Considering home birth - silly?

[FindTheLightSwitchDarren]

I have a DD who is 2yrs and 10 mo. We are expecting another baby when she will be just over 3yo.

With DD I ended up being induced as we had gone 2 weeks overdue. I had a sweep, then a pessary, they were going to break my waters burn found none to break (think the forewaters went on the morning of my induction, before the sweep). I did a lot of waiting about in hospital and eventually had the hormone drip followed by 1.5hrs pushing (no luck) and then ventouse delivery with (fairly mild) shoulder dystocia.

I hated being induced, was exhausted by the long labour and by just being in hospital so long. I ended up with an infection post partum (DD did too), so we both had to go back into hospital. DD for a week, me for 3 nights.

I have to see a consultant this week, (due to previous shoulder dystocia) and am considering asking her about a home birth. I keep being told how much easier the second time is and I also just wonder if being in the clinical setting for all of my labour, made things harder.

Is it worth even considering it, based on my previous birth?

Any advice much appreciated.

How far are you from your nearest hospital? I think you need to consider how long it would take to get in if something happened, including how long you might wait for an ambulance.

I would love a home birth but we're an hour from nearest hospital down horrid little lanes, I wouldn't want to have something go wrong then be so far from help

Thanks, yes, that's definitely a consideration.

We have two hospitals about 20 to 30 minutes either side of us, (the one which is slightly closer in miles would take longer to get to if traffic was bad.

Having had 4 home births I'm probably not an impartial opinion! But there is no such thing as a silly question. I would expect your consultant to be reluctant to encourage you having had one shoulder dystocia - but having said that, everything will have stretched a bit, although I have no clue on statistics on whether it raises your chances of another shoulder dystocia being more likely.
You're probably right that the clinical setting tensed you up against the natural relax into labour ideologies, but if you may be late to get started naturally again (some people seem to take longer to 'cook' their babies than others) the choice may be taken away again :)
Keep your options open

Another thing was that DD had a swab come back positive for strep b after we had to go back into hospital and they were trying to figure out what had caused the infection. So that's another obstacle...

I'm hoping that I might go into labour on my own this time, as I had been having start / stop contractions and think my forewaters had already gone on the morning of my induction. Tricky..,

A previous shoulder dystocia does increase your chances of a repeat with subsequent babies by around 25% I think but may be wrong on the figure so don't quote me. Is there a midwifery lead unit near you you could consider? Before your appointment try and do some of your own research into birth after shoulder dystocia from reputable sources like WHO, NICE or any research papers to get an idea of the risks. As long as you have all the facts you are free to birth anywhere you wish, not where the hospital decides they want you to deliver.

It sounds like you need to discuss whether the complications are likely to reoccur or if they were due to the induction because if they're not and you go into labour naturally then I don't see why they should treat you any differently to any other low risk pregnancy.

I'd be very wary of attempting a home birth with your history of shoulder dystocia. There's an increased risk of it happening if it has happened before.

I can understand why a home birth is appealing to you, but after having a shoulder dystocia in your first labour your chances of having one again are increased. As I'm sure you're aware in these circumstances having the correct expertise available immediately is critical to your baby's survival. If I were you I wouldn't feel comfortable with the risk.

Hmmm tricky. A few midwives have said that I might be induced at term or maybe 41 weeks to reduce chances of another shoulder dystocia.

I think my main 'problem' with that is the hormone drip, which I just found utterly exhausting last time. I'm sure the length of time it took fucking about with pessaries and waiting around to see if I needed the drip, then having the drip etc meant I was in hospital from about 8 in the morning and didn't give birth till 4 the next afternoon.

Not silly at all, and you don't have to ask anyone for permission... if it's what you want then you're entitled to go for it! I was induced with my first (traumatic) and had an amazing, wonderful, lovely home birth with my second. My eldest was there too ❤️ I recommend doing hypnobirthing, I just used an audio track and listened to it at night whilst I fell asleep then put it on in labour.

My second and third babies were born at home, but if there'd been shoulder dystocia with the first I would have had all hospital births. The risks would have felt far too high for me to attempt home birth.

Sorry that last sentence came out weird! I mean that all the fucking about and waiting round just prolonged it so much that Dd and I were too exhausted for me to feed DD properly and we both ended up quite seriously ill. All fine after a short stint in hospital though, but it wasn't good at the time.

