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

I am thinking off trying for a home birth but with a very low threshold for transferring. If that is what happens I am ok with that. Labour is such an unknown that I think it's better not to be too fixated on a certain outcome (other than healthy baby and mother).
Mine will be a VBAC and when I spoke to the Midwife today he said that being at home might make me more relaxed, have less adrenaline and possibly have less risk of uterine rupture. It's an interesting point but I am still undecided due to distance to hospital.

As we said before, it's not 50% of women who transfer from a homebirth, but that aside, what you think is traumatic may not be for other women.

After the birth of my DD I was advised to consider a homebirth if I chose to have another one. My labour came thick and fast and by the time I got to hospital I was fully dilated and ready to push. Yes it took me another couple of hours to push her out (I was not pushing effectively), but with a second one things may be a bit 'looser' I suppose. I might not make it to hospital next time.

I am not expecting at the moment, but if and when I get pregnant again I will definitely consider a homebirth, as giving birth in a car or somewhere along the way as an option is really not that great...

Not sure if I should have read this thread its left me doubting my decision yet again. I'm 38+5 with dc3 and currently planning a home birth against medical advice.

I've had two straight forward labours of good size overdue babies. My only risk factor is raised bmi so I have low blood pressure, been tested for gestational diabetes and had growth scans. In all other areas I have had a low risk straight forward pregnancy.

I've had some awful conversations with the supervisor of midwives about the potential risks. However I don't believe hospital id always safer. Dedpite being high risk last time I was told I wasn't in established labour and told to go for a walk round the deserted hospital in the middle of the night or my husband would have to go home. I returned to the antenatal ward 1hr 30mins later just in time to push and he was born there just 3 minutes later.

So during my supposedly high risk labour I was with a midwife for about 20 minutes of a labour that had lasted over 24hrs. If my baby had been distressed no one would have known until it was too late. In my opinion based on that level of care I will be better cared for at home with two midwives from earlier on in labour.

Hospital doesn't always equal better care but reading emotive posts like Mark's really make me doubt myself. Sorry that was so long winded but I wanted to present my story as to why hospital isn't always safer. The outcome of my last labour could have been so much worse, especially as I nearly didn't return to the ward when I did I dread to think of what a birth with just my husband in an empty hospital corridor would have been like.

I booked a home water birth for my first (and subsequent children) with no trouble at all - I had a normal healthy pregnancy so there was no reason to not have a home birth. In the end, I was induced in my first pregnancy as the baby was distressed. I had two lovely home water births after that.

I had a really fast labour with dd and a hospital birth simply wasn't an option. If I had tried for a hospital birth dd would have been born at the side of the M1 without professional assistance. Yet there are people who believe that I was totally reckless to have a homebirth. I really took up very little midwife time. Dd was born quickly after the community midwife arrived and the second midwife didn't get there in time. I really don't think I was selfish with resources.

There is a world of difference between an NHS homebirth with an experienced midwife and free birthing. Midwives do have resuss equipment and are highly skilled professionals. There aren't many senarios that they can't cope with. The one to one attention in labour with an experienced midwife means that problems in labour are picked up faster. There are two midwives for the second stage - one for the mother and one for the baby.

The biggest risk in homebirth is a prolapsed cord, however this risk is miminised as the NHS will only recommend homebirth if the bady is in a good position. Prolapsed cord is more like to happen with a breech birth or early rupture of menbranes before the head is engaged. Brain damage caused by prolapsed cord happens in hospital as midwives have too many mothers to look after at once.

In my experience tranfering to hospital while in labour is traumatic. They won't let you transfer until you are having contractions every two minutes.

Just noticed eurochick's comment that she can't plan a hospital birth and at the last minute stay at home - you certainly can. A friend of mine did just that, by the time she was in labour she didn't want to move, she called the midwives who despatched a community MW to her.

