Home birth for first baby

[Sleepybeanbump]

I'm 26 weeks. Gradually as I've gone through pregnancy the idea of a home birth has started feeling really really appealing- would never have expected to feel like this. However the stats I read from the Birthplace report all say that there is an elevated risk to the baby for first babies in home births. For this reason alone I don't think I can do it.
I think there are likely to be big advantages in a home birth which balance some of that risk, but ultimately if anything bad were to happen I couldn't live with myself knowing I could have avoided that risk.

However, I've tried to find more information to make more sense of exactly what this risk is without any real success. So for example I live in London within a few miles of 3 very large hospitals. I would like to know whether the elevated risk is something inherent to first births/home births that cannot be much reduced or, say, whether the risk varies a lot depending on transfer time to hospital. Ie whether in my specific circumstances my risk as a first time mother would not actually be very elevated in a home birth because my transfer would be so quick.

I guess I don't want to completely write off the idea without understanding the risk fully.

Does anyone know more about this?

Watching with interest, I have a home birth planned for my first.

I havent been able to find any info or firm stats with the risks when i was pregnant with my first. A lot of info pointed toward it being as safe or safer than hospital birth as there is a much lower rate of intervention and you are much more likly to have a positive experience.

I had ds 6 years ago and looked round our local hospital, and hated it. It was birth on the bed, you WILL have VE's theough labour, you will be monitored etc, awful. I told my community mw that i was really not happy with the hospital and needed to explore other avenues, and she straight away said, have a home birth.

I didnt think it was a good idea, then looked into it more, spoke with her about it and decided to go for it. So i did.

I hypnobirthed and had a pool in the lounge, my community mw came, along with another mw and a trainee (which i agreed to) and they sat on my sofa and they waited, they reassured me, spoke calmly to me and respected all my wishes.

My labour was 6 hours start to finish, i had no internals, no monitoring (doppler 2 or 3 times) and no one shouting push or touching me.

it is completley personal choice, you have to feel hapoy, dont forget you can book the home birth, then later change your mind, or once in labour ask for transfer.

I say go for it, i enjoyed giving birth and cant wait til my baby is due in November :)

I had a first birth at home. My nearest hospital is 15 mins away, there had been no complications in pregnancy and my DM and DSis both had two healthy straightforward births, two of them at home.
I just went into it with the attitude that I'm more likely to be happy and relaxed at home, and the MW would send me in to hospital at the first whisper of a problem.
As it happens my birth was incredibly straightforward, I coped with two paracetamol and a TENS and it was so quick we didn't have time to fill the pool. not money wasted as I had the best bath in the world that night, in the living room with my brand newborn and a glass of bubbly!
I hope it works out for you too!

Thanks everyone. I'm finding the decision so hard. In every other respect I am so keen on a home birth- I know I will be made really nervous and uncomfortable by a hospital environment, I really want my own space and to minimise the risk of intervention. I also hate the idea of an overnight stay in hospital after. My doula has said that I can book a home birth and then change my mind at any point, so I guess that's the best option maybe as I'm freaking out 'committing' to a hospital birth OR a home birth at the moment.

The other spanner in the works is that my closest hospital, where I was planning on going, don't cover my area for home births, so I'd have to book it through one of two further away. Move all my records, change all my antenatal appointments and have a longer transfer....rather annoying.

I wouldn't risk it-you have no idea what sort of birth you are going to have. Nothing prepares you for what it is actually like.

I had a planned home birth with my first and would heartily recommend it.

My reasons where the same as yours. I knew I'd be anxious in a hospital setting. I knew I didn't want unnecessary interventions. I was worried about midwives being spread too thinly and not getting the care I needed. I knew I didn't want DP to have to leave me and a new baby in hospital.

I ended up with two dedicated lovely midwives with 45 years experience between them. I got to go to my own bed afterwards with my brand new snuggly baby. I got tea in my own mug and toast with the required amount of proper butter!

If your pregnancy is uncomplicated and it's what you want then I would go for it .

I should add that due date is December 29th. One other possible risk factor is how good ambulance service will be (if needed) on Christmas / new year...

I'm planning a Homebirth for my first. The antenatal care is way superior to routine care as am part of a caseload. If during labour or before I decide I want to be in hospital in labour I just go there.

I know there will be no back and forth in early labour to hospital. Midwives will attend me and judge if I am in established labour and if it is progressing well and I can attend hospital then if I choose.

They carry all the medication I will need for the major risk which is bleeding so it is safer for me as I am less likely to bleed anyway at home excessively.

For baby the carry basic resus which I know is more than enough to get me to my nearest unit for more advanced medical care if needed. Having been trained in neonatal resus myself.

It's a no brainier for me.

I'm lucky my first choice hospital is my local hospital which does home births. If it weren't I'd book at more than one to give me the choice to attend whichever hospital I wanted to and have the option for Homebirth.

