Home birth

[Sheepoverthemoon]

Has asking for a hb been a challenge with the midwife and drs? I'm really keen to have a home water birth (and thought I did my research well) and was really positive for asking, but my friends have been trying to put me off and say that it's a battle to get a hb for your first baby and it's very risky for the first one...
Any advice would be great

emsyj - I don't know what the outcome would have been had I birthed at home, and I do understand about the spiral of intervention that happens in hospital. However my labour and birth wer straightforward in hospital, I felt relaxed, only gas and air, laboured upright/mobile, 10 minute second stage, no continuous monitoring, no ventouse, no tears, no stitches.
I had a perfect pregnancy, fit and healthy.

However within seconds my newly born baby crashed unexpectedly, thankfully a paediatrc team were there within a minute or two who rushed my baby to give him the critical care he needed with all the equipment and medication to hand. Thankfully the outcome was good, with no lasting damage, but the level and speed of support my baby was given could not have happened at home.

Are you telling me my baby would have been fine if he had been born at home?

I appreciate that this is purely anecdotal, but it hit home when a few months later I met a lovely woman at our breastfeeding group who had lost a baby the year before in similar circumstances but the baby was born at home. The midwife was unable to revive the baby and the emergency services - although quick- could not either. By the time the baby got to hospital it was dead.

Fifteen years later my friend still blames herself, and although there are no guarantees of outcome either way she feels that her baby would have had a fighting chance if he had been born in hospital.

I know this is not what the OP wants to hear but emsyj did ask.

We are lucky to be able to have safe hospital births in this country. Many women in other countries are not so fortunate.

There do seem to be double standards on this: I have had friends who have lost their baby in hospital. It's always just put down as being 'one of those sad things which happens sometimes', but with a home birth someone will blame you for not being in hospital.

I have no way of knowing the truth of these individual cases, but as someone upthread pointed out, the study showed that there is little difference in safety for the baby for first time mothers, and none for subsequent births with a home birth, and the outcomes for the mother are better at home/MLUs.

Thanks - I was left disheartened with the first post, but now there is lots of discussion, I'm feeling stronger with my decision for a water hb again.
I really like city dwellers advise about who I talk to about it, I would like to hear more from afterthestrokeoftwelve and jcb77, but this is often what I'm finding, people with positive experiences have very rational and evidence based discussions, but the negative ones are often one liners with a warning with little to back it up by?

My midwife was all for a home birth for my first dc. You are monitored more closely so at the first sign of something going wrong you can be transferred. Of course sometimes things can go horribly wrong but this can also happen in hospital. You need to do what you feel is right for you. How far away from the hospital are you? That might be a factor too.

Sorry I didn't see the second page, new to this. Thanks afterthestrokeoftwelve for sharing, I do want to hear both sides, but I do agree with levolcan, and whilst I'm fit and healthy and everything is going ok, I will have a water hb, otherwise I would be glad to be with the experts if needed in hospital. Now hopefully I have a nice and supportive experienced mw, fingers crossed. If I ring beforehand and ask for someone who is experienced in hb would that be a good idea? Or do they just send anyone out for first talk...

LaVolcan I absolutely agree. I know far more people who have had bad outcomes in hospital than I do for homebirth (although to be fair I also know more people who have had hospital births). It's not like bad outcomes never happen in a hospital environment, unfortunately.

eurochick you're right.

When home births have a tragic outcome the mother is inevitably vilified for being reckless and careless .

Which is frustratingly off the mark given that all the HB mothers I know spend far more time actively researching birth and making an informed decision than most women who just rock up to a labour unit and put themselves and their babies unquestioningly into the care of the professionals.

People seem to accept the many maternal/foetal deaths that happen in hospital though. Even the ones caused by being in hospital.

It's quite misogynistic really.

Jcb i was paraphrasing from homebirth.org.uk which states
"The UK target for delivery by emergency caesarean is 30 minutes from decision to delivery, but research suggests that this target is not usually achieved. For example, MacKenzie and Cooke (2001) found that the average time from decision to delivery in emergency caesareans where there was fetal distress was 42.9 minutes in their large Oxford teaching hospital."

The stats are obviously a little old however

For every baby who "would have died if they hadn't been in the hospital", there must also be one who who wouldn't have died if they'd been at home. Otherwise, the statistics would be worse for home births and they aren't. It's just maths.

The 2001 study... (BMJ 2001;322:1330) (Highlighting is my own and i have picked relevant parts of the text. Link to full article here )

Objectives: To audit interval from decision to delivery in urgent caesarean section to determine whether the current standard of 30 minutes is achievable routinely; to determine whether delay leads to an excess of admissions to special care.

Results: In the continuous audit 478 of 721 (66.3%) women were delivered in 30 minutes and 637 (88.3%) within 40 minutes; 29 (4.0%) were undelivered at 50 minutes.