Stroke - It is, of course, lovely that you had a relaxed and positive journey to hospital. But again, you are jumping from your personal experience to assuming that the alternative scenario is negative. For me, going to hospital first time round was hideous. I held out as long as I possibly could, called, went in, examined, monitored and sent away. Then again, waited as long as I could, travelled in in masses of pain, monitored and nearly sent away. Oh, but before I was monitored I was left whimpering in a side room (basically a large cupboard. Two plastic chairs, no window, one light bulb, no other furniture). I would far rather have been in a situation of transferring in in more advanced labour, with the support and agreement of a midwife that the time was right. Going in later, in more pain and more established labour isn't necessarily a negative as you assume.

Lizzie - In my area you can't. If you haven't pre-booked a homebirth and been risk assessed they will not despatch a midwife, they will send an ambulance to transfer you.

Cake - Make the decision that is right for you, but don't make it based on emotive stories. I can offer a similar horror story for a relative's recent hospital birth. If you feel safer in hospital, be there. And listen to personalised advice based on your risk profile. But listening to the story of paramedics is like listening to the stories of paramedics before deciding to drive on the motorway.

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

If you read my post then you will be able to answer that question for yourself. I didn't say that, I didn't suggest that. How would I know what would have happened if you had given birth (or attempted to) at home? You stated quite categorically that he would have died if you had been at home. I was simply asking if you would share the details so that other posters can understand why you needed to be in hospital and hopefully glean some useful information from your experience, rather than simply read another scare story.

I didn't actually elect for a home birth with DD2. I used the local alternative service, One to One Midwives, and was attended at home by my own midwife who had cared for me throughout my pregnancy. I had refused her offer of a home birth and booked the local hospital. On the night that I went into labour, I asked my midwife to call the labour ward to say I was coming in and to ask them to fill a birth pool. They said I absolutely could not use a pool and that I would have to have continuous monitoring and be on the bed. I knew I wouldn't cope with this as I need to be mobile in labour. So I just didn't go.

I'm very glad that I stayed at home and if I ever had another baby I would stay at home again. However, I wasn't totally on board with home birth before I had done it - so I do understand the perspective of those who say they don't want to take the risk (however tiny that risk may be). I do think it is important, though, for all women who might be interested in home birth to be able to get accurate information about all the options and what can happen at home and in hospital.

Joker, I'm assuming that you anonymised the names of the babies and altered the exact details of the cases, as otherwise that's a horrific breach of your professional standards as (possibly) an NHS employee. (I'm aware that many of you paramedics and ambulance technicians and drivers are employed by private agencies too).

If they were anonymised, because you couldn't possibly give their actual names in this way, then why on earth is there a need to add fake names at all? I'm not sure why you felt the need to add names for each of the babies, but I'm going to assume for your sake that you did that for some extra supposed dramatic tension, which is a bit naff in the context of a reasoned discussion.

Childbirth is risky wherever you give birth. Different women experience different risks. If homebirth was half as dangerous as some people make out then it would have been banned years ago.

Planned homebirth is rare in the UK and makes compiling statistics hard. Studies struggle to find a statistically significant different in outcomes between a hospital and a home birth. There is little point in looking at data of other countries that have a poorer hospital instrasture than us and barefoot untrained midwives.

jokersgiggle I have reported your post as I feel it breaches confidentiality with the very identifiable descriptions, even more so if those are real babies' names.

I also think there's a lot of inaccuracies in the descriptions you give.

1. The options for pharmacological pain relief at home births are gas and air, or diamorphine/pethidine. Gas and air is generally delivered beforehand with the homebirth pack or arrives with the midwife. Use of opiates may be restricted by local guidelines, but if its requested and local policy allows it can be prescribed by a doctor before labour for the woman to obtain from a pharmacy and the midwife to give when required.

1. I don't even know how to start to comment on the scenario you describe in the woman's home. However I will say that I have never heard of a woman with an obstetric hemorrhage being cared for on A&E or that they would be admitted to any ward other than maternity where a baby would be expected to stay with mum unless she/he was requiring special care from the neonatal unit. In fact in my experience most places in the hospital are very reluctant to have anything to do with pregnant/postnatal women, I have cared for a women with a variety of medical/surgical issues on maternity wards who were obstetrically well, because other wards weren't happy to have them. So I think the situation you describe must be incredibly rare.

