Has anyone regretted a home birth?

[WonkyDonkBonk]

I'm expecting DC2 in December and had a very straightforward birth last time at a MLU so my midwife suggested a home birth. At first I dismissed it, but it has been rolling around in the back of my head. There are lots of people saying how wonderful and calm a home birth is and I don't think I have ever read any negative comments.

I wondered whether anyone out there didn't enjoy it or found it a logistical nightmare.

We live about 10 minutes away from hospital by car.

Thanks in advance.

What "studies show on risk"? This one based on CDC data of nearly 14 million births and deaths says that the risk of a baby dying is nearly four times higher when delivered by a midwife at home than by a midwife in a hospital.

The researchers found that the absolute risk of a baby dying at birth or in the 28 days following delivery was 3.2 per 10,000 births when a midwife delivered the baby in a hospital, compared with 12.6 per 10,000 births when a midwife delivered the baby at home. Moreover, if the home delivery was the mother's first, the risk increased to 21.9 deaths per 10,000 births, the researchers found.

People have given examples on this very thread. What do you think would have happened to the MNers who needed emergency sections if those births were at home? What would happen to the babies born with an APGAR score of 1?

If all goes well, it's wonderful to be in your home, in your own bath etc. If it doesn't, those comforts are nowhere near as important as an ICU, an operating room, and a surgeon.

The place of birth study

international studies are not particularly applicable to the UK.

What would have happened to those needing emergency sections?
They would have been transferred to hospital, with the EMCS then showing up in the home birth stats. You may easily be attended to more quickly than in a badly staffed hospital, where one midwife is running between three people and no-one knows there is a problem brewing, simply because they can't be in three places at once. At that's part of the trouble - women are encouraged to go into hospital on the basis of 'what if' not 'what actually'.

You can't tell from the CDC article what they mean by a 'midwife' - it could be a lay midwife, who wouldn't be able to practice in the UK. With a UK midwife you know that she will be trained and qualified to attend a delivery. The UK stats don't show that the risk of a baby dying is 4 times higher when delivered by a midwife at home. They show it's slightly riskier for the baby in a nulliparous woman, and safer than a CLU for a multiparous woman. So unless the OP plans to deliver in the US, what happens there is not particularly relevant.

There is also the issue of transfer protocols. The UK has a clear and easy process to transfer someone from a homebirth with continuity of record keeping and a defined pathway. That isn't true everywhere.

Place Of Birth study is not a resounding affirmation of homebirths. Given that only women previously judged "low risk" give birth at home and those deemed "risky" births happen invariably at the hospital, rates of perinatal death & intrapartum related morbidity should have been MUCH lower in homebirths if risks of giving birth at home and in hospital were indeed similar.

In other words, more low-risk births take place at home while all high-risk and medium-risk births happen at hospitals. And yet, the same number of dead babies result from homebirths as hospital births. What does that mean?

It means that a low-risk birth suddenly ceases to be low-risk when it takes place at home.

Statistics can be bamboozling and tweaked to say different things. I made my choice based on what I knew I could live with should things go wrong. I would never have forgiven myself for wanting a 'great experience' at home if my babies were hurt by it. I agree that you may not get the undivided attention of 3 midwifes/serene surroundings/mum on had to make delicious meal but, for me, I'd rather have full medical team and facilities. Having said that, I work in hospitals and so they feel quite homely to me!

You didn't bother to read anything on the study before attackig it did you Cote? You point would be an excellent one, except that strangely enough the researchers realised that comparing all births would render their results meaningless. The groups are based on low risk women for both settings. Hospital transfers also still count as home as it is done on planned place of birth, not actual place of birth.

You are twisting the stats Cote. The study did show that intrapartum morbidity was substantially lower at home and for multiparous women was safer for the baby. Furthermore to say that all low risk births take place at home simply isn't true when something like 3% of births are home births and perhaps a similar number are MLU births. It means that the CLUs are dealing with the vast majority of low risk births.

I too made my choice on what I could live with. It was about safety - the idea of taking pot luck in a large hospital who appeared to neither know nor care about me or my health or a home birth with a known midwife, made it no contest.

Full medical team - tell that to the friend who was turned away three times from the hospital because they were too busy, who eventually got the support she needed after 60 hours. Or the friend who delivered unattended in hospital, with a cleaner sitting with her immediately post partum, whilst her husband went frantically in search of assistance.