Conclusions: The current recommendations for the interval between decision and delivery are not being achieved in routine practice. Failure to meet the recommendations does not seem to increase neonatal morbidity.

When an urgent caesarean section is performed, it is widely advocated that the interval between the decision to operate and delivery of the baby should be less than 30 minutes. The recommendation states that a unit should be able to be ready to perform a caesarean section within 30 minutes, implying that the interval between decision and delivery may be a little longer

Fewer babies were admitted to special care when the interval between decision and delivery was shorter, but not when prematurity was excluded as a reason for admission to special care

The numbers in this audit indicate that delay is an unusual cause of neonatal problems. It could be that the time taken to deliver makes no difference. This is scientifically unlikely, as a compromised baby is going to deteriorate if left in an unfavourable environment. However, it may be that for the most part a baby can recover from any additional compromise caused by the delay. Delays of up to 50 minutes seem to be an unlikely cause of problems for an infant.

Some more recent stats on this (Pearson et al 2011 link )

68% Category 1 deliveries were achieved within 30min and 66% Category 2 within 75min
8% Category 1 and 4% Category 2 neonates were acidotic or asphyxiated. The risk of acidosis was not reduced by delivery within 30min for Category 1 (OR 0.56; 0.11–2.81), or within 75min for Category 2 (OR 2.72; 0.6–25.1).

Conclusions
Our data suggest that clinical triage is effective, with the more compromised fetus delivered more rapidly using general anaesthesia. For Category 1 deliveries a 30min target DDI is appropriate, although those born after longer DDI did not show developmental impairment.

Current NICE guidelines on unplanned C section decision to delivery intervals;

1.4.3.1 Perform category 1 and 2 CS2 as quickly as possible after making the decision, particularly for category 1. [new 2011]
1.4.3.2 Perform category 2 CS2 in most situations within 75 minutes of making the decision. [new 2011]
1.4.3.3 Take into account the condition of the woman and the unborn baby when making decisions about rapid delivery. Remember that rapid delivery may be harmful in certain circumstances. [new 2011]

Most recent stats (England NHS births 2012/13)
Unplanned C section was 13% of all births over 37 weeks
Unplanned C section was 1% of all birth episodes where the duration of delivery episode was 1 day or less (it is 25% where the duration of the delivery episode is 2 + days)

The biggest consideration is your transfer time to hospital in an emergency.

You should be priority for an ambulance in an emergency, however you should also plan on the time it takes to get the ambulance to you (how far their geographical area covers) and what happens if they are already busy.

For balance I meant also to quote the below.... I shall now get off my soapbox

This is from an NHS news article summarising BMJ 2011;343:d7400. Full study can be found here and NHS article can be found here

Is it safe for women to have a baby at home?

The overall rate of negative outcomes (a composite of outcomes of death or serious complications) was 4.3 per 1000 births (95% confidence interval [CI] 3.3 to 5.5) and there was no difference between non-obstetric unit settings compared with obstetric units. This indicates that as a whole, home births are as safe as ones in medical settings.
The researchers then looked only at women who were going through their first pregnancy. They found that women having their first birth at home had a greater chance of complications leading to injury in the child than women who had planned to go to an obstetric unit in a hospital. This risk was almost doubled (odds ratio [OR] 1.75, 95% CI 1.07 to 2.86).
Furthermore, when the sample was restricted to women who had no complicating conditions at the start of labour, there was almost a three-times greater risk for women with planned home births than for women having planned hospital births (OR 2.80, 95% CI 1.59 to 4.92). There was no difference in the rates of such complications in either type of midwife-led unit compared with hospital units.
An important point to note is that even though the risk associated with home births seems greatly elevated in women going through their first pregnancy, the absolute risks were still relatively low. To put this into context, they occurred in 39 of the 4,488 women who delivered their first child at home, and 36 of the 4,063 women who delivered their first child at home without complicating conditions at the start of labour.

How many women planning home deliveries or midwife unit delivery ended up in hospital?

Among women having their first pregnancy who opted for a home birth, 45% were transferred to hospital before or after delivery. For women attending a freestanding midwifery unit, 36% were transferred, and 40% of women attending an alongside midwifery unit were transferred.

I have read the figures but I am unconvinced. One thing I do know is that hospitals are better places for treating ill people than homes. My comfort is secondary to my baby's welfare.

My MWs suggested a HB for my first baby. I said no at first, but as time went on the idea grew on me. In my area they were proactively supportive of HB as it gave better outcomes. I did have a HB but I wasn't sure until the day that I would - I just thought it was easier to change my mind one way than the other.

