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

Transfering in during a home birth is no different to a domino delivery. (Ie. community midwife comes out to you while in the early stage of labour and you transfer in for the second stage if you choose.) Lets face it, its more comfortable at home and in someways it is cheaper to the NHS to have domino delivery and and just transfer in those who need it.

Why is it cost effective to have someone blocking a labour ward bed when they are two centimetres dialatated?

Why is it cost effective to have someone blocking a labour ward bed when they are two centimetres dialatated?

Except that these days they are more likely to send you home, so you can spend your labour rushing backwards and forwards, which is not a recipe for staying rested and conserving your energy.

In terms of "tying up resources" with midwives attending home births vs hospital births, home births are cheaper than other birth options in the UK.

To me, one attendant per woman should be a minimum standard, and the idea that this is 'tying up resources' is little short of disgraceful. Some will need more assistance, but having one midwife running between however many labouring women might be 'efficient' on paper, but it certainly isn't in practice.

LaVolcan - born on back of ambulance 'BIBA' - worst of all worlds I would think :(

Weebairn - yes, too risk averse also bad. I think a lot of docs are by nature pretty risk averse. I think you said that up thread. And some specialties seem to select for the most risk averse (anaesthetics is possibly one of them). The other point to make, which we might have been skirting around a bit, it that risk tolerence comes with experience. Where you have a reduced body of experience, more interventions are likely, 'just in case'. Although I can't back this up with numbers, but it seems to be the way, and not surprisingly really. If a possible consequence of wrongly interpreting a host of readings, traces and test results, however subtle and non specific they can be, is a poorly or worse baby, I'd be pretty risk averse too. Clearly there is also the mum to think about, I know, and again it comes down to balance, but it might help explain why so many more interventions happen in hospital, possibly unnecessarily. That and the fact that they're easily available. So it's easier to 'err on the side of caution'. Even among consultants it seems there's often room for 'discussion' about the way forward. It all seems quite grey. Until it's not.
And weebairn - I so couldn't do your job. I'd be on tenterhooks every time I discharged someone, just in case. But then, I spose, with experience I have become a lot more chilled (but still aware) of the risks in my job.

Yes absolutely and that is why there are more sections at night (sorry can't quote source but read that somewhere and sounds absolutely true to me - more junior docs).

And, I feel, led to my reasonably long labour being managed so successfully at home - I had two very relaxed, very senior midwives in their 50s. They did not have to ring a bell for a doctor at the first abnormal sign - they knew what could be safely managed and what could not. Of course midwifes can be like that in hospital too, but I do think the continuity of care is generally better at home (this isn't really a plus point for home births, more what it should be like in hospital but isn't) .

I think my only point about doctors originally was that people often say, if things like home births/natural births are safe, why do so many doctors opt for ELCS? And my point was that it's not because doctors know something other people don't, or are better at processing evidence, but just it's more a personality type that prefers things to be "known" and "in control". Not always, but often.

Most days I can do my job and then sometimes there is one of those humbling days that makes you reassess everything… but I see the flip side too, you know, the inappropriately admitted elderly patient who has nothing wrong with them but no one's really coping with their care, who gets a hospital acquired infection and dies pretty quick. I have seen patients seriously harmed by inappropriate investigations, I have seen people become depressed, bed bound, develop blood clots when we can't discharge them quick enough. Hospitals are for ill people and we do our absolute best for them - but they're not without risk. I would be glad and grateful to go there if I had problems in my labour and praise the gods of modern medicine that we have this wonderful free service, but I wouldn't look to be there otherwise.

Um, sorry, got a bit carried away with my train of thought there. I don't mean to imply those risks above are risk of labouring^ in hospital, just some of the things I've seen in my patients (who are a very different population to obstetric women). Labouring in hospital is safe, there are some risks that are higher than being at home and some risks that are lower, but in general both are safe. Being in hospital is just not my preference.