Excuse me, I'm not twisting no "stats". The study says (and I quote) "there were no significant differences in the incidence of the primary outcome (death of baby) by planned place of birth." Given that pretty much the only homebirth candidates are low-risk pregnancies, it is not great that homebirths have the same probability to result in the baby's death as hospital births. That is all I said.

"Furthermore to say that all low risk births take place at home simply isn't true"

I did NOT say "all" low-risk births take place at home.

However, it is a FACT that homebirths are indicated for low-risk births only, while high-risk births are directed to the hospital.

"Full medical team - tell that to the friend who was turned away three times from the hospital because they were too busy, who eventually got the support she needed after 60 hours."

It sounds like hospital care in the UK is absolute rubbish. Maybe that is why homebirths look about as safe as hospital births in the UK, whereas they are 4x as likely to result in the death of the baby in the US.

Again. It was comparing low risk mothers by place of birth. Not all mothers as you are assuming.

US stats are very different mostly because of differences in what it means to be a midwife and protocols for transfer.

It seems that you have a problem with home births per se, Cote. That's fine if you are the one to give birth, but in this case you are not.

OP. who now seems to have disappeared, is the one who is going to give birth, so what matters is her opinions, her health, her baby's health, how far she lives from the hospital etc.. She has had one straightforward MLU birth, has been offered a home birth. She isn't apparently in the US so hearing about what happens there isn't going to have a practical bearing on her choices.

She was wondering about breastfeeding support. I don't think anyone has answered that. I suspect it varies around the country. I would imagine that this is a question she needs to ask her midwife about.

"US stats are very different mostly because of differences in what it means to be a midwife and protocols for transfer."

You assume.

Quite possibly, US statistics show that homebirths have 4x risk of death to the baby than hospital births, because hospitals show proper timely care to women giving birth. A single midwife isn't responsible for 3-4 women giving birth at the same time, women in labour are not turned away because the hospital is full, etc.

I don't have a problem with homebirths or people having the choice to have them, LaVolcan.

The problem, as I see it, is that some people are overlooking the importance of having an ICU, an operating room, and a surgeon at hand to whisk the baby out with an emergency cesarean or resuscitate a very poorly baby. Statistics are all well and good, and they clearly show that giving birth is a pretty safe affair in the 21st Century. However, if something goes terribly wrong, calling an ambulance, spending 10-15 minutes getting to a hospital etc is going to affect a baby's chances of survival, as evidenced by people's stories on this very thread.

OP needs to know this along with stories of how lovely it was to be in your own bed after the birth and your mum's cooking for dinner.

Not going to acknowledge that your long statistical risk posts were based on misunderstanding who was being compared then?

Midwives don't deal with hospital births at all in the US. Hospital births in the US are attended by an ob-gyn (doctor). Midwives in the US are not (necessarily) trained and regulated in the way they are in the UK. You are comparing apples and oranges.

Anyway, back to the OP's question re. breastfeeding. We did struggle (undiagnosed tongue-tie), but I'm not sure we would have been much better off in hospital, based on anecdotal reports from friends.

Once I realised things weren't going well I contacted my mw team, who arranged for a bf helper to come to my home - she was brilliant and visited us lots of times and eventually pointed me in the direction of a way to get DD's tongue tie assessed and cut privately because the GP wouldn't refer us bastard I also wonder whether in hospital we would have been encouraged to 'top up' with formula, something I didn't want to do, but might have been persuaded into in the middle of the night by a possibly well-meaning postnatal midwife. Again, who knows.

To OP or anyone else considering a hb: do you own research, ignore scaremongering, and just base your decision on your own instincts and the evidence. I'm afraid it really isn't a decision that anyone else can make for you.

The thing is that those who argue against homebirths (or who patronisingly say that they are fine but it's prioritising your own experience and your own risk over risks to the baby) often over-weight the benefits of proximity to an OR etc in their argument. (Note: all of this is about low risk, multiparous women).

Yes, there are situations where it will be safer to be in hospital. In a placental abruption completely without warning signs, you are safer in hospital and the crash section may well save your baby. On the other hand, the statistics show that the risk profile overall is lower at home than in a CLU, where you are right next to the OR. What that means, put bluntly, is that there are even more situations where being in hospital indirectly risks your baby's life.