My son had shoulder dystocia. It was never even mentioned as a concern in my second pregnancy. I had my daughter in a midwife led unit very quickly, calmly and with no issues at all. My sons birth was very traumatic as he got stuck. Couldn't get him out after 2 1/2 hours of pushing and then of course had the shoulder dystocia as they were trying to get him out. My daughter born in 15 mins of pushing.
Speak to your midwife and see what she says.

That's interesting thanks quiet.

When I last spoke to my mw about shoulder dystocia she said, based on what I'd told her about how they managed to get DD out, that it sounded quite mild and she thought I'd be fine this time, (though I think that was just a passing comment).

You are absolutely not silly to be considering home birth!

From what I can see, having had a previous shoulder dystocia may increase your risk to 1 in 6 for your next birth. However, the ventouse delivery may have been a factor in your previous birth, as basically you are lying flat on your back and unable to move around and get into an optimal position for getting the baby out. Induction of labour is also listed as a risk factor. You may want to check out the other risk factors (big baby, high maternal BMI etc) to see if you had other risk factors or whether those were the key ones last time.

Here are the RCOG guidelines: www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-shoulder-dystocia.pdf

Personally in similar circumstances I would seriously consider a home birth on the basis that it would allow more active labour and for you to be in a setting where you are more relaxed and less at risk of intervention (e.g. the ventouse). Perhaps you could ask to speak to an experienced midwife (perhaps the supervisor of midwives?) about home birth after a previous shoulder dystocia? A midwife is more likely to have experience of home birth after shoulder dystocia than a consultant, who will only have experience of the clinical setting.

Also perhaps ask what the home birth midwives do in the event of shoulder dystocia? It's not an uncommon eventuality and understanding what they would be able to do in a situation like this may help you to make up your mind.

This homebirth website isn't the most up-to-date, but may also give you some data to start investigating: www.homebirth.org.uk/shoulders.htm

Thanks shivery.

With DD, they did a MacRoberts manoeuvre and she came out fairly quickly after that. I had been more or less on my back (though I dragged myself into other positions as much as possible with epidural), from about 2 - 3 in the morning I think when they started the drip. I wonder if that was a factor. She wasn't a massive baby, but was larger than average. Bmi not especially high, (though I was probably heavier than I should be at the start of this pregnancy - bmi of about 26).

DD was coming out in a funny old position. Someone said that possibly the contractions I'd been having in the run up to the birth may have been her turning to get into position. So I wonder if the induction made her come out before she'd had time to turn? Total speculation of course. But I know she was back to back and then turned to the side which is when they decided I would need help getting her out (ventouse and then MacRoberts).

Shoulder dystocia is one of my pregnancy nightmares. No way in hell would I even consider a home birth 20 minutes from hospital with an elevated risk factor for SD. If it reoccurs, your baby is not getting oxygen as the cord is being compressed and seconds count, both to extract the baby and to treat him afterwards if required. A home birth midwife team are not a neonatology expert team.

If induction is your big sticjing point, would you consider a C-section instead?

I would consider c-section instead of induction, but not sure that will be an option on NHS. I'm planning to discuss that with consultant at appointment.

The thing is, if the consults thinks I have an elevated risk of SD again (i.e. it wasn't just due to position, but something to do with my shape and babies being too big for me), then why on earth would they want to compound that with induction which also elevates the risk? Unless they plan to induce me properly early, like 38 weeks.

Loads to discuss. I'm glad I started this thread as I'll write bits down from it I think. So thanks for commenting!

Please listen to what your consultant says is the best choice. Very early in my career (biomedical scientist) a woman died at the hospital I worked at because she insisted on having a homebirth against medical advice. It was awful, my colleague had to have counselling for a fair bit after. If your consultant says it's ok then that's different of course but please remember that childbirth can be very dangerous, I feel like a lot of people forget that these days. If there's any risk you could have complications imo just have the baby at hospital, it's not the most fun environment but it is the safest for both of you. Yes you can go to hospital if homebirth goes wrong but sometimes that's not fast enough (as happened with the woman who passed away).

I don't have anything against safe homebirth btw I just hate the thought of people unnecessarily taking risks

Thanks Lucy.

I have a great deal of respect for doctors (most of my family are doctors or nurses)! If she says no way after we've discussed everything, then I will definitely listen.