Home birth with first baby

[Didi1994]

Hi,

Just wondered if anyone had any advice for home birth with my first? Lots of people look at you like you're a bit mad when you say that's what you're planning! We live 5 miles from hospital but hoping to hypnobirth and have water birth at home. I have heard that quite often the NHS will okay you for a home birth but try and back out very last minute saying there will be problems providing two midwives because of their rota etc... anyone had any experience of this? Thanks :)

Midwives here don't push homebirth at all. The community midwives simply ask where you would like to give birth and then refer to the homebirth team - they then discuss the risks and the woman makes the decision from there.

No forcing women in to anything they don't want or being patronising at all.

Maybe things are different in your area.

Midwives also don't encourage women with risks to have a homebirth, however they support the women with their choice. If that choice is a homebirth and the woman is fully informed then the midwife will support her and her family.

I chose a homebirth with my first as I was genuinely concerned what would happen to me as a low risk healthy woman in an obstetric unit. Unfortunately with the NHS the way it is, obstetrics is a bit of a conveyor belt. The drs I work with are amazing, however they don't see how damaging or traumatic an instrumental delivery can be for the woman. Obviously a healthy baby is a priority but it's not all that matters. Alot of ppl are saying how they would have died without being in hospital, but often this is simply not true.

Anyways, with all the preparation in the world, until you start labouring, you can't be sure how you will cope with it at home. I think it's great to book a homebirth if you are low risk, and if labour starts spontaneously then you can get assessed at home. You can always head into hospital at any point if you wish. I find that homebirth midwives are more than willing to come out for assements and early labour support. That's much better than getting into the hospital, then having to be sent home again until labour establishes.

“sycamore54321“

According to NICE outcomes for the babies of first time mothers giving birth in a freestanding MLU are no different to similar mothers giving birth in OU’s.

Out of hospital midwife led birth in this case doesn’t seem to increase the risks for babies and it seems to significantly decrease risk for mothers. So it’s not out of hospital birth per se which increases risk to babies.

As for describing and explaining risk - talking about ‘doubling’ or ‘halving’ risk is actually discouraged when talking about any sort of choices people make in relation to medical care, because it decontextualises risk.

This may help (from NICE)

Birthplace study is really quite poor as a source; it was filled in by midwives only and many hospitals don't properly track deaths of neonates so it's hard to say with any confidence that home birth or birth in an FMU is definitely better/the same as hospital birth as the data quality is so poor.

Secondly women who choose to give birth at home are likely to be the lowest of the low risk; low risk/high risk is not a binary thing and the upper end of low risk, as it were, will probably choose to give birth in hospital...so you really should be expecting better outcomes in homebirths/FMUs not just equivalent outcomes. Some clinical negligence lawyers report that 50% of their cases are coming from FMUs which is crazy given that the vast majority of women still give birth in AMUs/Labour wards.

Having said all that labouring how you want is a fundamental right, and in all likelihood you will be absolutely fine, the absolute risks of homebirth for an FTM are still really low. Just make sure you are fully aware of the risks and are comfortable with them.

I had both of my children at home in my late 30s/early 40s. Community midwives were very supportive and care was fantastic.

I was inundated with midwives for my first birth simply due to shift change over and students. I got the impression they enjoyed a home birth as they didn't have so many. Second birth I barely needed a midwife and the second one only turned up after my son was born. All was going well so it wasn't an issue and as I was closely monitored, I'd have been transferred in at the first whiff of trouble.
I honestly think my first birth wouldn't have gone so smoothly had I been in hospital. I think the stress of the situation and the length of the labour would have led to intervention.
It is important to recognise that this is a low risk birth though. Keep an open mind and you can always go to hospital if you prefer or it's indicated.

"Birthplace study is really quite poor as a source; it was filled in by midwives only and many hospitals don't properly track deaths of neonates so it's hard to say with any confidence that home birth or birth in an FMU is definitely better/the same as hospital birth as the data quality is so poor."

I know someone who worked on that study and the way you say important data from the study was handled by midwives and hospitals - it's simply not true.

You need to stop using the Birth Trauma Association, James Titmarsh and Amy Tuteur as authoritative commentators on this study. They are driving an agenda - and that agenda is not fundamentally about the safety of both mothers AND babies. Those criticisms have been answered by the BirthPlace team. The study is considered of sufficient quality to form the backbone of the NICE recommendations on place of birth, and that's good enough for most of us.

"Secondly women who choose to give birth at home are likely to be the lowest of the low risk; low risk/high risk is not a binary thing and the upper end of low risk, as it were, will probably choose to give birth in hospital...so you really should be expecting better outcomes in homebirths/FMUs not just equivalent outcomes. "

You are parroting random, agenda driven critiques of BirthPlace, without having read the study or understood it.

Birthplace compares outcomes for low risk mothers. It controls not only for health in pregnancy but for risk status at the start of labour, in order to be able to compare like with like.

"Just make sure you are fully aware of the risks and are comfortable with them."

What is missing from the discussion are the additional risks for low risk mothers (and babies carried in subsequent pregnancies) associated with choosing an obstetric unit as the setting for birth.

