Consultant against 1st time births at home - your advice

[Annie75]

My consultant says that she wouldn't recommend first babies being born at home for two reasons: not having adequate resusitation equipment on hand should the baby deteriorate immediately after birth; not being able to offer blood tranfusions should the woman need one and/or suffer a large loss of blood. I can't quite see why first births should be different from subsequent births as surely every birth is different?

I'd desperately like a home birth for all the advantages listed repeatedly by women on this and other message boards (the ability to relax in my own home, avoid medicalisation and intervention, labour at my own pace etc etc). I'm not put off by her comments as I reason that I live a max 15 min journey to the hospital should I need an urgent transfer, will actually benefit from increased monitoring by my midwife prior to a homebirth, and will hopefully have adequate warning signs should anything go wrong. I am also having additional scans prior to the birth to monitor the baby's growth.

Any thoughts about first-time home births or the consultant's concerns? Thanks

you should go for it if you are comfortable with doing so, and no real contraindications or health issues

homebirth site is an excellent resource

not recommending it , is not the same as saying you cannot ! and even then, you can do what you feel is best for you and your baby !

sounds like you are really positive and have made a decision based on what is best for you and have thought it all through !

go for it !

Hi Annie. I had DD1 at home and am blimming glad no-one tried to put me off like your consultant - for you. It was great - like you say, if you have a trouble-free pregnancy and scans etc then go for it. I too was only 15 mins from hospital but was never tempted to go even when gas and air ran out a bit early in proceedings . It was so comforting to be in my own living room, with all my stuff to hand and the midwives were ace and seemed to enjoy themselves too! In stark contrast to DD2's birth as had to be induced and absolutely hated being in hospital even though I accepted I had to be. The best thing about the home-birth (apart from DH's ability to keep slipping out to the kitchen to guzzle wine to steady his nerves!) was getting straight into own shower then own bed after it was all over with DH and DD and supping champers and eating toast in comfort. Good luck!

I've just had my second baby at home and it was an incredible experience. I'm slightly dubious about your consultant's points as surely the risk of you bleeding or baby being resuscitated is no more for a first birth?

Having said that I decided to have my first baby in hospital for two reasons - firstly that you're more likely to need transferred anyway if it's your first and secondly I was scared of the baby becoming very distressed in the second stage and not being able to push it out fast enough - I reckoned by the second time my pelvic floor would have more "give" IYSWIM .

I'd have been transferred if I'd gone for a HB first time as there was meconium. It's a very personal choice so go with your instinct!

I think your consultant is just a typical Consultant, that isn't keen on Homebirths!
I suppose, you cna't even always blame them, as they hardly, if ever, see a normal straightforward Birth...if they are called to a Birth, I would suspect it's because of problems!

I remember wiht my es, my mw even offered the Homebirth...but at the time it was, for me, just to weird a concept...stupid me...I should have gone for it, but well, hindsight and all that!

I had my first baby (only so far ) at home last year. Went fine, fantastic experience. As far as I am aware, the MWs that attend you at home DO have resucitation equipment if needed. If you are seeing a consultant, are there probs in your pregnancy that could mean you are more 'high risk'?

If you feel happy to go ahead then you should. You sound as if you are well aware of the benefits and the risks.

I was offered a home birth first time around by my mw. She said that all women considered low risk should be given the option. I decided against it but wished I had been braver because whilst my labour and birth was quick and hassle free, my subsequent stay in hospital was lonely and miserable. I hated the light, the noise and the fact that DS and me were spending the first night of his life away from his daddy.

Good luck with it.

I'm not sure it's true that first births are as easy as subsequent births -- I know an awful lot of people who had problems of one kind and another with first births and ended up with epidural, ventouse, forceps etc.

You can of course argue that with the proper midwife support and in a relaxed environment most of these women could have given birth naturally, but then again most of them went on to have easy spontaneous births with their 2nd child, so there must be more to it than that. You don't know how your body will react to labour until you've done it already.