I know that post was a little off topic re the elderly weebairn, but I heartily agree with it having seen it happen to a close relative.

You an anaesthetist JCB? I couldn't do your job either - would have to spend too much time around surgeons I'm always very happy to see you turn up at cardiac arrests though ! :)

I can't decide whether I'm happy I found this thread or not... I'm 37 weeks with second baby and had planned a homebirth from the start (also planned with ds but SROM and induction happened). However, 20wk scan resulted in poor view of four chambers (could only see three) which happily showed up as soon as specialist scans were done days later. So down to wriggly baby (very) and scanning issue - not heart problem. But our (risk averse) consultant has said he can't 100% rule out a small septal defect, therefore advising against hb and suggesting mlu instead.

Community midwives meanwhile are happy that as we've been discharged back to community care, I'm low risk and fine for hb.
So now I'm torn. Afaik, I'm no higher risk of having a baby with a heart defect than a woman who hadn't had the scans (and the majority of defects aren't picked up by standard anomaly scans anyway) so I'm in the same place risk-wise as I was at the beginning. Right? But obviously if the worst happened and baby was born blue, I'd never forgive myself if being in hospital would've made a difference... We're around a 5-10min drive from the main hospital.

So why do I want a hb? The postnatal care (in a different hospital) was awful with ds and we were stuck there for 2 days. It was traumatic having dh leave me those nights, and feeding was horrendous with contradicting advice left right and centre. I really want to avoid this again. So far, I've thought I'll make the decision when I go into labour. Still very torn though.

Interesting debate.

Its all simply about assessing risk for yourself....

Risk of getting vile infection/ noro in hospital. Risk of going gaga in the postnatal ward. Risk of not making it to hospital and birthing in the car. Risk of receiving less dedicated care and less soon in hospital V Risk of having to transfer for some reason. Risk of less support in emergency situation.

On these threads you always get the 'I'd have died at home' brigade. That may or may not be true. There are procedures for pph/ resus of babies at home, yes in this situation hospital would be the best place but to say that the outcome would have been bad is pretty much impossible to say. A friend of mine was adamant this was the case - I think with how it is round here the issues with her labour would have been picked up much earlier. Who knows?

OP make your own mind up rationally is my advice.

Can I ask a totally dense question? What is actually the difference between a MLU and a homebirth? If (as I think someone quoted earlier) the average MLU is 17 miles from the nearest CLU if you needed to transfer, then why would you go there rather than staying at home? Obv if you live in the sticks or the MLU is attached to a CLU then things are different, but in general.......? Wouldn't you still get midwife led care with the drugs and experience they can bring but in a unfamiliar setting with (although possibly better than hospital) NHS wipe-clean furnishings? Why would you choose to do that rather than stay at home? I've never been in an MLU and hadn't really thought about it til now. I'm just struggling to see the advantages over a hb unless proximity is one of them.

Jcb some people think a home birth is unpleasant for other reasons. You're not actually far off with "wipe clean furnishings"! I've seen people on these threads say they couldn't sit on their sofa again if they knew they'd given birth on it, or they have cream carpet and are scared of bleeding on it etc etc etc.

But it's probably mostly less logical. The language used to describe birth is that it is something that is done "to" women (doctors "birth" babies), with options they are "allowed" or "not allowed", so I can see why people think they need to be somewhere official.

Some people don't want the hustle and bustle of a CLU and live in small flats so feel they haven't got the space for a homebirth, (but erm, you don't need much more space than you did to get the baby in, in the first place). Some worry about noise, and the neighbours hearing.

I actually feel the same JCB. My choices in my area are a stand alone MLU, home or a rather half hearted MLU attached to the CLU.

For me, homebirth is the obvious option. My older children can remain in the house if it happens over night. No one can tell me I can't use the pool as it is my equipment not theirs (not in an irresponsible way, but I labour erratically and the 'you must be 5cm' rule many hospital settings apply has been problematic for me in the past). I don't have to make a decision about when to transfer in (unless I decide to for pain relief or there is a problem).

