Homebirth with no.7

[annelid]

I am planning a HB with baby due in 3 weeks. My usual midwife is not very supportive with comments like 'I'd better book my holiday for when you are due' and 'people in the office will be hoping they don't get called out to you!' and now I have to see the consultant again on Tuesday so he can yet again warn me about the risks of a HB as a grand multipla and ignore all of my reasons for planning it this way.

I am in two minds as to whether I should just cancel the appointment and save myself all the stress of having to sit there and tell me how stupid and irresponsible I am.

How were your other births? If fairly uncomplicated then you may be ok.
I had a home birth with my 2nd. My 1st was a ventouse delivery but very quick so i was worried about getting to hospital on time.

Personally, it was great. I had two midwives all to myself, felt totally comfortable, didn't have to cope with contractions in the car, and afterwards had a shower in my own shower and tea and toast in my bed!

If you are fully aware of the risks, and controls then tell him that.

It is his job to help you decide by making you aware of the risks. He would he negligent if he didn't do so.

Why are they not keen on you having a HB? Is it due to this being your 7th or are there any other underlying health concerns?

My community MW is very pro homebirth. She brought up the idea of HB with no3 and when I saw her at booking visit (This is my 4th baby) she again said they will provisionally put me down for a HB but recheck its ok to go ahead at 36wks.

I know some areas have a high HB rate and others are very low, any idea what the figure is like where you live?

I don't know much about it, but I believe the risks of heamorrhage get higher with each birth. I think the risks are for the mother not the baby.

I can see (with very little research) why there are concerns. But you will have done much much more research than me, and I don't know what your reasons for homebirth are.

The decision has to be a guided decision. It should be guided by the risks AND the benefits and I think that sometimes healthcare professions only see the risks.

My other births have all been straightforward, no problems at all. The only issue I usually have is low iron, but at 28 weeks my iron was 12.6, so very good. I have no health issues. They are not keen because it is no.7 so more risk of bleeding afterwards.

I know the consultant is only doing his job and I respect his knowledge and experience, it just seems it doesn't work both ways.

The main reason for planning a HB is that no.6 was born within 20 mins of my waters breaking without any prior notice. No.5 was a very painful 20 minute car journey to hospital with DD arriving 5 minutes after arriving.

So I am worried that I will be giving birth in the car! The hospital is the other side of the city which can be anything from a 10 - 20 minute drive depending on the time of day.

dillydollydaydream I have no idea what the figures are for our area. I guess I ask my midwife about that.

Maybe I am just being ridiculous to be considering a HB.....

I don't think it's ridiculous. How far from hospital are you if there are any problems. The thing is if you labour quickly it will be safer having a homebirth with midwives present than giving birth in the car with no medical help.

Seeing your reasons FOR a homebirth can I suggest a compromise (which may placate the HCPs?

How about you have the home birth kit in place. I think that with the speed of previous births you are justified in asking for this.

Would you be prepared to go to hospital if you thought you could get their? E.g. if time of day meant traffic was light and the 10min journey instead of 20?

Could you ask them what control measures they would put into place if you go ahead with home birth? Could you have the appropriate medications in the home birth kit that mws could use to help the uterus contract down and stop any haemorrhage if it happens. What warning would you have if you do have problems. Is that enough time to get you to the hospital?

I'm sure you've probably thought of all these. But I think a compromise is worth discussing. Plans in place for home birth because there may be no option but that you (on paper) agree to keep am open mind about transferring in.

I don't like the sound of your midwives' comments, doesn't sound like they like homebirths at all - really unsupportive.

Your reasons for homebirth sound good - the risk if you don't plan a hb is that you have no7 at home anyway without the kit in place! However I don't know the figures on increased risk for bleeding after several babies, which of course it is their duty to tell you as it is pretty serious if it happens.
You should perhaps be discussing the plan for what if it happens anyway after the homebirth, or any unplanned quick delivery which sounds like it could happen anyway even if you plan to go in (hope that makes sense...)
You have a right to change mind and go in if you want to later.

I had homebirth with babies 2, 3 and 4.

I was very supported though.

my last came within an 30 mins of waters breaking so I was glad to be at home!

I agree with heliotrope. It seems legitimate to be concerned that you might be at greater risk of heamorrhage - but would they really prefer that you risk that in a car by the side of the road?

Is there a more senior midwife you can discuss with, to get a proper plan put in place?

There is no actual evidence that grandmultiparity means more risk of heavy bleeding if no other history of heavy bleeding it's of those myths that can believed without looking at the actual evidence. HTH

Thankyou for all of your replies, they have been very helpful and given me lots to think about.

I am an nHS mw specialising in homebirth. We recently had a 6th baby at home (which was fine). Statistically there is an increased risk once you get past 5 but that doesn't mean you have to deliver in hospital. The risks of PPH with high parity also have a relation to your age and general health. In this situation we would discuss the risk ie the background stats, how quickly paramedics can arrive in your area, transfer time to hospital, your personal history of labour, delivery, bleeding and avoiding anaemia. Ultimately its your decision and we would make a plan to reduce the risk. The Supervisor of midwives offers support and advice to both mothers and mws, and this is usually reassuring. You might want to talk to her, she might offer to see you at home (with your big family responsibilities).

We would offer to put a cannula in a vein in order to give emergency drugs if they were needed but if you are very fast, there might not be time before delivery! We also carry a drug called misoprostil which can be given after delivery to control bleeding, if the usual drugs, syntocinon, ergometrine are not enough.

Another concern is that when you have had a lot of babies, the womb gets very stretchy and sometimes this allows the baby to take up odd positions, making them difficult to deliver eg transverse, lying crossways.

The other annoying thing that can happen with a womb that has had a lot of babies is that the contractions might be uncoordinated, ie painful but not progressing the labour. This can happen in women who have previously delivered swiftly. Its not dangerous in itself but medical aid might be needed to get delivered.