My experience was pretty much as above -- back-to-back positioning with first baby, long labour, exhaustion, intervention, epidural, ventouse, big loss of blood, but I still feel we made the right decisions at the time and the birth was the most peaceful and tranquil of all of mine, and the only one where the baby was delivered purple and wriggle straight onto me.

With the second birth there was definitely a feeling of my body going, "Okaaaay, I remember what to do.." and just getting on with it -- ds was born 10 mins after we got to the hospital with no drugs or intervention.

I wouldn't want to put you off, and maybe I could have had a natural delivery with my first. But it is my experience and those of loads of people I know, that first births are on average more difficult than subsequent ones.

Thanks all for that - any more posts welcome too! Knowing about other people's experiences with having their first baby at home is tremendously helpful - bad bits and all. So far, I've had some strange looks from colleagues and some friends I've told about my preferred labour.

My instinct (and research) tells me to be persistent in pursuing the home birth I want, but then you get one comment from a consultant about why they don't recommend them and the brain quietly starts introducing doubts that repeat like a bad curry I wouldn't put my baby at risk and should I receive strong medical advice/evidence that I should be in hospital then I would, but it would be nice if consultants and midwives saw eye-to-eye along these lines as it's disconcerting to get v different advice as a first-time mum.

i see what you mean frogs, but i feel it is a bit of a chicken and egg scenario

first time mum, goes to labour ward bit sooner than needs to, maybe sent home, maybe sent to ante natal ward, feels dejected, alone, unsure, not sleeping, worried, tired, finally gets to established labour, pain takes her by surprise, cannot cope well, no midwife by her side, opts for epidural, ends up immobile on bed, with drip and continuous monitoring, cannot feel urge to push, so pushes perhaps not as effectively, tired, scared, needs help to get baby out.....

at home , you can mobilise, have a bath use a birth pool if you hire one, TENS, no back and forth, can rest in own bed, have constant support, eat and drink when you need to ..midwife there for you. can have as many birth partners as you want, being active, comfortable, feeling secure, does make the pain easier to cope with

can see how the same woman can have such a different birth experience

No, sure, and I tried to say that, lulumama.

But I suspect that, statistically, first births have a higher complication rate regardless of environment. Wonder if there are any stats on that?

would be interesting to know, but i can tell you , the stats from Ina May Gaskin;s birth commune in tennessee are a revelation, something like a 5 % c.s rate ,and includes first time mums, breech babies, and difficult presentations such as brow...IIRC !!

think those figures are from 2000

but i take your point !

15 minutes is a really long time in an emergency. When a natural birth goes to crash section, sometimes every second counts. I can't understand why anyone would want to take that risk.

this is such a personal choice
I'd go for hospital every single time (and did)
I just couldn't think of if something did indeed go wrong.....I'm only10 min away from our local maternity unit, and wouldn't take the risk
it's for some and not for some - I think on a board like this the percentage of woman who have had or would like to have a homebirth will be higher than the national average, so you'll get lots here agreeing with you, but it is such a personal choice - one that I would never make

I thought that the MWs that attend a homebirth have basically the same resus equipment i.e. oxygen...I am willing to be corrected on that though.

I agree with the logic that all births are different and why should the first one be more likely to need resus or a transfusion...maybe it would be helpful to talk to a supportive midwife on this to get an experienced opinion from the other side. Maybe the consultant has an opinion of first labours as 'trials'.

IMO it is most important to get the first births right if possible as that will set the blueprint for your future births. Also, as they tend to take longer and you might be more apprehensive it would be the best place to be in order to help you relax and help labour progress.

I had my first birth at home and noone said anything to me like what your consultant is saying. (It was all very good and straightforward, by the way). People did say I was brave though .
Yes a lot of fist time home births will transfer (40% I think) but that is still the minority and those who transfer have still given themselves the best opportunity to get the birth they want. At least they can look back and know they couldn't have done anything else to improve their chances.