1. That is very sad.

Most midwives attending homebirths carry portable suction devices however it sounds as if this maybe wasn't the issue if you weren't able to get air entry even after suctioning on the ambulance. It is entirely possible that there was another problem with this baby that would have resulted in the same outcome regardless of where he was born, its impossible to tell from the information you have given/know.

I feel for you, I know what it is like to go over and over events in your head though, I have also been involved with a completely unexpected tragic outcome, in hospital; and spent many sleepless nights wondering what I could have done differently (nothing was the conclusion of the local investigation, the parents, the paediatricians and the pathologist).

Sorry for not having posted sooner. Internet at work rubbish and wouldn't up load. Good point about MLU vs CLU penguins. I suspect that the because total disasters that might well have had a difference made by being in hospital are really very rare, the difference doesn't reach statistical significance.
I don't have specific numbers (and am not an obstetrician - am an anaesthetist) but I imagine it would be very hard to unpick the difference between a 'get it out now' crash section, where minutes, if not seconds, make a difference (tend to be for things like cord prolapse, uterine rupture, massive abruption) and a poor trace that's not getting better very well, where 20 minutes is the aim. They'd all be classed as category 1 sections, but there's quite a difference clinically.
Most transfers in from home are for increased pain relief or a trace that isn't perfect, where there's plenty of time for transfer. Remember though that transfer time isn't purely taken by the time from your front door to the ambulance drop off point. That's only a small part of the journey to theatre, if that's what you need.
I have seen several (not many, but enough) normal low risk pregnancies end with a 'get it out now' style crash section where the baby was pretty flat despite being out in minutes. It's really not common, but it does happen. I've also been on the receiving team for a home birth when a very well monitored woman with 2 experienced midwives suddenly lost the foetal heart. She was blue lighted in and the baby delivered in minutes but it was too late. Very uncommon and bloody awful for all concerned. That kind of thing scars you, even if you are only the 'professional' looking after the case. I cannot think what it does to the mother.
I love the idea of a home birth. Close family have done it and loved it. It sounds great. But it's something I'd not risk because of the potential outcomes that I know I couldn't live with. It's a very subjective thing. We all view risk differently.
For example, many people refuse and epidural 'because of the risk of being paralysed'. That's fine. But the risk is tiny. 1:200,000. The risk of stillbirth is about 2:1000 at term, rising to 3:1000 by 3 weeks overdue, but people happily refuse induction because the risk of going over is 'low'. It's much bigger than the risk of being paralysed, but perceptions are different.
Yes, more mothers and babies die in hospital but that is because more mothers deliver in hospital, so on proportions alone of course they do. Also, high risk maternal and foetal cases deliver in hospital so the odds are skewed even further.
Another point I want to make. Maternal and foetal deaths are incredibly rare in this country. We are very lucky. They are NEVER seen as 'one of those things'. There is a huge amount of formal investigation that goes on into seeing if anything could have been done differently and the hcps a involved are affected on a very personal level. I have seen midwives refuse to do future homebirth a because of things they've seen, consultant obstetricians in tears when there's nothing they could have done to help anyway and I have had nightmares and felt sick for months after an event where I could do nothing to improve matters. We are not automatons. We have feelings and normal human responses. We have to deal with them at the time to get the job done but they leave their mark, believe me.
The risk of something going catastrophically wrong at a home birth is very low. Usually there's time to transfer in if something starts to go wrong. So it'll almost certainly be fine and a lovely experience (with nicer wallpaper and better quality tea). However, there is a chance that something could happen that means mum or baby dies or suffers serious ill effects where they wouldn't have had they been in hospital. The chance is very small. But I wouldn't drive to the hospital without a seatbelt on either.

Thank you for the detailed reply. I suppose what weighs in the analysis for me is that there is no downside to wearing my seatbelt. Whereas there may be for hospital- one example would be things like increased rates of instrumental delivery (and obviously for homebirth they count transfers in, I know no one gets out the forceps at home!) with the long term complications they can cause.

I also find it interesting that quite a number of midwives I know have had home births, whereas every doctor I've talked to says they would never do so. I can utterly understand that personal experience scars you.

