Home birth for first baby

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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?

Gosh, I do hate these 'horror' stories like Boosiehs

Gosh, I do hate people's situations being described as 'horror' stories. They are not stories, they are not fictional tales of ghosts and ghouls. They are a simple relation of anecdote which is what you'd expect on a forum. I don't agree that you take them with a pinch of salt, you accept them for what they are and that's an example of what can happen in a tiny minority of cases. Being informed does not mean picking and choosing which bits you listened to.

I was very careful to point out that I needed a bluelight transfer and yet still remain pro home birth and tried again with my second. My experience was not a 'horror story'. My babies could not be birthed vaginally. The first suffered some temporary damage which would not have been sustained during a hospital birth but likewise would not have been sustained if I'd transferred earlier.

I prefer not to have my experiences dismissed as horror stories.

But some stories do almost come into the 'horror' category - when it's anecdotal and someone who knew someone who would have died if they hadn't been in hospital. Yet without knowing more about it, no one knows if that really was the case, or if it was poor management of the birth, or simply no management, (because they were too short staffed to keep an eye on the woman), which might not have happened at home.

For me, the Place of Birth study was a revelation in that it gave substance to what to me had been anecdotal observations - all the CLU cases I knew, including me, had had some sort of intervention, without there being any obvious benefit to the baby. Only one of the MLU cases had. Maybe all the CLU cases were 'high risk' causing the interventions but I don't think it was so.

No idea if it was a rare type of retained placenta, only that the consultant who fished it out said she sees it about once a year. Can't remember if she told me the 1 in 1,000 stat or if I looked it up. Once removed a retained placenta is no problem, so I'm not surprised the people you mention had no further complications once it was out (neither did I). The risk is in leaving it in too long before removing -- that's when people can haemorrhage, and you're almost certainly going to have it in you longer if you're at home for x amount of time before they decide to transfer. My son's situation was significantly more serious, but the placenta is another example of an unexpected event that required hospital-based medical treatment without too much delay.

It seems as though you'd like to minimize my story and/or make it sound like I'm being hysterical about perfectly normal childbirth events that are easily dealt with by a quick transfer to hospital. That's a bit insensitive, which I can deal with, but more importantly it misses the point, which is this: unexpected things happen, some of which can be immediately life-threatening for the baby or mother, and it's problematic to be an ambulance ride away from medical help if they do occur. If my experience or the ones Boosiehs and villainousbroodmare had don't sound serious enough to make that point clear, then replace things we described, like plummeting foetal heartbeat/baby not breathing/post-partum haemorrhage, with whatever you would agree is an absolute emergency, perhaps placental abruption/cord prolapse/dystocia or similar.

I just get fed up with people saying they don't want to hear my 'horror' story. To me, it's just fact. I had to transfer in because the baby was in a position that could not be delivered at home. She was born with damage which would not have happened had I transferred earlier or opted for a hospital birth. This is not a friend of a friend, it is not anything other than absolute fact. I remain a massive advocate of home birth but when people ask for advice on a forum, I think it's because they want experiences. Real ones. Just as I wouldn't dismiss somebody describing a 100% straightforward home birth as telling 'fairy stories', I expect people not to unfairly label complicated birth stories. It's not horror, it's my real life.

There is a MNer, though I'm not sure she posts atm, whose homebirth absolutely did result in life changing and limiting damage. She's well known on here and I would hate for people to advise that her daughter's life and her experiences be 'taken with a pinch of salt'.

Thanks for everyone's opinions. I really don't want this to turn into an argument, and I - as you can see from my OP - already have reservations, based on the latest stats, about the safety of first births at home.

BUT can I point out to those talking about all the crash section, bleeding-to-death type stories...It's not simple and black and white. While there are some heightened risks, there are also a lot of benefits that this has to be weighed against in terms of your hormones being allowed to do their thing more effectively, and reduced intervention/infection etc. So the flip side of some (some, not all!) of these stories about C-sections, heartrates etc will be that a hospital birth actually made these situations more likely. Cascade of intervention, labour becoming prolonged and ineffective because of the unsuitable environment for the mother, and sometimes excessive use of monitoring actually creating the situation its designed to detect and/or not being reliable etc etc.