You absolutely can't make sense of this issue when you are steadfastly refusing to acknowledge that low risk women who choose an obstetric setting for birth appear to have significantly lower rates of straightforward labour: they have higher rates of complication, more major surgery, more blood transfusions, more forceps deliveries, higher rates of admission to HDU, and long hospital stays than similar women who choose non-obstetric settings for birth.

@gallicgirl you say "Second birth I barely needed a midwife and the second one only turned up after my son was born. All was going well so it wasn't an issue and as I was closely monitored, I'd have been transferred in at the first whiff of trouble."

I'm delighted the outcomes were positive for you but don't your realise how horrendously dangerous that situation was? What if you'd had a post-partum hemmorage and your baby needed some help breathing, for example? Neither of these are uncommon. Or multiple other scenarios where both the newborn and the mother need immediate attention. I am so glad everything went well but yours is not a story of safe home birth I'm afraid. you say you felt closely monitored but you were put at appalling risk by them failing to ensure the arrival of the second midwife on time.

Sycamore for women with precipitous labours homebirths are often recommended as it's safer to give birth at home with even one midwife than in the back of an ambulance or unattended in the back of a car.

Your posts on this thread are totally unnecessary.

I'm having a HB with my second partly because my first was so fast. Do not fancy giving birth in an ambulance / car park thanks. I had a straightforward first delivery with no intervention. I know I'll be less stressed at home.

Good luck OP, for low risk pregnancies (even first time) HBs are no less safe than hospital.

Minifingerz - just saying that I shouldn't listen to xyz because you disagree with their agenda doesn't make it not true - or not something to talk about, I would encourage anyone interested in the criticisms of Birthplace to read more about it here: www.birthtraumaassociation.org.uk/media-information/press-releases/36-first-time-mothers-in-free-standing-midwifery-units

Sheena Byrom et al also have an agenda - an agenda which I would say is weighted heavily towards natural birth at pretty much any cost and ignores the well documents damange to women & babies that this has caused/is causing. Perhaps it is fairer to describe the attitude as "birth is inherently safe" despite all evidence to the contrary.

I'm interested in what you think James Titcombe/Amy Tuteur etc. agenda actually is? Are you implying they want birth to only be safer for mums and not babies? or what?

Now most people will sit in the middle of the two camps, and where you labour and how you labour is a choice but it should be a choice based on robust evidence and fully informed, women should be consented to vaginal birth in the same way they are consented to anything else. Including the risks of prolapse, incontinence (urinary & faecal), tears etc.

@sycamore
I had a 30 minute active labour and the 2nd mw arrived a couple of minutes after my son. Funnily enough, neither I or my son felt like hanging on until the mw got there. She was on her way but my son arrived first and at no point do I think I was at risk.
However a hospital birth would have put me at significant risk of intervention, c section and birth injury. The c section rate is 30% locally and I think the intervention rate is over 40%.
Scaremongering much?

"You absolutely can't make sense of this issue when you are steadfastly refusing to acknowledge that low risk women who choose an obstetric setting for birth appear to have significantly lower rates of straightforward labour: they have higher rates of complication, more major surgery, more blood transfusions, more forceps deliveries, higher rates of admission to HDU, and long hospital stays than similar women who choose non-obstetric settings for birth."

My point is twofold: first of all those low risk women may well have had worse outcomes at home - there's a reason they decided on the place of birth they did. Perhaps they were classified as low risk but had a gut feeling or perhaps they were classified as low risk but their BMI was at the upper end of normal and their blood pressure was at the upper end of normal too.

Women who choose non-obstetric settings are a different population. I also think it is probably true that all things being equal, you are more likely to end up with an intervention in a non-obstetric setting as the availability of interventions drives intervention. However this should be weighed against the access to fast obstetric care. In reality this is a choice; I would rather have an unneccessary-in-retrospect caesarean than end up with incontinence or a baby with birth damage. You may feel differently.

I queried Emergency C-sections with various midewives and was advised that in the time it takes to prep theatre, I would be at the hospital, it doesn't happen immediately. Obviously if I lived hours away from the hospital it would be a different matter.

The OP asked for advice, not a load of horror birth stories!

Incontience and birth damage to mother and baby are both outcomes from instrumental delivery as much as a straightforward home birth of course. Women who labour on their backs under continuous monitoring (something still widely done for minimal cause despite NICE guidelines) may need more assistance than women able to move and choose positions, being regularly intermittently monitored wherever they give birth.

Painting this debate as home=reckless and unsafe and hospital=safe and low risk is just disingenuous.

You must live very close to the hospital, they had theatre prepped, me put under and baby out within 12 minutes of pressing the big red button. My DP told me how scared he was after a midwife told him they needed the baby delivered within 15 mins and that it would take about 10 mins to prep theatre.

I had a home birth with my first. It was a six hour labour, no problems, gas and air was fine for pain relief. It worked out really well.

By the time dc2 came along so many of my friends had had complicated births that I lost my nerve and had him in hospital.

