Home birth after 42 weeks

[ginagenie]

Hi
I'm currently 41+4 and still very much want to try for a home birth if I go over 42 weeks.
The midwives don't even want to let me go past 42 weeks as its hospital policy to induce by then so have booked for me to come in at 42 weeks but if baby is ok I would much rather wait and monitor.
No complications in pregnancy and I'm low risk. I keep reading that it's my decision and no one can force me to be induced or refuse me a home birth but I'm feeling a lot of pressure and not very assertive or confrontational at moment.
Just wondered if anyone had any tips or experiences they could share on home birth after 42 weeks where midwives were reluctant?
At the moment my best idea for a plan is when in labour just to say I'm not happy to come into hospital and hope they don't argue too much.
I'd obviously go in if there was good reason but a blanket 42 week rule doesn't feel v logical or fair to me. Thanks

[NerrSnerr]

I did a lot of reading up on this during my first pregnancy, in my opinion the risk of going over 42 weeks is far greater than the risk of induction. I would no way agree to a home birth after 42 weeks as if things go wrong they can go wrong quickly. As you have said they cannot force intervention but they're not doing it for their good, they're doing it as they want the best outcome.

I had an EMCS for my first baby and the one on the way will be a planned section, the only important thing is that we both come out of it healthy. It's scary when things go wrong so I would try and reduce the risk of that happening.

[Pluto30]

I don't think it's purely about 'an ideal birth plan'.

I wasn't talking about induction; I was talking about insisting on having a home birth past 42 weeks.

[Blackfellpony]

I literally had no plan other than listen to the professionals who have trained for the job and seen thousands of births and go with their recommendation. Please don't listen to a load of random rubbish on the internet.

They won't be saying induction for a laugh, listen to the experts.

[minifingerz]

Can I add by way of balancing out some of the hysterical shroud waving which is going on on this thread, that you find vastly differing rates of induction at different hospitals, even when patient and hospital characteristics are controlled for.

This suggests that there isn't a consensus among the medical profession on the timing of induction. There are uk hospitals which induce over 40% of first time mothers, and others which induce under 20%.

And given that the risk of stillbirth is as likely at 37 weeks as it is at 42 weeks I wonder how many of the shroud wavers here would feel comfortable at telling a mum who is 37 weeks pregnant that her baby is now at 'huge risk of death'?

Shame on you.

[minifingerz]

"They won't be saying induction for a laugh, listen to the experts."

No - they'll be saying it because of an NHS protocol based on a great deal of complex evidence, whose aim is to reduce overall stillbirth rates, but which cannot take into account the particularities of an individual pregnancy.

Not all babies are equally at risk.

Natural gestations vary.

[CatchingBabies]

Those screaming about how stillbirth is much more likely at 42 weeks clearly haven't looked at the research or the tiny numbers involved. Did you know that we induce before 42 based on 3 babies? A national policy based on what happened to just 3 babies.

Did you know that France see 43 weeks as being term and don't induce until then and yet have a lower stillbirth rate than we do?

More stillbirths happen before term than after but are we inducing everyone early but in case?

Of course there are risks in every decision and you look at those and weigh them up against the benefits, making the best decision for you isn't putting your baby at risk or being selfish!

[ghostspirit]

I did not go over due. But I had anemia. The midwife was happy for me to have a home birth given my history and straight forward births.

But the consultant was not happy at all she was almost shouting at me
That the risks are high of loosing to much blood because of the anemia and being my 6th child. She even wrote in my notes there was a risk of death.. she got another midwife in to take sense into me. But the midwife said she felt I would be fine.

My situation is not the same as yours op but in my last 3 pregnancy alot of midwifes and consultants tried to put me of home birth. Only a couple were supportive.

Sorry if this has been asked.

Have you had a sweep?

[Trifleorbust]

I think you're entitled to do what you want but the midwives are entitled to decline to support your choice. I am very forthright about people being able to make their own choices (and I support your right to do so absolutely) but I also think it is sensible to take professional advice seriously.

[sycamore54321]

"Hysterical". "Shroud waving". "Screaming about"

We are talking about a clear risk factor that results in dead or brain injured babies, versus the alleged comforts of a home birth. I don't see any hysteria in the tone, rather I see realism and an acknowledgment that the possible negative outcome of one of these choices (death or brain injury) is of multiple orders of magnitude more severe than the downside of the other choices. The OP's medical team know her case and have advised induction at 42 weeks. Many here agree that this is a wise course of action and also agree that the OP is free to choose otherwise. If anything, I see shrillness and panic on the opposite side of the argument who are telling her to disregard the very real risks with assurances ( that cannot possibly be reliable) that all will be well.

OP please listen to your doctors, fully understand the issue and then choose.

[CatchingBabies]

Sycamore - Read the research and then tell me there's a clear risk!

We induce before 42 weeks based on poor evidence, on a tiny risk of just in case. Induction also carries risks, nothing is risk free and no choice is safer or more valid then the other.

The professionals are not perfect, they offer induction at this time because they have to according to guidelines not because they think it's the best. The theory is your more likely to get sued for not doing something then you are for doing something, regardless of it that something is the best thing to do. Trust me I know!