A couple of your points need picking up on though Jcb77. The place of birth study took pains to only analyse low risk cases, so that they were comparing like with like. IMO it's a bit of an easy excuse to say that the CLU get all the high risk cases so more things go wrong there. Yes, but since the vast majority of women are given little choice, CLUs also get the overwhelming majority of low risk cases too. (One survey I would like to see done is a comparison of consultant units, to see which ones have the better outcomes.)

You don't comment on the fact that the risks were found to be less for the mothers, so it's not just a question of nice wallpaper and better tea. Avoiding a CS and a greater facility in establishing breastfeeding for a couple of examples, are worthwhile in my book.

Things going wrong may not be seen as 'one of those things' in hospital, but these results don't get broadcast to the general public as a rule, so my comment was made in the context of the general public's opinion. In some cases, I am sure that, it was just one of those things - in others I think it could be questioned.

As the poster upthread said, her homebirth was much safer than a roadside delivery would have been but it didn't stop people offering opinions as to how wrong she was to have one.

Ahh, but Penguin - seatbelts can cause horrible injuries - severe bruising at best. Fractures ribs/sternum, ruptured liver/spleen, gut injuries..... Again, not a common occurrence but by wearing one for the small chance of saving your life, you put yourself at risk of some pretty horrible stuff too...... But they do save lives, if not injuries.
Having re-read some of Merkin's posts - good papers. As I said though, those cat 1 sections where only 66% had baby out in the aimed for 30mins cover a whole heap of clinical situations. They will range from the cord prolapse (category 1/2, if you like) to the 'trace was shit but now with some fluid and better positioning it's recovered and staying fine' scenario (category 1.5 perhaps). They all get recorded at cat 1 with no qualification, unless you read the individual case notes. Also, as was notes in one of the papers, rushing unnecessarily can actually do more harm than good (as with many things in life). That's when clinical experience and judgement come in. When we need to rush, boy do we rush. If it's clinically appropriate to back off the gas a bit, then that too. Remember, categories are made, ascribed things used as audit tools. Not predetermined givens. A cat 2 can also become a cat 1.....Most 'emergency' sections are category 2, where decision to delivery is aimed at an hour. Category 3 is within 24 hours so again you can imagine the huge variety of a cases that get shoehorned into those wildly different categories.
Being able to read the papers and look at the numbers but also apply clinical knowledge to bare figures probably makes a difference. You can't really take one without the other, although I'm not sure if it's a blessing or a curse in my current state! If I only relied on what I'd seen, then I'd be convinced that no one delivers except in screaming agony (epidural), with an induction of a section or a tear. Now clearly that's not the case, but I have only seen 1 natural delivery (and that's cos I asked to as I felt I needed a bit of balance!). I'm not going to base all my views on childbirth on my own experience, it's waaaaay skewed.
The homebirth numbers are so very small in this country, and not representative of the population (low risk) that comparing them with hospital births is very difficult. Ditto MLUs. Less of a dichotomy but still there in both numbers and caseload. The fact that about half of 'home births' end up not being also skews things. If about half of hospital births ended up being sent home for delivery, what would that do to figures? Homebirthers are a pretty select bunch; low risk, not wanting intervention and successful, by definition, at birthing at home. Usually, if something goes wrong, they come in. And the complications/interventions happen in hospital.
As somebody earlier said: 'it's just maths'. Yes, it is. But it assumes equal populations and the populations are anything but.

