Homebirth, am I crazy?

[rubberducky87]

Just that really. I'm a first time mum and I really want a homebirth but scared because I've never done it before. Only a few more days until I'm due! My midwife is very supportive but I'm still nervous. Any stories to share??

Flowergirlmum the fact that your waters broke before you had a contraction put you at higher risk for a cord prolapse.

My waters never broke with ether of mine- their heads were too far engaged. My risk of prolapse was zero as there was no space for it to prolapse into. So you can't compare everyone when 2 women can have such varying risk factors.

Cord prolapsed which happen during the second stage can be managed at home using an episiotomy & forceps- just as they would be in hospital. You had a c section because you weren't in that stage of labour. Not all women with prolapse get/need c sections.

Also as to the 'first day on the job' comments. 2 midwives attend home births. So there will always be one experienced MW there.

Out of hours emcs done in July by the new batch of jho's on the other hand- that's inexperience I wouldn't want.

Jackie- most women with prolapse end up with a section unless they are a long long way through their labour. Even if forceps were to be attempted you would have to be in the hospital which would delay the time it took to get the baby out.

If things go wrong the best place to be is in a hospital therefore be in a hospital if at all possible. Yes, things might happen. Yes your baby might accidentally be born at home due to time issues but this thread is all about a planned home birth not an accidental one. I don't think anyone would argue that accidentally giving birth at home is for the best!
Again re autism yes I have seen people in the grip of autism and I do understand your point. I just wonder how on earth the moment of stress should a transfer become necessary would affect you. I honestly feel that a calm, planned arrival at hospital with staff who were aware of your situation would be easier on you than a panicked arrival where there was no time to explain.

And of course when you say that waters breaking ahead of a contraction creates a higher risk of prolapse you're right but that wouldn't be a risk that would cause a transfer to hospital in a home birth situation would it? And I'll say again, her head was, according to the midwife at my last appointment, engaged. Had I planned a home birth we would have been all systems go.

I'll tell you another story of a friend of mine who chose to give birth in a MLU. I haven't mentioned it until now as we've been discussing home birth but it is relevant to the discussion on transfer. At her final appointments and in early labour she was told all was well. However at some point during delivery they realised the baby was breech and they needed to get the baby out ASAP. The MLU is about 30 minutes away from the nearest hospital and so they didn't have time. They had to do the best they could. The baby survived but has cerebral palsy. Had she chosen a hospital birth (and make no bones about it, she chose the MLU on the grounds that it's a more comfortable environment) the baby would have been born by C section and almost certainly be fine.

Flowergirlmum

Your situation was vanishingly rare. Even RCOG own guidance say that a cord prolapse cannot usually happen when the head is engaged. Yes, prolapses happen, but not normally without risk factors. (I'd link, but it keeps opening as a pdf)

I get why you think that the only factor women should consider is the possibility of an unpredictable and unpredicted disaster scenario. I get why you think that the teeny increase in chance of a good outcome (because, in the vast majority of hospital births, you wouldn't haven been in hospital on a monitor when your situation occurred) on a highly unlikely scenario is 'enough'. I do.

You've said you don't see any upsides to homebirth. So of course you're going to think that. It doesn't mean that you are 'right' and that others are gambling if they don't make the same choice as you. As has been repeatedly said on this thread, people can weigh lots of factors, including the benefits of proper one to one care, mental and physical health outcomes, etc. That is no less legitimate and logical than your choice.

you have a very touching faith in what happens in hospitals flowergirlmum. the statistics show that mlu are safe overall, just as safe as hb or hospital birth, safer than hb for first time mums. if hospitals were safer, that is what the data would show.

there will always be sad anecdotes on all sides as all birth is risky.

30 minutes by ambulance is quite a long way away though, is it just a rural area? our mlu is in the hospital - great - except of course they closed another mat hospital so some women have a longer more dangerous journey in labour. i wonder sometimes if that leads to an increase in unsupervised births for some poor women. even 30 mins away by ambulance for a homebirth is part of the risk

why wasnt the breech position picked up earlier? some countries scan before birth - our outcomes are not that great for birth, perhaps this is an area we could improve in, instead on focussing on the last few hours of the pregnancy. equally, the lack of experience in delivering breech births nowadays can lead to difficulties, perhaps greater training is needed?

Flowergirlmum - yes. And my friend's baby died in part because she was in hospital. It doesn't mean hospital isn't generally safe. The same goes for an MLU.

Flowergirlmum that shows how little you know about home birth.

The home birth kit they bring to your house at 37 weeks contains forceps. If a sudden emergency like an unexpected cord prolapse happens they can use forceps at home.

Flower I have told you already that you are wrong when you say that waters breaking ahead of contractions wouldn't trigger a transfer from a home birth situation! That is exactly what happened to me! Look:

Planned home birth.
Baby's head engaged at 36 weeks appt.
Waters broke without warning at 37 weeks and no contractions.
Called labour ward and advised to come straight in.
Baby delivered in hospital.