Oh yes ambulance service should be be very good early-mid January

I had a hb with my first. I remember having some of your concerns, but unfortunately no one can tell you the risks specific to your individual situation. All you can do is read the general risks and then decide if that's something you're comfortable with.

For me, the 'risks' just didn't seem significant (or at least, no more likely or significant than the risks of a cascade of interventions in hospital, for e.g.). Like you, I knew i'd be more relaxed and comfortable at home and thought that therefore I'd be more likely to have a straightforward birth. I also liked the idea of having 1-2-1 care from a mw at home, as opposed to being left to my own devices in a busy mw unit or labour ward at hospital. I too am very close to lots of hospitals, so knew that a transfer would be quick if necessary. Also, for me hb feels very normal. My DH was born at home, many moons ago, my Dsis had a hb with her DC2. Birth to me, is not something that necessarily needs to be medicalised.

And indeed, I had a very straightforward labour and water birth at home, albeit at 2 weeks past my 'due date'. 3 hours from mw turning up, examining me, saying I was 'only 2cm', to baby being born. I did natal hypnotherapy, which I believe helped me a lot - not in terms of making it pain free (it hurt, a lot), but in terms of empowering me to believe I could 'do it' and generally helping me feel relaxed about the birth in the run up. I also recommend Ina May Gaskin's books, specifically 'Guide to Childbirth'.

Ultimately, only you can decide what suits you, no one else can tell you what you should do. And remember, you can always book a hb and change your mind at any time up to and during the labour if you decide you actually want to go to hospital.

From the alternative perspective....

My SIL was super low risk, had a home birth for DD1, ended up with a massive PPH blue lighted to hospital and nearly died.

Me - massive complications with DS1, a 3 min transfer wouldn't have cut the mustard and we both would have died.

As nice as a home birth sounds, it wasn't worth the potential risk to me.

I booked a home birth with my first.

My only bit of advice is that you shouldn't see it as a simple black or white. Plan your ideal birth and if that's a home birth, then think about why that is right for you. There is a subtle but very important difference between planning a home birth because of the positives it offers and planning a home birth because you're keen to avoid the negatives of the hospital.

I know it sounds like the same thing but when I planned to give birth in a pool at home, I foolishly got it into my head that this was the only positive way to delivery. I saw the hospital as a poor cousin, a failure, a negative.

Of course, I only know how important that subtle difference is because I did have to transfer in. I ended up feeling like I'd failed and I'd ended up terrified of going to hospital. In hindsight, the care of the hospital saved the life of my baby and there's nothing more positive than that.

I'm still pro birthing at home. I planned a home birth with my second too. I also ended up with another emcs. However, it was a positive, empowering and wonderful experience. The home birth was the ideal, the hospital was the back up plan and thank feck for that.

Gosh, I do hate these 'horror' stories like Boosiehs. Try to take them with a pinch of salt as it's impossible to know what the exact situation was. For e.g. as scary as it sounds, her sister didn't die. And hb mw are very very highly trained to anticipate any issues. They are very risk averse! They will transfer you to hospital at the first whiff of a problem - so she herself probably would have been transferred in plenty of time to deal with the complications with her DS1. No hb mw wants to be dealing with an emergency or tragic situation, they are not cavalier about it - their priority is the mother and baby's safety. And for what it's worth, I know far more hospital 'horror stories' (including a stillbirth) that most likely wouldn't have happened at home. Everything in life comes with associated risks, it's up to you to assess their relevance to your situation.

I'm planning a hb with my second and as mentioned above my first birth was quite quick. So my mw and I were chatting last week that if this labour ends up being long the mws would sit up and take notice at that - and question why isn't the baby coming out as quickly as expected, is there something stopping labour progressing as expected, do we need to transfer, etc.

I am very glad that when my baby's heart rate plummeted that I was able to be whisked to theatre for an EMCS within moments. I will not forget the tense conversation between the obstetric surgeon and the anaesthetist when he wanted to cut and the anaesthetist wanted to wait another moment to let the block take effect. I would have had a dead or at least severely compromised son if I had been delayed.
I'm 32, very fit and had an entirely uncomplicated pregnancy and my labour appeared to be progressing well until the monitors revealed that all was not as it seemed.
I think it's like driving without a seatbelt - it'll probably be fine - but I'm bloody glad I was not at home!

I've read somewhere that the safest option for first baby in uncomplicated pregnancy is MLU, and HB is #2. HB comes #1 with subsequent babies.

I'm currently planning a home birth for my first, due mid Nov, and I feel really positive about it. I'm very close to my hospital and feel ok about the high chance of transfer there. My main reasons for wanting home birth is the fact you get far better dedicated antenatal care from the same midwife throughout, and the atmosphere at home is much more conducive to oxytocin production as you can control it more!

I think hospitals are fantastic places to help those who are ill, but pregnancy is not an illness! Good luck OP ??

I had DC1 before the current research came out, and was happy to give birth at home. Knowing what I do now, I would still make that decision because for me, the choice was between a CLU and a home birth, and the odads of us both escaping long-term damage would be better at home. If there were the option of a proper MLU, though, I would probably take that as my best choice.

