How much to 'fight' for a home birth?

[Strawberrythief87]

Hello
I'm 27 weeks and thinking more about my birthing options. I originally preferred the idea of a home birth but my midwife wasn't sure as I'm on a 5th floor with no lift so she said it might not be safe to get me out if needed. This has played on my husbands mind since as well. But speaking to people about it since this seems silly as an ambulance crew would be able to get people out of our flats for a number of different reasons.
The thing is I've been reading more and understanding how I'm going to need to be relaxed during labour and I know that I will most probably find a ward quite stressful, I've experienced quite a bit of anxiety and have PTSD where shouting and loud noises can be quite triggering for me so I'm thinking even in a best case scenario I would probably need more medical interventions on a ward than not.
My husbands happy to follow my lead on our birthing plan but when I pointed out that sometimes they don't have the staff on to be able to do home births and the way that some people then 'fight' for their right to have one he thought that was really selfish so I'm not sure how supportive he would be when it came to it and I'm going to 100% need to feel hes on my side
I know I've got time to decide but I wondered if anyone else has had to persuade others of their rights/need for a home birth and how this went

Oh and other option is a midwife led centre thats attached to our hospital but it only has two rooms for a very busy area so there is a high chance we wouldn't get it

'fighting' to get a homebirth due to the location of your flat is very different to fighting for one when there are no staff. Yes, they should send staff out to you and have a responsibility to do so, however sometimes this isn't possible. I'm a midwife and where I work homebirths are very much supported, but occasionally when a woman requires a midwife at home, we advise them to come in, as there isn't any one available at that time.

No experience of trying for a homebirth.

For what it's worth, I used an MLU - was really calm, quiet and peaceful. Just me, midwife and OH in the room - only loud noises were from me while pushing and an alarm the midwife rang when my baby needed assistance (he was fine, just needed a bit of extra help getting his breathing going to start with). Mine only had 3 rooms.

Delivery Suite was in the same building, and though I can't say for certain, on my walk through to get to MLU was also pretty calm and quiet. I think shouting/loud noises is very much avoided unless necessary! You won't be on a communal ward for labour itself if that's a worry.

I don't think there is anything wrong with wanting a homebirth, but maybe worth discussing your reasons for it with you midwife to see if she can reassure you? I don't think they can completely deny you if it's rally what you want. Can you visit hospital for tours of MLU/delivery to see how they feel? Good luck!

Go with a home birth but don't get set on the idea it will happen, there's so many variables in childbirth, have an open mind to take stress off yourself.
If you get a homebirth fantastic, if you have to be induced in hospital fantastic, if you have to have a emergency cesarean, fantastic. Go with your plan but just remember, the end goal.. How you get there you can't control. Good luck 🤞

i Totally understand why a home birth might help you to stay calm, and if everything is going smoothly and your Labour is straightforward it sounds like it could be a very positive thing for you.

But....

While I would absolutely advise to plan for best case scenario and be prepared to change the plan if need be, I think it is worth considering the reality if you start off with a home birth and need to be transferred / rushed to hospital for some reason. Reading your OP it seems it could be quite stressful getting you down the stairs to an ambulance. Just worth thinking about how that would be in the event and how you would react to it. Would this be triggering for you?

I can only go on my experience but I had to move (not from home birth set up though) midway through labour. They tried to get me to walk and I couldn’t. They tried to get me to sit in a wheelchair and it was the most excruciating thing, I just couldn’t. I was quite far on in labour but imagining the process of being manouverred down five flights of stairs at that point would have been unthinkable for me. Everyone is different though.

For what it’s worth I wanted MLU but had to have labour ward birth and it was fine. There was no shouting, everything was very calm and I was pretty zoned out anyway.