You can't just say 'but my friend's brother's aunt nearly died' and think that conclusively proves that hospital is safer or better. It's not that simple. Sadly. I wish it was - it would make my decision easier. It's about balance of risk - I essentially have to be able to predict the 'risk' to me and the baby from giving birth in what my body will instinctively see as a hostile environment which will probably hinder natural labour, surrounded by people over-eager to leap in with interventions (statistically I am much less likely to have a natural labour or escape intervention if I enter hospital) and the risk to us both from not being one door away from emergency care should we really need it. It's balancing absolutely worst-case risk against quite-likely risk. Difficult and subjective to call.

And I know that not all of you with the bad experiences are saying 'this proves home births are awful and dangerous and you should always go to hospital'.

And completely off topic - ShowofHands...not after the folk band by any chance?

But showofhands if we are thinking of the same MN poster, then she wasn't a low risk case, so you are not comparing like with like.

For OP it's all about weighing the balance of risks to her and the baby. I don't know who she has talked to but her midwife might be able to offer some guidance, or there might be an MLU available to her, which might be a good option.

It's a shame there isn't more detailed research - some midwives have caseloading, some do a lot of home births. Do these have better outcomes than those Community Midwives who hardly ever do a home birth, and are not very confident about their skills? That's the sort of information which might help make a decision.

My point isn't that I'm comparing like with like (I'm not arguing either , just making a polite request that people are a little sensitive with the language they use to describe other people's situations as I found and still find it hurtful). My point simply was that I don't like people's experiences being called 'horror stories'. I have said repeatedly that I am pro-homebirth. Utterly pro it, as in have supported other women through it as a birth partner. I think in a low risk pregnancy, it's a very good choice. I tell my story as an example of experience of what the op is talking about. I was low risk, trouble free pregnancy, no contraindications at all. My problems arose at home and I tell my story to highlight that end of the scale. No hospital environment, no cascade of intervention. I was at home for the majority. I was fully dilated for four hours at home. I only transferred in because I needed intervention (emcs in the end, though I asked for ventouse and manual rotation to be tried first which they did attempt), the intervention did not happen because of a hospital environment.

As always, anecdote does not equal data but when I talked about home birth on here in preparation for my first attempt, I wanted to hear real experiences and how people felt about that experience. I had a complicated home birth necessitating transfer and my one regret about the whole thing was that I had built home birth up as positive and hospital as negative when really it's never that black and white.

And yes, absolutely the folk band. I love them.

Quite possibly my favourite band! Good taste

My favourite band too.

A boyfriend took me to see them on our very first date 17 years ago and I still love both of them very much indeed.

I genuinely wish you the very best of luck for your birth btw. I do not regret my two attempts at a home birth at all and I hope you don't mind me sharing my experiences with you. Good support, knowledge and trust in your caregivers makes all the difference and knowing that whatever transpires on that day, you are magnificent. Of course you are. You like Show Of Hands.

I am sorry for all the posters who had awful births and shared their stories.
However I don't care for the 'seat belt' analogy; deciding to have a home birth shouldn't be compared to a foolish, dangerous, devil may care, illegal action.
Unless you agree that it would be a private road with no other vehicles on it and two private driving instructors slowly guiding you in the car and along the road, with a team of motoring professionals waiting at the end of the compound.
In that situation I'd probably not buckle up either.

Yeah he sounds like a keeper with a first date like that. Dh and I discovered them at Ely festival a few years ago. Standing out on the most gorgeous clear night, pint in hand... they opened with Roots and I thought the top of my head was lifting off.

I really appreciate your sharing your experiences, and your kind words. I think I know that a home birth is not going to sit right with me this time round, given the stats for first timers. If the worst happens I know I'll need to be able to say to myself 'well at least I did the best I could, based on what we know, to be in the safest environment'. Luckily I have found an active birth doula who I have great faith in and have bonded very well with which alleviates my worst fears about finding hospital such a hostile unfamiliar environment that I just seize up. I just feel sad and frustrated that it feels like the 'price' for that peace of mind is the likelihood of a worse experience in a whole host of significant but non life-threatening respects. But your warning against a black and white positive-negative viewpoint is helpful. That's definitely where I'm at and I need to get myself out of it.

Assuming things go ok this time round, I'd love to do it with a second though.

What Peregrina said.
The fact that CLUs did not come out as the safest places must mean that, in them, things go wrong for otherwise low-risk women which would not have gone wrong in an MLU or at home.