Ultimately though, giving birth in a place where you feel comfortable and secure is really important - think of all the people who had straightforward first births and have a second baby in hospital even though that is the riskiest option. Generally speaking, you are more likely to have problems if you feel frightened and uncomfortable, so go for wherever you feel like making your secure labouring nest.

Hi!
I have no experience of home birth but simply reading the thread I realised you might be making a wrong assumption about home birth that your baby will be born at home or that you will not spend a night in hospital.
As a first time mum you have a 45% "chance" of being transferred to hospital during labour or soon after a home birth.
www.nhs.uk/news/2011/11November/Pages/hospital-births-home-births-compared.aspx

I just thought I'd flag this up.

Also, have you visited the midwife led units? Looking at the setting might push you one way or the other.

All the best whatever you decide.

Pinguin - I did already know that, but thanks. I have a doula, which I believe reduces my likelihood of transfer, but yes, its a consideration. Esp given time of year, and also the balance of stress for me. So home birth sounds lovely, but actually a transfer in an ambulance is likely to be even more stressful than just going into hospital to start with....so difficult to judge.

Sadly my local midwife unit doesn't do tours, which is really, really annoying, and, combined with the stories I keep hearing locally about MW units being full when you arrive and you being shoved on labour ward whether you need/want it or not is one of the reasons I've been finding the home birth idea so appealing.

You're due the day after I am. Nothing I've read here has put me off having a home birth. Good luck whatever you decide.

Sorry to be negative and I don't know the details of the risks.
All I can say is that I know some people whose babies would be dead / severely disabled if they had not been able to have crash sections. And post-partum bleeds would worry me too.

I'm not particularly risk-averse on the whole but for me it was a no-brained to have my babies in hospital. I could never have forgiven myself if something went wrong.

This is of course all anecdotal and not evidence-based. I would have thought this would all be provided for you when you booked.

I wish you a safe and healthy delivery whatever option you choose. Please remember that the only thing that really matters when it all comes down to it is that you have a healthy baby and mum. Once the kids are older you realise how minor (in most cases, I appreciate some folk have birth trauma) the mode of delivery is and no-one gives two hoots who had a natural birth / who only used paracetamol.

I had a perfectly normal pregnancy with no risk factors or complications and a perfectly normal natural delivery, right up until it wasn't normal and became an unexpected emergency. My son's heartrate dropped, and when he came out shortly afterwards he had significant breathing problems. I then had a retained placenta, which if left too long can lead to haemorrhage. Fortunately, we were in a hospital. DS was whisked off to the neonatal unit within seconds, and when I hadn't delivered my placenta within 30 minutes I was whisked off to the operating theatre to have it removed. Both of these things were flukes. DS had no infection, was normal size, vaginally delivered, etc. -- no reason but bad luck for his breathing issues. As for my placenta, that's about a 1 in 1,000 thing. The doctor who retrieved mine in theatre said she sees it about once a year.

When I saw our practice nurse a couple of weeks later for DS's first vaccination, she asked how things had gone. I told her the above, and she said "Wow, thank God you didn't have a home birth." I shudder to think what would have happened to DS or me if we'd been an ambulance ride away from help, all because I decided I preferred my living room or a non-hospital birthing unit to a labour and delivery ward. If my son had ended up brain damaged or dead, or if I had bled to death, I could not have argued anyone for finding me and DH negligent in relation to that outcome.

At the risk of being flamed, our most important jobs as parents is doing everything we reasonably can to ensure our kids' safety. Mercifully the chances of something going wrong in childbirth are low, but if something does gone wrong the consequences can be devastating. It's like the seatbelt analogy a previous poster used. We are lucky to be in a position to minimize that by stationing ourselves as close as possible to medical help. A hospital might be 3 miles away, but how long will it take an ambulance to get to you? Once there, how long will it take you to get to the right ward/operating theatre in the hospital? Seconds can honestly count when you're talking about the kinds of things that can quite unexpectedly happen in childbirth.

I don't mean to offend anyone, and I genuinely understand the importance of minimizing anxiety, discomfort and medical intervention during childbirth. But there are ways to do that don't involve the risk of a home birth -- there are a variety of hospitals, some with birthing centres onsite, and all sorts of things you can do to make yourself safe and comfortable in one of them. Well worth the compromise, IMO.

All I can say is that I know some people whose babies would be dead / severely disabled if they had not been able to have crash sections. And post-partum bleeds would worry me too.

And yet, if that were really the case, the Place of Birth study would have found that CLUs were safer. But it didn't; for a first time birth it found that stand alone MLUs were the safest place.

It's not either/or home birth or hospital. If you need to transfer you will be. If You could book a home birth, with a view to keeping your mind open about the possibility of transfer.

Was it a particularly rare type of retained placenta? Because I can think of five or six women I know who've had retained placentas, in home and hospital births, and the home birth ones just transferred to hospital to have the placenta removed with no further complications.