LaVolcan - I agree, a successful homebirth is a nicer experience for mothers. And a lot of it is about being relaxed and happy in your own environment (wallpaper, tea, own bed. They make a difference). For some though, the risks of a homebirth aren't worth the fretting involved. That's a valid as wanting to be in your own surroundings.
As for 'excusing' the higher intervention rate that occurs in hospital by saying that's because where high risk cases happen - it's not an excuse, it's a reality. High risk cases are more prone to problems and hence intervention. High risk cases as a rule deliver in hospital. Thus interventions, as a rule happen in hospital. And clearly they don't happen at home - they get transferred in for that - to have their intervention in hospital. The only way you could reliably assess the difference would be to randomly allocate women to deliver at home or in hospital (or MLU), not allow transfers and see what happens. Clearly that's bonkers and not going to happen. But it is also not fair to say that homebirths are all lovely and have no problems and hospital births are horrible and all have unnecessary intervention. Neither is true. As several people on this thread have said they had lovely low risk quick discharge hospital births. And some have had awful homebirth experiences.
The bottom line, for te original op, is that statistically speaking, if you are low risk, a home birth is really pretty safe. With some added benefit of your own surroundings and the likelihood of a speedy transfer if needed. If you are happy to accept the small but definite risk that something could occur that endangers you or your baby that can't be dealt with adequately or transferred in time, then that's your decision.
For many people that's not an option they want to live with. Which is their decision. Population based statistics can't tell you what is going to happen to you or where on the line you fall within that population and numbers alone only tell part of the story. Professionals get to see the numbers and the clinical realities to which they apply. Again, it doesn't provide crystal ball answers for individual cases but it rounds the picture. Think of your own jobs - how the Daily Fail and relevant reports (ofstead for example) portray your colleagues and situations and how you know what the difference in reality is.
This is a massively emotive subject where you can only 'make the right decision' in retrospect. Up til then it's often a best guess based on numbers, experience and feelings.

Homebirthers are a pretty select bunch; low risk,

Not necessarily by any means. Some homebirthers will be women who would be classified as high risk but are refusing to go back for more of the same as last time.

Usually, if something goes wrong, they come in. And the complications/interventions happen in hospital.

And show up in the home birth stats. Otherwise, how else did the Place of Birth study record CS and forceps for home births? The days when they happened on the kitchen table are long since gone.

Jcb77 I feel you are missing my point. Yes, high risk cases have more interventions, no one disputes that. No one on this thread is really discussing that group, although as I said, some high risk women do chose to have a home birth.

The Place of Birth study looked at low risk cases only and matched them and found that for multiparous women there were no extra risks to the baby for home birth and that the outcomes for the mothers were advantageous.(For women having their first baby at home the risk to the baby was slightly higher.) Most low risk women deliver in CLUs because that is the only choice they are given, so itis then an excuse to say 'ah but we have more problems because we have the high risk cases' when that category has been excluded from the equation. The results don't show that hospital is overwhelmingly safer for low risk cases. As far as I know, no recent studies have been done looking at high risk cases - probably there are too few to make such a study valid - so we can't make any judgement for them.

I don't think it's just a matter of a nicer experience. For me, and others here, it was the safer one, but that is just my opinion.

Agreed, some home birth ladies are 'high' risk. But mostly not. And some high risk births happen naturally without intervention and no problems. Some low risk go horribly wrong. That's the problem with risk - it doesn't tell you which one YOU will actually be. Advice is given and management plans made on the basis of likelihood and retrospective experience.
Sorry if I sounded confused - of course the salad tongs aren't whipped out on the kitchen table :). I didn't mean that. I meant that interventions (by definition) happen in hospital. This is therefore always correlation but not necessarily always causation. Yes, I am aware of the 'cascade of intervention' (am potentially facing it myself and grumpy about it) but it is still true to say that intervention rates are higher in hospitals because of the different case mix they deal with. People often chose homebirths to 'avoid intervention'. But, if you plan a homebirth and end up needing intervention (recorded as such) then surely you'd have it anyway?
I agree that a homebirth seems to reduce the incidence of intervention (reduces the incidence of epidurals too) but it doesn't exclude it and it does have other associated risks. The fact that so many planned homebirths fail to end up as such gives me pause for thought. Can you imagine selling a car or marketing a drug that only worked half the time?