[PenguinsAreAce]

I read up on the risks about 7 yrs ago. I went back to the studies. They are based on v small numbers of babies, but now cannot be repeated, as induction at or before 42 weeks has been policy for so long. From memory, if one accepts the studies as valid then the risk doubles... but from a very small absolute risk to a still really small absolute risk. As others have pointed out, induction is not risk free. There really is a balance to be weighed up and this can only be done individually. All people who are mentally competent have the right to refuse all interventions, even where there is a risk of harm. Of course one stillborn baby is too many and the consequences of everything going wrong are huge. This does not mean it is wrong to consider and weigh up the risks and your views for your own circumstances.

[Whatthefreakinwhatnow]

DD1 was late, my hospital booked my induction for term plus 10 but no beds were available, nor the next day, nor the next.... whilst in for monitoring at 42+1, my placenta gave out, and I almost lost DD and almost bled to death.

I get that this won't happen to everyone who goes over, but it was truly terrifying and I don't know why anyone would put themselves and their baby at even a minor risk of this when a perfectly safe alternative is being offered. I just don't.

[HomeIsWhereTheGinisNow]

Their policy is guided by the enormous rise in stillbirth rates after 42 weeks. As mother to a stillborn girl, I can tell you that your perfect birth is not worth risking this for. I know you're not making this decision lightly but the risk is a very real one, I would listen to them. You do not want to be where I have been.

[FutureMrsRanj]

The research does point to a slight increase of stillbirth at 42 weeks, from memory, although don't quote me, it increases to almost the same as a baby being born at 38 weeks, also considered term and safe for a home birth. In your situation, I would seriously consider accepting regular scans after 42 weeks to check your placenta is still working efficiently. Having said that, EDDs are not an exact science Plus you may not get to 42 weeks. If you want to speak to someone, AIMS have a team of midwives you can speak to for impartial advice, I hope it starts for you soon and you don't have to make any difficult decisions.

[HomeIsWhereTheGinisNow]

I should clarify - my DD didn't die because I went overdue. My point was a more general one. Please believe me nothing in this world matters other than having a live baby. Listen to the doctors.

[FutureMrsRanj]

And for home

[sycamore54321]

Nobody gets sued if the outcome is a healthy mother and baby.

[CatchingBabies]

Not true sycamore, look online at the NHS cases they are all there to see.

[nephrofox]

Placental degredation can start before 42 weeks. Mine showed clear signs at 40+6. Those using the argument that the dates could be wrong need to remember they could be wrong in the other direction also.

[Redkite10a]

According to AIMS:

'The rates of an unexplained still birth is as follows:

37 weeks - 1:645
38 weeks - 1:730
39 weeks - 1:840
40 weeks - 1:926
41 weeks - 1:826
42 weeks - 1:769
43 weeks - 1:633'

from www.aims.org.uk/faq.htm#Question8 .

That's hardly an enormous increase in risk from 41 to 42 weeks.

Induction is also not risk free, this site gives a helpful review //www.google.co.uk/amp/s/midwifethinking.com/2010/09/16/induction-of-labour-balancing-risks/amp/?client=ms-android-samsung

'The most extreme of these risks are rare, but fetal distress and c-section are fairly common. The potential effects of uterine hyperstimulation on the baby are well known (Simpson & James 2008)- which is why continuous fetal monitoring is recommended during induction. This may also explain the association between induction and cerebral palsy (Elkamil et al. 2010)'

[Sweets101]

The only instance of someone insisting on letting nature take it's course when 42+ weeks I know off ended in a still birth. I don't imagine that's what you wanted to hear but you did ask.
It depends I suppose how important the birth experience is to you and whether you believe modern medicine has had a positive impact on maternal/neo-natal survival rates.
Fwiw if you're in the UK we have a poor rate of still births and a lack of intervention hasn't ever been noted as the reason.

[user1471446433]

Assuming that you have done your research & are happy with the tiny absolute risk in going 'over'.
The best way to get them to back off & keep your HB plan is to get the consultant to agree to changing your due date. Batshit but true.
Speak to a SOM to make this happen.

Agree with all above re tiny amount of data that all this is based on, it's crazy & your placenta doesn't have an off switch! Placentas degrade at different rates & grainy placentas are found on occasion at all different healthy gestations.

[user1471446433]

Oh & I have had 2 HB post 42 weeks.
I know one other that has too.

[viktoria]

My second child was born at home after being 15 days overdue.
I had been encouraged/pressured into being induced. I had to go into hospital every two days for monitoring for the last 10 days of the pregnancy. Of course the last thing I wanted to do was to endanger my unborn baby. At the same time though, I did feel that the baby would come when he was ready. My first born by the way was 10 days late.
Best of luck.

[HomeIsWhereTheGinisNow]

Redkite the stats you quote are for unexplained still birth. Stillbirth overall is 1:200, in most cases they know what happened once the baby has reached term.

OP you need to do your own research. Some of the stuff on here is misleading. But in the end it is, of course, your choice.