Anecdotally, the MLU in my area does seem quite underused. Many feel it is a first step towards closing maternity services at that hospital. It used to have a full CLU. I think people choose it because, if you are that side of town, it is a lot closer to home (and obviously hospital to hospital transfer is likely to be quicker and easier to arrange from an ambulance point of view), because they feel more comfortable 'in hospital' (even though it doesn't have theatre facilities, etc), because they worry about noise/mess/neighbours at home. Lots of reasons. However, for me, a stand alone MLU has never really been on the list of options.

If it was a standalone mlu then I also wouldn't really see the point over a homebirth; mine is an mlu attached to the main hospital and labour/delivery ward. Hence my consultant recommending this as a compromise.

I'm leaning towards sticking to my hb though.

Thanks guys. I suppose mess is a concern, but several hb threads I've read say in reality it's not a problem, and the neighbours - the teenage boy next door gives me funny enough looks as it is, without having heard me mooing through labour! So I can see how a 'home from home' MLU might be a better option for some.
Having been a guest of the NHS several times, the whole wipe clean mattress/pillow combo is really ick, esp if you're bleeding/sweaty/hot. All of which apply above. Even the comfy chairs are wipe clean! I think some of the on call rooms have had a 'proper' mattress - bit knowing some of my colleagues - that's not always a good thing either ;).

Mess isn't really a big deal I found. I may have underestimated lochia when walking to the shower but it did come out of the carpet, it was only a few drops! And DH did find emptying the pool the next day quite revolting given that DD greeted the world with a big meconium poo! But I didn't have to deal with that .

I concur, mess wasn't a problem - the midwives will clear up what there is. We have had more mess in our house when someone has been ill, clearing up sick and poo and constantly having to change bedding.

No mess at all ime, I wouldn't even think about that. Dd1 does go on about her sister being born 'in front of the telly' though

I don't quite see the advantage of MLU over home either. Perhaps if it's nearer the hospital, or if you have loads of kids at home and don't want them around, or neighbours you don't want to disturb.

But mostly I think it's for people who want the advantages of home but don't feel comfortable with the idea. Which is fair enough.

I know one woman who went for a MLU - she would have loved a HB but ultimately really wanted a pool and her floor wouldn't support one. She went with the MLU because she was guaranteed the pool and wanted to have a natural birth (which she ended up having).

The other I think wanted to feel like she had a compromise between being in a medical environment and being in a homey one, I think in part it was psychological.

I think whether you get the 'advantages of home' very much depends on how good your MLU is too. Lewisham, for example, the rooms look lovely (which is one of the reasons it was so scandalous when their CLU was under threat because of Greenwich's financial problems, and why I am appalled that the Government have subsequently changed the law after being stopped. But that's enough of my political soapbox). Double beds, actual cribs, really homey. I used to live in that area and would love to have used it, but DD1 was born before it opened and by DD2 I had sworn off hospitals unless I was high risk.

My current area, dear god it's a half hearted affair. A few walls have been painted bright colours. The rooms have either a 'birthing couch' or a pool instead of the main hospital bed. That's it. It's still quite obviously a standard hospital room where minimum effort has been made to call it a birth centre. I wouldn't feel any more 'at home' in a hospital room with one burgundy wall and a birth ball than I would in the CLU.

I liked that we were just left to it, no doctors and only an occasional midwife. The MLU at Whipps isn't homey in the slightest, but it's more about the attitude than the surroundings for me. And the doctors and theatre and NICU are only a lift away, which DH finds very reassuring.

I can understand that. For me, I found I had to go really 'into myself' to labour effectively. I just couldn't let go in strip lighting, with people coming and going (though left alone for hours on end), no privacy, chemical smells, etc. I seem to need to really 'turn off' and I just couldn't.