A family friend was left labouring in a room with her husband in a CLU. As a result, a number of warning signs of a placental abruption were missed. As a result, even being right next to the OR sadly did not save her son. Funnily enough, no one has suggested that being at home would have been a safer choice and saved her baby - yet the investigation found that one to one care would have been likely to pick up the warning signs and the way to get that at the moment on the NHS is to have a homebirth. If she'd given birth at home, no doubt many people would have felt able to judge her for doing so and 'risking' him.

Being right next to the technology is great, and you would think it would improve outcomes. The fact that it doesn't shows that there are one or more balancing factors going on in a hospital which are nullifying that benefit. We can hypothesise what they are - most likely one to one care and a greater degree of caution at home - but we don't know for sure.

Not all homebirths are low risk. Just wanted to highlight some HB are not low risk but mothers prefer them and know they are the best for them and their DC.

I had:
DC1 planned HB, classified as low risk.
DT1 & DT2 planned hospital birth (due to exomphalos in one twin) ended up with EMCS due to waters breaking at 31 weeks.
DC4 planned VHBAC classified as high risk.

I was consultant led care throughout pregnancy 3 due to the issues in pregnancy 2. Still preferred to have a VHBAC.

People seem to think that having a theatre etc as in hospital leads to the quickest CS, in my case waters went, foetal distress, staff handover, then EMCS. I would probably have had a section quicker if I had transferred in from home. As it was I sat holding two dopplers on myself whilst staff did handover.

If there is any sign of distress then transfer becomes a possibility, at which point systems should be in place for your arrival from home.

Good luck with whichever you choose.

Citydweller - totally agree. I said to someone on another thread recently, if you have doubts about homebirth, if it makes you feel less comfortable. Then don't do it. If the thought makes you feel safer and happier, then check which risk group you fall into and make your decision.

Since OP gave birth in an MLU last time, one must imagine that she has already weighed up the risks by not being in hospital 'just in case'. We don't know how far her MLU was from the obstetric unit. If I remember correctly the Place of Birth Study said that the average distance for a freestanding one was 17 miles, and yet they had the best safety record. So no ICU on tap there either. The one story you instanced Cote was someone who would already have been deemed a high risk, which is not OP. A few people have said they have had home births with problems - some would have a rethink as a result, and some say that despite that they don't regret it.

I think the comparisons were all CLU vs. home though, not MLU vs. home. Maybe someone who has had both could shed light on the pros and cons of each one?

Funnily enough, no one has suggested that being at home would have been a safer choice and saved her baby - yet the investigation found that one to one care would have been likely to pick up the warning signs and the way to get that at the moment on the NHS is to have a home birth.
and
Being right next to the technology is great, and you would think it would improve outcomes. The fact that it doesn't shows that there are one or more balancing factors going on in a hospital which are nullifying that benefit.

I was trying to write a post last night which basically said that. One factor I considered when choosing to deliver my later babies at home were stories I had heard from women who would probably have been left alone at home being put on drips 'to speed things up' and then having horrible births/crash sections. There are clearly things which happen in hospital which negate the effect of all that technology (or maybe the technology breeds complacency).

or maybe the technology breeds complacency

I sometimes wonder that, or if it's because there is no bell to ring to summon assistance, that a midwife in an MLU/home has to be just that bit more alert, just a bit more on the ball, (as well as not having to divide her time between other women.) Or perhaps has more of an attitude of 'how do I help this birth go right?' rather than 'if it goes wrong then we can do such and such'?

How the devil are you m'dear? Tis SOH btw.

Hospital water birth -loved it
Home birth ok- no gas and air as no time

If I had another I'd choose hospital.
I felt safer
More chance of a few puffs of gas and air
Might not mind an overnight stay as know what I'm doing with newborn and a break from toddler siblings!!

If def want an active birth though with a birth ball and option of pool! (Ideally)

I had a wonderful hospital water birth.

Similar to fizzyplonk here - I thought recreating my first lovely hospital water birth at home would be amazing! But gas and air didn't arrive in time and I actually felt a bit invaded at home and wanted everyone to go away . I wouldn't say I regretted it though, just surprised it wasn't as good an experience as I had hoped. It was also quite fast, with a much bigger baby, which was a bit of a shock!