Because if things go wrong Eleusis you should know before the '15 minutes' kicks in. MWs monitor just as frequently, if not more so with a HB. Also I personally can't live my life in a 'what if there's an emergency?!' state of mind. Giving birth shouldn't be overly medicalised IMO. A very great deal does come down to your mind-set.

I think they have the very basic resus equipment - oxygen and suction - and a bag of IV fluids and associated needles. If they suspect something is going wrong - and they nearly always will get warning of a problem - then they will phone an ambulance.

I'm not a mw, I'm just trying to remember what my midwives told me.

Yes belgo I think I remember the mw saying that. Whenever I said 'what if...?' to her she said that it was extremely rare for things to go from 100% fine to emergency stations immediately. She said they always had warning signs before things went wrong and because in a first birth things take longer that meant things took longer to go wrong. She was always quite emphatic about that with me.

Thanks for more honest opinions. Found some stats on transfer rates for first time mums from the report by the National Birthday Trust (from 1994). It said:

"60% of first-time mothers who had planned to deliver at home, did so, and 40% transferred. 90% of multigravidae [those who'd had previous babies] who had planned to deliver at home, did so, and 10% transferred. The single largest reason for transfer was slow or no progress, accounting for 37.2% of transfers."

I guess too, that first-time mums are likely to be more stressed out by the length and pain of labour than someone who has an idea what to expect. I think reading other people's experiences about the pain of labour has helped me get a handle on what to expect and will help me feel prepared. I can't imagine having a baby in the days when you couldn't access this sort of shared experience and real honesty! Mums and friends don't want to scare you and won't tell the whole truth - gah!

I can see the attraction in a home-birth but it wasn't an idea that appealed to me when I had DD. Are you sure that you can get to the hospital if necessary, using your own transport? You wont be able to rely on getting an ambulance in time, sadly.

Good luck anyway.

I agree LM, although I know what frogs is saying.

I think the main reason why my birthing experience went well was that I didn't go to hospital until my contractions were less than 1min apart (almost on top of each other) so I was there for very little time before DS was born.

The best advice I ever received in pregnancy was to stay upright and mobile until you're almost passing out with the pain and to give birth in an upright position. I think home births are usually so successful because women are more inclined to do this at home. Whereas, if you're stuck in a small room too early which is dominated by a bed, you're more inclined to get on it.

i think homebirth is best suited to women who don;t think 'worst case scenario' ..but look at it as the best place to be to get the best outcome.....of course, not saying for a moment that all home births are perfect and successful, but if you go into a birth, wherever it will take place, with a positive mindset, that cannot hurt!

until homebirth becomes the norm again, women do have to overcome this sort of advice from docs , that often conflicts with advice from midwives !

when homebirth does become the norm, hopefully, for women in hospital, low tech birth units, and home from home environments will follow, with obstetric led care being limited to the truly high risk

hey, a doula can dream !!

homebirth site did addy wrong before !

Interesting views from your consultant... I won't repeat all that everyone else has said about homebirth but I would like to make a couple of points:

Midwives attending homebirths carry much of the same resuscitation equipment that is available in hospital. They are also trained in inserting airways if necessary. What they do not carry are the drugs that are - very rarely - needed for very severely compromised babies who have not responded to stimulation, oxygen or chest compressions. These babies will usually show signs of distress well before delivery and hospital transfer can then take place. Community midwives are well-versed in spotting the signs and will not take chances with your health or that of your baby.

Furthermore, it is a stipulation of the every individual midwife's registration that she/he must attend (at least) yearly updates on neonatal resus. In any case, resuscitation of the newborn baby is no more or less likely with a first birth than with any other!

As for blood transfusions - it's true of course that you can't have one at home! However, unless there is reason to believe that you are at high risk of post-partum haemmorhage or your Hb is very low, again this is sounds rather like a bit of scaremongering than actually looking at your case individually.

However, could I ask why you have been seeing the consultant? A healthy woman with an uncomplicated pregancy should be able to have midwife-led care and should not need to see a consultant unless problems arise. Are there concerns about the growth of the baby or your own health?