Hello, thanks for your replies. I am absolutely covering all the bases and having a plan a,b,c etc in my birth plan. I know things won't always go to plan and the 45% of first time home births that end up in hospital. But I think my chances of staying calm, centred and focused are going to be better the longer I stay at home so I want to have that opportunity. Also I think there feels like a difference in having to go in due to a medical need (which of course I'd accept) and something that seems more about technicalities

In case it's any comfort to you, I have never heard shouting or loud noises in hospital when giving birth.

Home birth carries specific risks, especially for first-time mothers (you didn't specify if you are one or not?). Has your midwife discussed these with you?

On the stairs issue, I think it is a very genuine consideration. Of course, you have no way of knowing what your labour will be like, but it's not impossible that you will be immobilised by labour pains and that it will be very difficult for you to move, or for you to be moved. On the one hand, of course paramedics will perform their work in whatever conditions the patient is in but it is not optimum to choose conditions like these. There is no denying that being on the fifth floor with no lift will cause delays if an emergency occurs and for certain types of emergency, every minute is critical. Of course, there's every chance everything might be fine and you won't need to be transferred. But unfortunately if you do need help, your specific circumstances mean that you will have slower access to help. And in certain circumstances that might not make a difference. But there are circumstances where it would. It might not seem fair and legally you can give birth wherever you like and if an ambulance is called they will have to attend you. But that does not mean that the risks do not exist. It is your choice but it should be a fully informed choice.

It's up to you but I would seriously think about your housing situation and the impact that would have on you and your anxiety levels specifically if you needed to be transferred in an emergency situation. I live on the third floor with no lift and I'm 37 weeks pregnant with my first. I think in subsequent births, if there are any, when I am living in a house, I will probably opt for a home birth if low-risk as I am now - I am on the autistic spectrum and have an anxiety disorder etc so I do genuinely understand your feelings and anxiety about being somewhere other than home!! My anxiety about giving birth and things has been so bad recently I've been referred to the perinatal mental health team and am going to see the specialist midwife next week to discuss it all. But I think potentially being moved down three flights of stairs in an emergency when I may be basically immobile, severely anxious and in severe pain, is a horrendous idea in itself and have ruled it out on that basis. And I only live about a 10 minute drive from the hospital.

I am thus booked in to give birth at the midwife led unit at the hospital. I have a hospital tour booked for next week that DH is coming to with me, they take you on a tour of the MLU and delivery suite, I think I will find that really helps my anxiety visualising it all beforehand and being the environment beforehand as due to being autistic I don't like change and new places etc as it is. Does your hospital offer anything like that perhaps?

Im having a home birth despite access issues to my house (no direct street access)
I havent had to fight for it at all.... they just said 'it may pose a problem'

Im low risk and this is my second birth. They were happy to go along with my home birth plans and just seemed to want to warn me about the potential access issue is all.
If you are low risk the chance of you being completely unconcious if they try to move you to hospital is very very low.
Majority of home birthers moving to hospital do so because labour is not progressing or they decide they want more pain relief options... in both these scenarios you would still be reasonably mobile...
The chance of you having to move in the last stages of your labour are very slim if you have been classed as low risk and have given birth before.

Of course theres always that chance it COULD happen.... but for me I think the risk is low enough that I am happy with my birth plan.
Like you its not that I would not be able to get to an ambulance at all in an emergency... it may just be a little difficult to transport me if i am not awake

OP you're right to consider the logistics of your labour, but that aside how are you going to manage walking up and down that many flights of stairs when you're heavily pregnant? Or worse, with a baby in your arms? Are you super fit??

Labour wards a very quiet. Definitely no shouting going on. I think you have been watching too many TV shows OP. One time I heard a woman screaming her head off (not that loud because it was behind closed doors mind you) but otherwise no noises at all. I certainly didn't make any noise while in labour beyond talking, nor did the midwives. I don't that is something you need to take into consideration.

I'd definitely consider how you'd cope with the stairs.

I planned to have my first at home - 48 hour labour with baby back to back, 3 hours pushing and she got stuck. I walked the 20ft to the ambulance outside my living room window and it really wasn't easy - I definitely couldn't have done 5 flights of stairs