The fact that my waters broke with no contractions raised the risk of prolapse so the home birth was immediately off the cards. It was certainly NOT 'all systems go' for the planned home birth!

wasnt there a tv homebirth recently with a cord prolapse?

The thing is, we could probably all trade anecdotes about births either going wrong or nearly going wrong. All the anecdotes I could tell are about hospital births. Does it mean that the hospitals were bad?

My own feeling is that Flowergirlmum was mighty lucky - she could so easily have been told, sorry no, too busy, go to the next hospital. She doesn't seem to want to acknowledge that. She seems to have a particularly rosy view of hospitals.

As I explained before, needing to transfer in because that is safest will not bother me nearly as much as going to the hospital just so I'm there already. I know which things are hard for me and going in when I don't need to is one. The nurses and other staff at the maternity ward are sure to be lovely, but it is unlikely that they will have a lot of experience with autism and what would work for me.
If I need to transfer in because of an emergency, then I won't care. If I need to transfer in because, for instance, the contractions aren't strong enough, then my trusted midwife is there with me to explain things. But again, going into hospital really is for when I need to, not for when I have the choice to stay at home.

Sanfairy my touching faith in hospitals is probably a result of the fact that they saved my baby's life. It wasn't so much faith that did it though. It was more down to equipment and skills.
I totally understand the desire of women on here to convince themselves that a) they'll be fine, emergencies are rare and b) I'm some sort of a nut case emotionally scarred by a traumatic birth or even c) I'm making it all up. It's perhaps easier to believe those things rather than accept that what I am saying is true. Emergencies are rare. As I've said you'll probably be fine. You might not. If you're not you'll probably wish you didn't have to go in an ambulance to a hospital and cross your fingers you get there in time.
I think there's a happy naivety in some posts that in a bad situation a midwife will whip out the forceps (which are not recommended for use by midwives in the UK at all), or the ambulance will arrive in perfect time or the hemorrhage will stop when commanded by the expert midwife. You might be ok. All things might fall
into place and it might be perfect.

I was lucky you're right. I was absolutely in the right place when things went wrong. I am under no illusion there. Some of you have no plans at all to be anywhere near the right place. That's my point.

Just to answer a question. Yes it's 30 mins to the nearest hospital from the MLU. I have no idea why they didn't spot the breech presentation but they didn't. They were sued by this couple and several others as a matter of fact and accepted responsibility. The resulting baby is now 10 and lovely.

By the way, to clarify, when I said forceps are not meant for use by midwives in the UK I did of course mean in home births.

Flower you seem to believe that a hospital provides a risk-free environment, although others have pointed out the ways in which a hospital can actually increase the risk of something going wrong. You don't seem to understand that everything in life is risky and you have to weigh up those risks in individual situations. Several people have pointed out that in some cases the journey to hospital is more dangerous than a planned home birth. You don't seem to understand that, simply because in your situation that wasn't the case.

There can be a risk involved in driving to hospital eg in adverse weather conditions or in the case of precipitous labour (you obviously don't understand this at all).

There can be a risk of overworked or negligent medical staff failing to recognize a problem that would be picked up by midwives in attendance at a home birth.

There is a risk of a medical emergency for mother or baby in a home birth that can't be dealt with in time.

It's not up to you to say that third risk is the only one that counts, particularly as you are so ill-informed about home birth and the situations in which they will transfer.

These risks will vary in each individual circumstance. It is up to each individual woman and the team of health care professionals with whom she is involved to assess these and make decisions accordingly. It is not up to you to decide you know the absolute risk for everyone else and to judge people as selfish for not agreeing with you.

Sometimes the wrong decision will be made. Sometimes there will be bad outcomes that could have been prevented. That's as true of hospitals as it is of other environments. There are never any guarantees.

I think it is highly likely that if DC1 had been born in a hospital, I would have ended up with a "life-saving" C-section due to foetal distress. And given that the last person in my family to have surgery came very close to death (and isn't out of the woods yet) from infection, I might well only be alive because of that home birth.

I tell you what, when hospitals start sending people home in emergency situations because it's safer for the baby and mum then I'll change my mind.

Jelly - I think you have your answer from Flowergirl's last post.

Sorry, pressed post too soon.

Flowerygirl does indeed believe that only one factor is relevant.

Understandable given what happened and how recently.

But it's not a balanced view.

Hmm, so she has no problem with hospitals sending people home for non-emergencies, but doesn't agree with home births. So what are women supposed to do?

They don't send people home for non emergencies! They send you home if you're no where near delivery. Hardly the same thing!

But you were nowhere near delivery. If it had happened an hour later you'd probably have been at home. Surely?

Surely given what you have said about how the only sensible place to be is hospital, all women should be there from first contraction (or waters breaking if earlier)

And also on continuous monitoring. Do you think all women should have continuous monitoring throughout?

They send you home if you're no where near delivery.
I can tell you of a few who would beg to differ!

Penguins I'm pondering on your question. I'm wondering what our grandparents would have said if asked that. Would you rather have your baby at home and hope for the best (as they had to) or be in hospital on continuous monitoring to ensure your baby was happy. I have a feeling I know what they'd say.