Homebirth for first baby? Anyone done this - good or bad?

[pippinleaf]

I met with our doula for the first time yesterday, I'm 23 weeks, and we chatted about what my feelings were around birth. I'd not considered a homebirth really but she got me thinking. We live less than a mile away from the hospital and I'm not keen on hospitals (who is?) she has her own water pool that she would bring round and set up etc for me which we could use regardless of whether I intended to deliver at home or go to hospital just for the later stages.

My thoughts on pain relief are that I'll go for gas and air and reserve the right to go for an epidural if I cant cope. I don't think any other drugs are for me as previous experience says I don't like anything which messes with your head. I know I would need to be at hospital to get an epidural but my understanding is that I can change my kind at any time and transfer to hospital so getting an epidural should be ok proving the anaesthetist is around.

My husband is happy to consider home birth but is anxious about anything going wrong and the need to be at hospital if it does. I'm 38 and there are no complications in the pregnancy but it is my first. We could be at hospital in less than five minutes if there was a problem but obviously if I'm bleeding to death or the baby isn't breathing then five minutes is a long time.

I'd be really interested in your experiences and thoughts?

I'm 32, 33 weeks with my first and hoping for a home birth after it was suggested by my community midwife. I'm 3 miles from the hospital and low risk. If your other half is happy, then I'd say go for it. There is no reason why you can't transfer to the hospital if you decide you need an epidural, but I think if you were to book to have the baby in hospital and then change your mind and want a home birth it's much harder to change.

I've had all three of mine at home and all very lovely positive experiences.

Incidentally I was booked into hospital for ds1 and changed my mind in labour when I was discovered to be almost ready to push when midwife checked me at home.

And if things do 'go wrong', remember during a home birth a midwife is attending only you and will usually pick things up much more quickly. They also tend to err on the side of caution.

I had my first at home.
I was closely monitored and midwife was present throughout so it would have been easy to transfer in at the first sign of a problem.
I was low risk and it was a very chilled out birth. I was so much more relaxed being in my own home.

I had my first at home (35 years old), it was great, do amazing to spend the evening with oh and and pfb!

they set up a resus area, my lo needed reviving a bit as he was slow to cry, but it was all fine and wouldn't think twice about doing it again

I'm 38 weeks and booked in for a homebirth for my first. I'm very much viewing it as seeing how I get on and going in if I need to.

I attempted a home birth with my first.

No regrets on that decision even if it didn't work out. My only advice is to go in with an open mind and if you need to transfer, do so without seeing it as a failure.

I had a home birth with DD, I do not regret it in the slightest.
The care I recieved was excellent and I really valued the privacy of being in my own home as I was sick a lot throughout my labour and would have been so embarrassed if I was on the labour ward.
G&A was enough pain relief for me and I didn't need stitches so I might have felt differently if that wasn't the case.
Personally, I think if you want a home birth then go for it :)

I'm going to speak to midwife at 28 week appt. my husband is not really on board he feels it's safest to be where emergency help can be given and won't buy that we'd get that just as quick with a transfer. Would a transfer be by ambulance or back of hubbies Volvo?

What showy said. And I loved my homebirth with DC2.

When I transferred it was by ambulance but we didn't have a car. From previous threads I would say it's likely you would transfer by ambulance but possible your DH would be asked to follow by car. Mine came in ambulance with me though.

You'll be transferred in by ambulance if need be.

I would reassure your husband with the fact that the midwife will be there to monitor you pretty much constantly whereas I believe in hospital the midwives look after more than one patient and you could be left alone. I'm sure any problems would be picked up very quickly.
Also you'll be more relaxed and in control in your home environment. As much as you should take your husband's views into consideration, he's not the one doing all the hard work!

I had homebirth with both of mine and wouldn't do it any other way!

As pps have said, I was closely attended by a midwife, and had total confidence that any problems would have been picked up and dealt with swiftly.

The available evidence shows that homebirth in the uk is at least as safe as birth in hospital (and actually safer in terms of maternal outcomes). Remember you can transfer in at any time, for any reason, including 'I want to be in hospital now' .

a friend of mine had a home birth for her first. very easy fast labour, but when baby was born she had meconium in her lungs and despite being transferred to hospital the baby sadly died. turns out the (very experienced) midwife missed seven signs something was going wrong. would they have been missed in hospital? I don't know.

Obviously if all goes well a home birth is the best option by miles - you get at least one to one midwife care, sometimes two to one, plus you get to stay at home in your own environment, you avoid the post natal ward and hospital food etc - everyone would choose a successful home birth if that was the guaranteed outcome, but its not. Like Spicelette I have a friend whose baby died because of her attempt at a home birth in an uncomplicated, low risk first pregnancy. A five minute transfer is long enough for your baby to get a hypoxic brain injury that could kill them or leave them profoundly disabled for life. I would much prefer to be at home than in hospital but for the sake of my baby's safety I wouldn't even consider a home birth. I am sure all the posters above had fantastic experiences and hopefully you would be lucky like them, but there are no guarantees. They had my friend in theatre and a c-section underway within 11 minutes of her arriving at the doors of the hospital - on any view the best the hospital could possibly have been expected to do in the circumstances, but it was already too late. If she had been in hospital, the CTG anomaly would have been picked up and she would have been taken to theatre without having to wait for an ambulance to be called, arrive, for her to be loaded in, drive to hospital, unload, and be assessed. Things can go wrong really quickly and if that happens, you are best off in hospital. I had an intervention packed first birth, but I don't look at these interventions as the negative consequences of being in hospital and having an over medicalised birth - the interventions saved the lives of both me and my DC and would have been dangerously delayed if we had been at home.

