Home birth against medical advice - raised bmi

[thecakeisalie]

I'm 34 weeks with dc3 and bmi was just over 40 at booking (though I lost 2 stone in the early weeks due to morning sickness). I had an appt with the supervisor of midwives and it's really made me doubt my decision after discussing the risks in such a frank negative discussion. I was already aware of the risks but now I just can't shake the doubt.

I've had yet another straight forward pregnancy, normal size and currently head down baby it's literally my weight that makes me high/higher risk. My previous labour was quick and straight forward but poorly managed at hospital so I ended up with little monitoring and delivering on the antenatal ward.

I really would rather avoid hospital after my experience last time but I'm wondering now if that's just a selfish decision and whether I should just go with advice to deliver on the consultant unit.

It's the worry of shoulder dystocia that really scares me but after 2 good size babies surely my risk of that is low even with raised bmi. So I guess I'm asking for advice and any experiences of home birth against medical advice. Am I mad to be considering a home birth?!

What are they saying are the risks of a home birth with raised BMI?

What makes hospital 'better' in their view?

Are there other ways to manage these risks at home that's you're happy with?

My BMI is high but not quite as high as yours, the only risk discussed so far (30 weeks) has been logistics of people having space/strength to manhandle me at home (!). Which made me want a home birth all the more - I don't want to be manhandled thanks!

Thanks for your reply. I know what you mean about being manhandled, I have no intention of needing manhandling either. I'm confident DH could lift me if needed so that's a non issue as far as I'm concerned.

The risks they perceive as being higher for me are shoulder dystocia, postpartum hemorrhage, baby turning just before going into labour and presenting as breech during labour, increased chance of blood pressure going up during labour and an increased risk of infection. The risk of baby being breech but this not being picked up seems really unlikely as I'll be having a growth scan at 36+5 and baby has been head down for about 4 weeks already I think I would notice baby turning and the community midwife had no trouble last week telling a bum from a head. So that doesn't concern me too much.

I'm dubious as to how much my risk of all of the above is actually raised simply because of my weight but obviously I don't want to be naive and take a risk I may regret.

The only two I am truly concerned about would be shoulder dystocia and PPH but I'm thinking surely my risk of these is lower than they are suggesting because I have two previous labours to take into consideration. She was saying the hospital would obviously be better equipped to deal with both of these situations as they would have access to equipment, more members of staff and those staff would have better experience of dealing with emergencies.

I was feeling quite calm about the idea of labour but now I can't stop dwelling on the possibility of it all going horribly wrong.