Avoiding interventions by labouring at home for as long as possible?

[musicmummytobe]

Hi all,
I was hoping for some advice. I was hoping for a birth in a birth centre but a routine scan showed slightly less growth for my baby than expected at 38 weeks, not much less and it was still growing but a little less than they like. The hospital did all the necessary tests on the placenta, heartbeat, amniotic fluid and everything looks fine. They have scanned again since (I am now in my 40th week) and again, everything still looks fine. However, because there was slightly less growth, they have now told me they want to hook me up to a machine all the way through my labour to monitor the baby's heartbeat so I can't walk around, have a water birth and I can't give birth in the birth centre. They want to induce and have warned of a c section if any problems with labour slowing down just to be on the safe side etc etc. The baby's movement is totally consistent and has been throughout - he/she is a very active baby and now I have had the two recent scans confirming there are no problems that associated with a growth slow down, I really feel confident in letting nature take its course and want to avoid these interventions spiralling.
What I would like advice on is how long to labour at home to make these interventions less likely. I live an hour away from the hospital so it is going to be tricky to time things well but I really want to be pretty far on by the time I get there so that labour doesn't slow down. Would really appreciate any guidance on this as I don't really want to give birth in the car (!) but I also don't want to be incessantly monitored and unable to do this as I hoped. Thanks so much in advance for any help x

It's difficult to advise as everyone progresses at a different rate, I headed to the hospital an hour after my contractions started as they were straight away 2-3 mins apart, three hours after getting on the birthing unit my DD arrived, my first baby and was super quick. Some people can labour at home for hours. With being an hour away I'd say it's harder to judge when you should go, hopefully someone will have experience of that, I was just ten mins away. Hope you have the natural birth you want and with no interventions :)

Agree with Dixie that it's hard to predict as every labour is different. With DC1, I laboured at home for approx 6 hours after my waters broke, using my TENS machine and watching TV, then I felt the need for more pain relief so we went to the hospital. I was hoping to have a birthing centre birth, but it was a long labour (21 hours from 5cm dilated to birth) so I chose to transfer to the labour ward so I could have an epidural. I had DC2 and DC3 with just gas and air though! (Much quicker labours.)

Good luck OP.

Also my understanding is that late growth scans are not very accurate. My friend had one and was told she was having a 12lb baby - it turned out to be only 9lb, so still pretty big but miles away from the forecast!

Both mine were inductions for medical reasons and require me to be on monitoring, drips,etc.

The second time I was mobile on the bed and ball, and managed with gas and air. Induction doesn't mean automatic epidural and interventions.

With an hour to the hospital it would be pretty tricky to judge the right time to head in. I wouldn't stay at home for very long but once you are at hospital you do not have to accept any interventions you are not happy with, if you want to have 15mins of monitoring and if all looks well then have intermittent then you can.

Thanks so much all, really helpful replies and I guess I will just play it by ear and remember that I don't need to agree to everything! Xx

An hour in the car in advanced labour will be pretty awful. Have you considered a home birth?

Definitely get a TENS machine - that really made a difference for me but then we're only 10 mins from the hospital so I felt safe leaving it quite late!

Make sure DH etc and all midwives are aware if your aim to stay as active as possible. Get DH to 'cheerlead' for you to keep reminding you to get up / keep mobile. It's VERY easy to get lost in your labour. I found a lovely comfortable position in the pool and just stopped moving. So labour stopped progressing and I needed forceps in theatre with DC1. For Dc2, DH was under strict instructions to keep me moving and it was a completely different birth.

Oh God, I really want another baby now

Another one with a fast first labour here (only a few hours) although my contractions were almost constant from the start so I knew things weren't following a "typical" pattern... But with an hour's drive you do need to be careful not to leave it too late! As a pp said an hour in the car in advanced labour may be almost unbearable too - I would not have coped unless I could have been on hands and knees in the footwell (not too safe!)

I can completely understand your reasoning, but there are arguments for getting there earlier rather than later too - or at least being as careful as it is possible to be not to leave it TOO late with that length of drive. A roadside delivery would not be fun!

My baby came really quickly (4ish hours start to finish) and ended up driving to hospital at 5-6cm. It was horrible and I wished I had gone earlier!

An hour in the car? I would be going in at the first twinge. I can think of nothing more awful than spending an hour in the car in active labour. Strapped in a car, sitting down? Not able to move? No. You're going in first thing, not later on.

I had 20 mins in the car with my first and it was hell. I was 5cm when I got to hospital.

