mats used when toilet training for the mw's to throw about in case of mess emergencies - no problems. After I was stitched up I moved to the sofa and the mw's cleared all the floor coverings up, put in a clinical waste bin bag that they bought and left outside for the local hosp to collect. Honestly, 20 mins later my cream carpet was back on show and you would never have known I'd just given birth on it!!

Two words: birth pool! My waters went in the pool and there really wasn't any mess (and I delivered the placenta sitting on the edge of a still-pristine white fabric sofa). The MW team and DH cleared up afterwards. We supplied shower curtain from IKEA for the floor, plus old towels. The MWs brought waterproof bed mats like they use in hospital, which saved my sofa!

DD was my second baby, born at home in water & it was ace. Loads calmer than DS's hospital birth, and no tearing or stitches this time, compared to ventouse + episiotomy in hospital. Go for it!

I would read all the studies very carefully, all scientific studies are biased in some way - they all have flaws, not including women who have been transferred, not including the high risk womn who giv birth in hospital.
Interestingly, the Netherlands which has a higher rate of home birth than the uk, also has a much higher rate if neonatal death.
The site that futurenannyodd cites looks very interesting! Apparently suboptimal brestfeeding also causes 1 million deaths and autism. I suspect that's one to ignore.

The stats for MLUs/homebirth do include women who have been transferred to try to eliminate bias.
Not including high risk - the OP hasn't said that she is; if that were the case she would no doubt reconsider her options.

Mayhew wrote :". I think the difference is that the closer you are physically to facilities for instrumental/cs, the more likely you are to experience them"

Of course !what a stupid reasoning ! That's because neither ventouse nor forceps or c/s will be done at home because they simply are NOT AVAILABLE AT HOME IF YOU NEED THEM. So theres no way you will have an intervention at home. Women who will need them will be shipped to the nearest hospital.

Besides , whether at home or at hospital you will still be delivered by a midwife no matter what ,who therefore will ultimately decide if you need an intervention or not . Or are home birth midwives different than hospital midwives ? Are hospital midwives pro intervention , because that's what you guys are implying .

These statistics are skewed cause there's no way you will have intervention at home because it's not available anyway even if you need it.

I do remember there were gushes of various things during mine. My waters went on the floor of my bedroom, as I was pushing him out, and though I was sort of kneeling on something it was a bit difficult to get it under me as I wasn't very cooperative at that point and then obviously I was bleeding like a tap after he was born, (sorry) but somehow there was only a minor bloodstain on the carpet after they had left, and I don't know how they managed to clear everything up so quickly.

I got the bloodstain out myself a day or two later - it was already pretty faint. Nothing else got messed up at all. I think it may have been cleaner when they left actually

I had laid out a waterproof sheet and towels downstairs but of course typically all the action took place in the bedroom...hopeless!

Rhianna, calm the exclamations?.the Birthplace study included outcomes of all transfers. IE if a woman was having slow progress at home and was transferred in for ventouse or cs, her outcome was recorded under homebirth regardless of where she eventually gave birth.

The most interesting outcome of the study was that for low risk women having a second or subsequent child the main difference in outcome was the rate of cs or instrumental. The safety outcomes for mother and baby were exactly the same for place of birth (Clu, mwu or HB) it was rates of modes of delivery that varied. This suggests that if you don't mind having a much higher chance of cs or instrumental then you will be happy to choose a clu. However if thats your worst nightmare then HB is a proven, safe alternative. I'm not a lentil weaving hippy but a very careful practitioner with a 20 year Hb record, the Royal College of Obs and Gynae support the findings of this study

I am not suggesting that hospital midwives are more pro intervention than homebirth midwives (though some are?..) but that the environment in which you find yourself influences your decision making.

Rhianna, have you considered that this research has been done by 'researchers' with qualifications and experience in er.... Research!?

One of the first things you learn at undergraduate level on relevant degree courses is how to control for variables and ensure that what you are stating has a significant chance of being true and unlikely to be able to be critisised. 'significant' in this case is a scientific concept with a mathematical definition and attached probability.

Have you READ the study? The confidence levels of their claims are clear as is the interpretation of outcomes.

Karolean - If you don't like the website in particular, or indeed any review of studies, you are always welcome to follow the links to the original studies and appraise them yourself. Most lay people haven't been taught how to do this, but the references are there if you want them. I chose that article because it breaks things down very clearly, not because I am a fan of the site as a whole.
Perhaps this might be preferable to you www.nhs.uk/news/2011/11November/Pages/hospital-births-home-births-compared.aspx
There are lots of theories about why the intervention rates are different, community midwives are always ready to transfer a woman in, early on, if they suspect a problem may be arising. However looking at various other studies into birth outcome, we know that active birth, upright positions, quiet comfortable environments, privacy and patience/lack of pressure all contribute to easier births. All these conditions are far more readily available at home than in hospital. Put simply, a hospital environment does not support physiologically normal birth. I don't think anyone is trying to blame the midwives. I would blame the stress of transfer, unfamiliar hospital environment, and policies that are implemented for reasons other than real evidence for improvement of outcome, such as continuous foetal monitoring.