Cross posted. Yes, just looking at low risk cases, especially for multips, home births do seem to be as safe as hospital births. I think the Crux comes because being low risk to start with doesn't mean you'll be low risk to finish with. That's the thorny bit that it impossible to tie down, hence the difficulty in decision making. Quite equally, plenty of high risk cases do just fine and could have had a home birth quite successfully.
Also, it depends on what level of intervention you (one) deems unacceptable. Too much monitoring? Not being able to move around? Fetal blood sampling? Instrumental or caesarean delivery? Some might well be unnecessary and being at home avoids them. Some might not. And the main point that I've been trying to make is that there is a small but ver y present risk that a home birth could result in a disastrous outcome that could have been avoided had delivery been in hospital. It's tiny, but it's there. For some, that's enough to make the difference.

I agree it's very difficut to compare the two. Social class is an issue too- home birth tends to be favoured more by middle class women; demographics do affect health outcomes.

I had a lovely calm home birth with an independent midwife. I had several reasons for choosing this:

• one to one care throughout my pregnancy was incredibly important to me. I'm an information sponge and I don't trust implicitly, so having someone I trusted able to answer my "why" questions was invaluable to a calm pregnancy and birth preparation. I was also scared by the prospect of such an intimate thing as birth being attended by a stranger, which is what happens in hospital.

• I don't like hospitals. At all. I get serious white coat syndrome. The one time I was in the day assessment unit for monitoring, DD's heart rate rocketed while I was talking to the registrar. And I nearly had a panic attack when the midwife was looming over my bed threateningly with a lecture on induction. I just find the disempowerment and sterile environment of a hospital incredibly stressful. Adrenaline and cortisol are the enemy of a good birth, so hospital wasn't where I felt safest and therefore not where it would be best to give birth. This is not a "feeling warm and fuzzy" thing - oxytocin is essential for the birth process, and in a stressful environment it will dry up and labour will stall. It was designed to keep us safe from an evolutionary perspective : all mammals will typially seek a safe dark isolated place to give birth, it's a process that takes all of the mother's energies so she can't deal with outside dangers at the same time.

• I read a lot about birth during my pregnancy. I read books written by midwives, I read Cochrane reviews, I read NHS policy, I read scientific studies... I concluded that the risks of a tragic outcome from a home birth, for me and my pregnancy, were (a) very very low, (b) not necessarily going to go away if I went to hospital, (c) could not all be anticipated through monitoring or tests, (d) offset by the negatives of hospital, and (e) acceptable to me. I realised that with birth you cannot know, there is no categoric approach to make it go well. You have to choose the path that is best for you, and never blame yourself for the decision because how would you have known otherwise.

• I didn't feel like I needed assistance to give birth. I wanted support, I absolutely wanted to be monitored so I could transfer to hospital if anything went wrong, but if everything went smoothly (and it did) birth was something I had to do myself. I think this made a huge difference to my successful home birth - I believed in my body's abilities. It sounds terribly hippy, and I'm the least woo person you can get, but I know my state of mind made a big difference.

My main piece of advice OP is go with your gut instinct. Birth is not a logical process, it actually shuts down your frontal cortex and prevents logical thought - you need to feel safe. Go wherever you feel safest.

The film "The Business of Being Born" is very good film.

It explains the cascade of intervention well. Ironically countries like the UK or Japan where childbirth is mostly managed by midwives have better outcomes than the US.

"I didn't mean that. I meant that interventions (by definition) happen in hospital. This is therefore always correlation but not necessarily always causation. Yes, I am aware of the 'cascade of intervention' (am potentially facing it myself and grumpy about it) but it is still true to say that intervention rates are higher in hospitals because of the different case mix they deal with".

The 'Place of Birth' study 2011 only looked at outcomes for women deemed low risk (at the onset of labour) according to their chosen setting (but not necessarily actual place) of delivery.

This study found almost double the rate of C-sections for low risk women who began labour in a CLU, compared to women labouring at home or in free-standing birth centres.

The outcomes for the babies of first time mums giving birth in freestanding MLU's (average transfer distance to a CLU in the study was 17 miles) was comparable to the outcomes for babies whose mothers planned to give birth in a CLU and were low risk at the start of labour.

All major surgery carries a risk of infection, bleeding, and in the case of c/s, unplanned hysterectomy. The evidence from the study I mention above suggests that hospital birth is resulting in at least one healthy woman in 20 having an avoidable C-section.