A better plan might be to go in earlier but as pp have suggested, refuse constant monitoring.

I laboured at home for 5hours. After 2hours my contractions were 3 in 10 and never got faster or stronger. I was only 10mins from the hospital but it was a torturous journey (the whole thing was torture tbh) but I laboured for another 15 hours after that! So could be long or could be quick.

I had an extremely easy and stress free pregnancy, but due to high blood pressure from 35 weeks I was also not allowed to give birth in the pool and had to be constantly monitored on the bed throughout my labour, also had the drip. As everyone else has said it's very difficult to advise.

I unfortunately was in early labour (at home) for 2 days, contractions coming and going from every 3 mins up to 10 mins, so very sporadic. Luckily the pain was bearable for the two days, on the 3rd day i stood up and my waters started to trickle out and with not much sleep over the last 48 hours i took myself straight to hospital as i was exhausted. Luckily i was 4cm when i arrived so wasn't sent home. The midwife broke the rest of my waters and within an hour i was 6cm. After another 12 hours of labour I was at 9cm, but unfortunately my son started getting extremely stressed and i just wasn't progressing to 10cm quick enough so i had to have an emcs.

To be honest my labour only started to go down hill in the very last hour so i didn't feel them constantly monitoring me on the bed for my whole labour was the best thing. I found being strapped to the bed very uncomfortable and I couldn't move around at all. Also if you can avoid the synto drip then do. All it did was make my contractions so much more intense, and he wasn't born any quicker.

havent read all the replies but they have clips they can attach to babies head so you can move around- was induced so had to have babys heart monitored and they gave me the clip- I wanted a birth centre water birth and had to go to delivery suite due to reduced movement and reduced fluid was induced at 37 weeks- at the end of the day the ideals you have ho out of the window and it best to have baby monitored if they think that is needed.

A couple of times my lo showed signs of distress and they though they would have to section me but he recovered well and I delivered vaginally, they only want to monitor to keep you both safe. I would just go in when they want you to and ask for the clip rather than be strapped and on the bed! xx

Honestly, I think you should speak again with your doctor to be sure you fully understand the seriousness of the issue. Growth restrictions in utero can be extremely serious and not all issues with the placenta or cord can be 100% screened for by ultrasound. Why would you feel so cinnfident to let nature take its course when there are already signs that your baby isn't growing as healthily as he/she could be? I don't mean to alarm but I would be seriously worried about a plan to avoid monitoring in labour with a growth-restricted post-40 weeks baby. Please think again. Interventions are not bad things in and of themselves, they are preventive care aimed at keeping you and your child as safe as possible.

Even in hospital you can decline intervention. But as above - if you decline to follow medical advice and your baby suffers irreversible harm will you be able to live with yourself? Doctors don't wish you harm, they are trying to keep your baby safe.......

Do you write birth intentions I the UK?
It's a page outlining your position on intervention and pain relief etc. I think you can download a standard one and amend, I specifically wanted a completely natural birth with no pain relief to be offered unless requested. You sign it and provide a copy to your midwife ahead of the birth so she is clear on what you hope for, this means they aren't pushing anything and you don't have to explain your wants at the time... Or get DH to manage her?

I'll never understand this desire to override medical concern just because body knows what to do. There's a place for that. But when it comes to concerns medical advice is more apt than internet strangers even if they say likeable things as on some Facebook natural mama groups like you show them Hun mama knows best.

You don't have to agree to constant monitoring in hospital. If you want to get up and move around that is your right. No interventions can be carried out without your consent.
I also agree with sycamore however, your baby's welfare is critical, you may feel things are just fine, but that's not always the wisest move.
Interventions are not carried out simply to give a mother a unpleasant birth experience, they are performed to give the safest and best outcome for mother and baby.
Don't underestimate the discomfort of car travel while in labour- especially a n hour's drive in late labour, something I would avoid if possible.

OP as much as I happen to be a great fan of active labour and letting the nature take its course, I also am an even greater fan of trusting the medical professionals during pregnancy and labour.

Safety first. As a wonderful doctor said to me during my last pregnancy: birth centre is not the holy grail of labour. Many start there but then get moved up to labour ward anyway.

Besides, once you're holding your beautiful baby in your arms, you will not give a rat's arse how they got there.

Some thoughts for you OP (based on a doula training I've done with Michel Odent) and my own experiences:

Have a more natural labour isn't necessarily about being in hospital or not, or in the birthing centre or not, but how safe you feel, how much privacy you have and being disturbed as little as possible.