My own view is that if you are going to feel stressed and unhappy in hospital, you're better off at home. We're mammals, after all, and relaxed mammals are better at giving birth than stressed ones.

I meant, what Peregrina said about CLUs several comments back... I'm typing very slowly tonight!

The key thing with a lot of the "I'd be dead if I had been at home stories" is timing. The time taken to get a CS is a lot longer than people generally believe happened due to obviouse stress of the situation and the way it affects memories. By the time babies heart rates are dropping there are signs way prior which mean you are already in a consultant led unit.

The research shows this. Also dead or maimed babies cost a lot of money to the NhS the evidence and the cost mean home births need to be safe for first time moms for the NHs to encourage it.

Also the key thing is booking a Homebirth especially if it is getting to know a midwife in your own home in pregnancy does not mean you have to stay there when you go into labour.

I'd do anything to avoid back and forth to hospital in early labour as many women seem to do with first babies.

12 minutes foetal distress to incision.
No prior signs.
No stress on my part... I was happy, well attended and felt totally listened to.
No way things would have worked out as well if I had been at home.

I am pro homebirth and have had two, though not for my first child.

I think it's inevitable with people who feel instinctively anti homebirth is that they say "well I (or X person I know) would have died if I'd had a homebirth". In fact, stories like ShowofHands and Boosieh's show very well how often problems are managed safely and well in a homebirth. A transfer to hospital isn't a failure or a horror story. It's responding to the situation in an appropriate way. Likewise the possibility of a retained placenta - if you have a retained placenta then generally speaking you transfer.

There are some situations - like expected cord prolapse - where you are safer being moments away from an OR as they whack you under a general (assuming the OR is free etc, being in hospital isn't a guarantee either). However, the fact that it's just as safe for a first time mother to be in a free standing MLU (and a non first timer to be at home) suggests that there are balancing factors that give negative outcomes in hospital that don't occur at home. It's also possible that the model of care means problems in hospital get picked up later - leading to more genuine emergencies and fewer controlled interventions.

I never understand why, when things go wrong at home, it is blamed on the homebirth. When things go wrong in hospital, it is just something going wrong. I know someone whose baby very sadly died because of the way hospital care was provided (not negligence per se). That isn't ever held against her as a reason she should have birthed at home.

Homebirth isn't for every low risk woman. Of course it isn't. And I'm not a home birth advocate at all. But I think women should do what they feel is right for them without fear of it being held over their heads at a later date.

You seem very well informed and I think you're coming at this decision in a really calm and considered way, OP. And your doula sounds great. So you will undoubtedly make the right decision for you, but I just thought I'd share my experiences in case they are helpful.

I was in your position about four years ago: pregnant with my first baby and attracted to the idea of a home birth but not sure whether to go for it with my first. I went for a hospital birth that time and it was fine. Although the pool was in use and I was coached to push, so I do wonder whether in hindsight I might have avoided the second degree tear if I had had a home birth. Mind you, I stayed in for an extra night anyway for the breastfeeding support so what difference a home birth would have made in that regard I have no idea.

For my second, I went for it and had a wonderful home birth. Followed by a less wonderful third stage. I started to bleed out (we later discovered some membrane had been retained). Only one midwife was in attendance as I had laboured so quickly but she managed to get the drip in and I was blue lighted to hospital. I have no regrets and would go for a home birth again in a heartbeat because the midwives (dedicated home birth team) were just so fantastic and experienced. They made me feel much safer and more in control than I did being a patient in the hospital. Like I say, it was fine, no harm done, but it just felt incredibly disempowering to me.

I realise this is not a straightforward answer, but as you know, it is not a straightforward question! Best of luck with everything whatever you decide OP.

There will, unfortunately, be a tiny minority of babies who have died dueing a home birth who would not have died in hospital. There will be others, equally tragically, who would have lived at home but died in hospital.

I have four dc. Two were born at home, two in hospital. Of the hospital births, one was a transfer from a planned home birth and I had a 3 litre PPH.

If I had another baby (which I don't expect to), I would choose Home Birth again even though technically I would be high risk for home birth. My experience of hospital birth is that it is very difficult to stay in control of what happens and the way the birth goes - and that there is a culture of "this is the way things are done". The "cascade of intervention" leads to increased risks when labour is augmented unnecessarily, induction is pursued aggressively etc.

The website homebirth.org has some very helpful information about the risks and how emergency situations would be dealt with at home.