I think that whilst there will be babies who have died at home who may not have died in hospital (you can never know for sure), there will also be babies who have died in hospital who would not have died at home, due to infections and the way the labour is managed. Obviously it's completely tragic when something does go wrong in labour but it's not as simple as hospital = safer. There are so many confounding variables.

Transfer to theatre won't necessarily be quicker in hospital as they'd need to get a theatre team together, prep the theatre, etc - if you're close to the hospital then that can be done as you're being transferred in.

As for resuscitation, the only thing that midwives can't do at home that can be done in hospital is intubation and ventilation - paramedics can intubate.

I didn't have my first at home as I didn't even consider it but I did have my second and third at home (and will hopefully have fourth at home very soon!). I researched it carefully when I first thought about it with dc2 - have a look at homebirth.org - there's a lot of information about different scenarios and what would be done at home as opposed to in hospital, plus I'm sure your midwife will be very happy to go through any specific scenarios with you.

I had my baby In hospital and we would both have died had we been at home. As someone in the medical profession who has rung for 999 ambulances on multiple occasions there can be substantial delays waiting for one. Mistakes get made, A&E's get backed up and sometimes there aren't ambulances available immediately.

Whilst paramedics are excellent they do not regularly resuscitate neonates. Intubating tiny newborns is a whole different thing from your average adult. They are unlikely to have this expertise. Paediatricians are highly skilled in resus and can administer drugs and fluids too. When it hits the fan you need a highly skilled team and equipment.

The truth is that most people can deliver without any intervention, women have done it for thousands of years. Problem is you don't know if you're one of them and that wait for an ambulance could be the worst few minutes of yours and your partners life.

Clearly I am biased by my experience but I would hate for anyone to underestimate these risks. i hope you have a lovely straightforward labour.

Also the pp was correct in saying there is a lower intervention rate for home birth for first time mothers but there are worse fetal outcomes. Transfer to hospital in first time labours was 35-45%. This is from the large uk cohort study of over 64000 labours.
www.bmj.com/content/343/bmj.d7400

I have got to agree with cheesilycheerful on this. I had a great pregnancy and labour with DC1. One to one care in the hospital in labour, actually 2to1 if you count the great student midwife in attendance. Was told all the way through that I was an ideal candidate for a home birth despite being very rural a 45 mins drive to the hospital. However, things got fraught at the end however resulting in an emergency forceps delivery and they needed DC1 out in minutes. No time for theatre, he had descended too far. I accept that generally childbirth is not fun and people have good and bad experiences in hospital and at home. Reality is though that DC1 may not have made it even if it had taken me 10 mins more to get to the hospital. During my first pregnancy and even labour I had been open to the idea of home birth in subsequent pregnancies. Having had that experience there is no way I would ever attempt it.

It really upsets me to see people scaremongering.

For the right candidates, a home birth can be just as safe as a hospital birth.

Your anecdotes are not fact.

I can never understand why examples of births which had problems in hospital are used as an argument against home births. To me they are only an argument to avoid either that particular hospital or that type of hospital. There always seems to be a hidden assumption that if something happens in hospital it's just one of those things.

I never considered a home birth as I find hospitals reassuring, not scary. I hated contracting at home and couldn't wait to get to the hospital!

It sounds like you have an open mind about things changing during the course of the birth, which is the main thing. I could have laboured at home but would have needed to be transferred in the end as I needed a forceps delivery (DS was stuck). Also consider yourself when you make the decision - my DS was perfectly fine during the labour & delivery but I had blood loss to the extent that I might not be here if I wasn't in hospital and access to immediate medical assistance.

What ever you choose, I hope you get the experience you want.

Yes but knowing who the right candidates are is the problem. The only way of saying for certain that it was a safe birth is once it's over. Once you've had one safe and easy delivery you are likely to have more but there are no certainties in labour.

I believe in a woman's right to chose how and where she gives birth. This is not fixing your ingrown toenail. The stakes are high for mother and baby and women have the right to all the evidence and information. This is not scaremongering but making informed decisions knowing the risks and benefits of all options.

So you would have all women deliver in hospital? Since hospital births don't have a 100% 'success' rate I find it a bizarre conclusion. Just because you felt safer and it was right for your birth to be at hospital, it is categorically not true for all women.

I felt infinitely safer at home. No my births weren't perfect but they were right for me and my baby.

Every woman should have the right to choose. And not be terrified into the wrong choice because 'your baby might die'. I make choices every day which might result in my children dying (driving, leaving ds1 home alone, crossing the road) but I ding live my life looking at all the worst possible outcomes.

I agree with you up to a point cheesily, except that you could say that of life generally - e.g. young people can drop down dead suddenly, but we don't say that everyone should never be more than 10 miles from a good hospital, just in case they happen to be the rare example of this happening. So pointing people in the direction of a good study, which you have done, is making information available. Stating how this that or the other person had a problem with a home birth and therefore all home births must be more risky than hospital births does become scaremongering.

To take an extreme example - for the sort of woman who is so terrified of hospital that if that was the only option, she would free birth, I would imagine that most people would say that a properly attended homebirth would be far preferable and safer.

It sounds like OP has a good attitude - start at home and see how it goes, transfer if necessary. If she opts for hospital she might end up spending much of her labour at home anyway, depending on how busy they are, and how slowly or rapidly she is dilating.