So, a move during labour is disturbing, whether to the birth centre or labour ward. But there are steps you can take to minimise this. Vice versa a home birth can be very disturbed, even if you haven't been anywhere.

Think of labour as a process like falling asleep, having a poo,or having sex. If, during nay of those, at some point you would get in a car, drive for a while, then walk through bright lights to meet a bunch of strangers who will then talk to you, shine lights in your face, have a prod, and then expect you to carry on. Some people can, but most would find it difficult to just drop off on the hospital bed, or carry on having enjoyable sex. Especially when those strangers continue to keep popping in to disturb you regularly.

Suggestions: talk your Birth partner through this. Tell them their job is to handle and minimise your direct interaction with other people, including doctors and midwives. This means:

• drill your move to hospital so he can navigate the whole thing without you (we didn't both as its not far, my DH cocked up and took me to the wrong entrance, I'm still angry about it).
• tell him it will be his job to monitor you contractions at home, length, time apart, but he must do this by observing you, not talking to you. Get him to make a chart maybe.
• write in your birthing notes that you want as little direct talking interaction as possible. So when you arrive at triage, your DH leads it, he briefs on time in labour, length and space of contractions, whether you waters have broken, etc. He asks all questions to be directed to him, and intervenes if hey are not. He only relays to you if absolutely necessary. I did not realise how even good news is disturbing. So having a midwife bellow in my face 'WELL DONE GOOD LUCK YOU ARE NINE CENTIMETERS' in triage is disturbing, which delayed my labour, just the same as if I appeared in your bedroom tonight, flashed a torch in your eyes and said loudly WELL DONE YOU ARE NEARLY ASLEEP NOW. Chances are you wouldn't be any more.
• I am a good negotiator so thought I could handle pressure for interventions. But the reality is, negotiating on this is disturbing. Just like negotiating about light on or off, window open or closed,will delay you falling asleep. So have your birth partner handle those discussions.
• ask now if you can have a mobile monitor. I ended up with one, but I could still move about. I also found it very reassuring to hear. Not all interventions have to be a problem - that one soothed me.
• try to be clear to your DH (only) about what you feel and need. Despite being 9 cm in triage, I was in labour for another 14 hours. According to my notes with a 12 hour pushing stage. This isn't really true. Rather the move to hospital and subsequent events disturbed and then frightened me. So my labour slowed halted at the transition point. I never had a true urge to push. Aside from being afraid (a midwife was struggling with a standard procedure which was triggering for me) I was cold, tired and hungry. However, the room I was I was freezing and apparently could not be warmed. No one offered me food or sleep. Rather I was instructed how to push (ie disturbed) repeatedly for about 7 hours. By the time I realised I needed to rest doctors were involved. So they gave me half an hour. After about 27 minutes I was just on verge of falling asleep (which is common in long labours, as the body needs to rest. Often delivery is swift after you wake up) when they crashed back in said WELL THIS ISNT REALLY WORKING IS IT. Waking me up, and moving on to the next stage of intervention (induction drip, which didn't work, since I was tired, my body needed rest first ).

Honestly, the less you directly interact with anyone, the faster your labour will go. Focus on that, and planning for that, not timing. A final though: could you find somewhere close to the hospital to be? That way you could travel early in labour (so you won't worry) then labour close by and go in when the time feels right.

There is some truth that the trick to a hospital birth is to go in late enough that the birth momentum is too strong for it to be disturbed by intervention. I wanted to go in as I could feel transition coming. I've often thought if I'd stuck it out for another 30mins the hormones of transition would have release naturally and I would have delivered much easier and earlier.

Fwiw the delivery was fine, in the end, though a on induction drip flat on my back, epistiotomy and ventouse was not what I wanted, at all, and I still consider unnecessary if my needs had been met (warmth, rest, food, to feel safe).

Good luck!

Having done a two mile trip to hospital at 9cm... I would say an hour in that situation would be utterly unbearable.

(I should add that the hospital had told me not to come in before then - apparently I didn't sound like I was that far on!?)
So make sure you let them know how far your journey is when you phone them up.

goodlucktime you make some interesting points, especially about travelling during labour.

However Honestly, the less you directly interact with anyone, the faster your labour will go. I don't think all women are the same on this one.
I had two hospital births, the midwives were great. I found their support and interaction really helpful. I found their comments and gentle easy talk very supportive and really helped me keep going.
They understood and helped me through transition, I became cold and hungry, one brought me a box of jaffa cakes and a blanket.

I don;t think minimising interaction is a rule that covers all women.