When the HV came afterwards she spent ages telling me I was foolish to do it because my baby could have died. She talked a lot about babies dying in general. She asked a lot of questions, followed by "right" answers (eg, no one smokes) and then went on and on about the risks to the baby if someone smoked and slept with her, for instance..... it was a long tiring litany of babies dying (cot death in co-sleeping, falling off sofas, falling off changing tables, various forms of suffocation, risks of smoking, etc etc etc) and at the end of it I was exhausted and depressed. I reported her.

But most pregnant women aren't ill, atthestroke. The 2011 survey cited was very rigorous, and it didn't show that the baby's welfare was served better in hospital.

Personally, I believe that we should take the mother's comfort/health into consideration too. After all, she is going to be responsible for bringing up that child, which won't be helped if her own health has been wrecked by a poor delivery - which may have been avoidable.

What about the stats doesn't convince you Stroke?

I found it very easy to get a home birth for my first, low risk, pregnancy. The midwives just said "fine".

I did have the baby at home and it was lovely (well, it was long and hard and painful, but being at home was lovely) - but in my experience none of my friends who planned home births did. The reasons were as follows

1 - had meconium in her waters early on in the labour, transferred to hospital, needed monitoring, had baby quickly (was on the drip) , with forceps
2 - laboured up to 8cm at home then transferred in due to meconium in the waters
3- was induced at 42 weeks

Not a big selection obviously but I think the rate of first time mums planning home births who actually have them at home is only 50%. Very rarely do these transfers happen as an emergency.

People (and health care professionals) can be very emotive about home births, and you often hear comments about babies that "would have died at home", and I am not trying to undermine people's difficult experiences, but the risk of home births must be balanced by risks in the hospitals that are not present at home, as a large robust study showed that home births are equally safe (and, actually, with better outcomes for 2nd time mums). I certainly know a number of babies who became ill purely because they were born in hospital (contracted infections etc). Nothing is risk free!

But it is very safe in general to have a baby in the 21st century in the UK which is great!

How far away are you from the hospital? That will probably play a role in what your midwife thinks.

One of the reasons I am so confident about having a home birth is that I am only a 10/15 minute drive away from the hospital, and I have heard a lot of people say that they are left waiting in the hospital corridor for longer than that.

"hospitals are better places for treating ill people than homes" OP is not ill.

I should add that all cases were close to hosps, not in some remote village in the middle of no-where.
Mark

Pregnantberry- no you are not ill, but giving birth can and often is a dangerouis time for mother and baby. THe potential for things going wrong suddenly is there for every birth. THe best place to be if that happens is in hospital

Mark I so agree. My friends baby died during a home birth and her life has been destroyed by it. I had a baby in hospital and needed a paediatric crash team within seconds of delivery- it was there within 30 seconds, and the outcome was good. Some have suggested my baby would not have become unwell if I had given birth at home- I am glad I did not take that chance.

Women in this country are extremely lucky to be able to give birth in hospital- it has not always been the case, and years before this was available, many women and babies died. Women in other countries who labour and birth at still have high mortality rates- it would be a luxury to have a hosptal birth.

I am extremely thankful that I have given birth in a relaxed and way- in a hospital, knowing that state of the art medical back up is there if needed.

Mark,

What a pointless and deliberately inflammatory post .

Your three anecdotes don't prove anything and are blatant scaremongering.

The statistics speak for themselves.

And why don't you mention the deaths that take place in hospitals?

Oh and here's one right back at you

1. Imagine labouring in your own home and feeling 100% comfortable and your body responding to your calm emotional state making labour easier.

Imagine having 2 midwives dedicated only to you and your baby who between them have 40 years of experience delivering babies.

Imagine not being subjected to pressure to have interventions to hurry your labour along.

Imagine giving birth and not having your DP asked to leave you and your new baby.

Imagine having a post-birth bath or shower or pee or poo in your own bathroom.

Imagine being able to establish breastfeeding in an environment of total safety, familiarity and comfort.

Imagine no Bounty lady.

This was my experience and I'll choose that over hospital any day of the week.

Mark- I understand what you are saying, but stats show that those horrible things arent less likely to happen and aren't less likely to have a poor outcome in hospital.

And it discounts the deaths caused by hospital. like a relative left with a very inexperienced midwife who failed to spot a placental abruption until it was far too late.

eyeliner, Mark is not scaremongering- he is at the cutting edge as tells it as it is.

"Imagine having 2 midwives dedicated only to you and your baby who between them have 40 years of experience delivering babies.

Imagine not being subjected to pressure to have interventions to hurry your labour along.

Imagine giving birth and not having your DP asked to leave you and your new baby.

Imagine having a post-birth bath or shower or pee or poo in your own bathroom.

Imagine being able to establish breastfeeding in an environment of total safety, and comfort.

Imagine no Bounty lady. "

What you describe is exactly my hospital birth.