I don't think it's home = unsafe and hospital = safe, it's about being aware of what the risks are as a ftm and what risks you are aren't willing to take. I personally think all women should have a midwife they know at their birth and that they should be able to give birth however they want, but choice needs to be informed. Ultimately we are lucky to live in a country where the absolute risk of any choice is still very low. It's up to the individual to decide what risks you want to take..

For example I would rather be in a setting where they are overcautious and thus intervene more rapidly with c section, even if in retrospect that c-section might appear to be unnecessary.

There's little evidence to suggest that labouring solely on your back does anything particularly bad...if we think back to the bad old days of obstetric care women were subject to routine episotomies, lying on their backs, limited movement etc. but c section and other interventions were lower than they are now.

Women are having more complicated and difficult labours as they have children later and at higher BMIs, both things which indicate a labour on an obstetric ward.

OP - I wouldn't make the same choice as you but you're certainly not crazy for wanting to give birth at home. It sounds like you know what the risks are and if anyone gives you grief they should frankly mind their own business.

You’re not crazy. I planned a homebirth for my first (and probably only). The trust are pushing to be more supportive, and it was my community midwife who floated the option.

I ended up in hospital with an emergency c-section after we discovered that what everyone had thought was a head, was a bum. But it was throughout a positive experience. I laboured at home for 30 hours with stop start and little progression then transferred to hospital with meconium showing up. The homebirth midwives came out and went away again, then I phoned when I saw the meconium and we drove the three miles to hospital. They were waiting for me, team all knew the story, had me set up for active labour with a mobile monitor and the handover was good. I went on for another 6 hours in hospital. They did offer me the choice to continue breech delivery but I was knackered and opted for c section.

I went into it determined not to get attached to any particular option and I’m glad I did. I wouldn’t make a different choice. Go for it!

I don't know why people are getting angry at me and telling me my posts are unnecessary or scaremongering.

A history of precipitous labour by definition means the woman is not a first time mother. So the general discussion we were having about risk levels for first time mothers do not apply. However, precipitous labour increases the risk of both the things I talked about - PPH and respiratory problems in the newborn. Therefore the attention of two separate medical attendants is more needed than ever. Birth with only medical attendant is simply not a safe practice. It cannot be. There are two patients. If they need attention, they need it immediately. If a home birth was chosen because precipitous labour was expected, then it is negligence for only one midwife to have been sent initially. I am very pleased it all worked out well but this was luck, pure luck, not safe medical practice.

For the poster being told it would take the same time to get to theatre in an emergency, that is an absolute outrageous lie your midwife has told you. You will likely be angry with me for saying this but the person you should be angry with is her for lying to you. There are different degrees of emergency section, but a true emergency crash section will have your baby whipped out in fewer than ten minutes from the time the decision is made. Thankfully these are rare but they do happen and there are times when things go wrong so rapidly in birth and every second counts to protect your baby from brain damage, and sometimes to protect your fertility, eg rupture. If your midwife has told you there is no difference in access to surgery between being in the hospital and being at home, she is lying to you. This is hideously unethical and outrageous. Again, why would someone do that? And why are we not all appalled that women are being lied to?

You are talking about crash sections, which are thankfully very rare, I was talking about emergency c sections. I've not come across anything that splits the two in to likelihoods, as they are so rare, however in most of what I have read, crash sections have occurred where there have been additional complications. Therefore my midwives (plural) have not lied to me and we have discussed the risks.

You are scaremongering - the risks cannot be looked at in isolation. A hospital birth would possibly increase the risk of survival in the event of a crash section, but what about the increase in the risk of infection or death from medical negligence? Unnecessary medical intervention? To many women, their mental health and ability to labour depends hugely on birth setting.

I'm bailing out of this conversation now as it's going nowhere - we're all grown adults and there is enough research around for women to make their own decisions on where they feel safe giving birth, there is no need to talk about worst case scenarios as though they happen on a regular basis. That is exactly why so many women feel forced in to a type of birth they are not happy with.

Sycamore54321 and I don't understand why you are so angry about homebirth? Why do you think midwives are so negligent? We are trained to deal with emergencies.

PPH and neonatal resuscitation are more likely to occur in a hospital setting following induction. Crash sections where baby needs to be out in minutes happen so rarely, the chances of being at home and everything going well and normal and low risk then suddenly going really dramatically wrong are so so small, birth just doesn't happen like that.

These threads always go the same way with somebody with a chip on their shoulder telling women who opt for homebirth they are irresponsible.

OP. Check out www.homebirth.org.uk

Ha I don't think you're being irresponsible, in fact I hate people telling women that their choices about their own bodies are "irresponsible". It's just about knowing the risks and deciding if you're OK with them...

There are a lot of things that can go wrong in childbirth but the likelihood is that you will be fine. You will be accepting a neonatal mortality/morbidity rate equivalent to giving birth in Ukraine or Brunei which is not exactly dreadful (5.3 vs. 9.3/1000).

Dreaming, births DO happen like that. Maybe but on your watch but they do happen. My friend started with a low risk homebirth, ended up with emergency transfer and crash section... and an oxygen-deprived baby.

I'm not saying they never happen, however this also occur in hospitals.