Home birth - the down sides?

[Lakedeal]

Hi all

I'm seriously considering a home birth for my first baby but struggling to find good quality information about the potential risks. I have read the Birthplace study and know the risks of a negative outcome are higher for first time mums but it doesn't give information about why.

We live 10 minutes from the hospital (by car) and I would absolutely go the minute a midwife advised it. Ideally I would discuss this with my regular midwife, but she's away at the moment and the midwife filling in with her just said I should let them know my decision at my next appointment (in two weeks' time, when I'll be 35 weeks).

Any insights or reading recommendations would be great - I know a lot of people have had brilliant experiences, I just want to make sure I'm making an informed decision.

Hi, I wouldn’t recommend it. We attempted a home birth with our first. I read everything, we were 5 mins from the hospital and I was fully confident that my home birth would be safe and much nicer than a hospital birth. I presumed that the midwives I had seen were fully aware of my medical health, I hadn’t missed a single appointment, if talked through home birth at length and was actively encouraged. I went over due, i had a sweep, still nothing, it wasn’t until my waters had broken with no labour for 24 hours that alarm bells started ringing.that was at a week and a half over due. Nobody called me, I was totally in the driving seat as it were, and frankly completely inexperienced. We ended up having an Emergency C section after being induced in hospital. The baby was huge. Like HUGE nearly 12 pounds. I can’t help thinking now that home birth could easily have turned to tragedy for us. How can nobody with experience have thought about the size of my bump even and warned me off? (It was enormous thinking back.)I had been back and forward to the G.P. With symptoms I now know were maternal diabetes but it wasn’t picked up. Even now after three children Im of the opinion that it’s too risky. My third had the cord around their neck. So I can’t even make the argument that more births makes you more able/safer to deliver etc. I think hospital is the best place to deliver. It’s not idilic, big of the worst happens you are not waisting precious minutes trying to get there.

If I had low risk pregnancies I’d consider it for a second or subsequent birth, in line with the NICE guidance. But not for a first, there are too many unknowns.

@Evenquieterlife I don't really understand. Your waters broke and nobody called you within 24 hours - didnt you call them? Surely you phone them and say your waters have gone and then they come out and start the process? It sounds more like an issue with your antenatal care and nobody noticing your gestational diabetes than an issue with home births specifically.

The risks will always be higher with a first birth as it's the first time your body has done it and you don't know if you'll be able to tolerate the pain. You might be a birthing natural and they'll tell you in hospital to def have a home birth next time. Personally I couldn't take the risk. In the end it was a moot point regardless as there was meconium in the waters. The best advice I can give you is try not to plan your birth too much- it leads to negative feelings when you don't get what you imagined

I wouldn't have a home birth for a first baby but am planning it for my second. There are too many unknown for the first baby and you're highly likely to be transferred in for more pain relief or other reasons.

I had a hospital birth op but actually spent the first 14 hours of my 16 hour labour at home. Obviously everyone has a different experience but just thought I'd offer a different perspective- sometimes the vast majority of a hospital birth can actually be spent at home! Not what u asked I know but something to have in mind.

You may only be ten mins from hospital but in an emergency situation you would need to go by ambulance which you would have to wait for. The time that takes can be enough to cause a negative outcome for you and baby. Birth is unpredictable particularly with number 1.

The risks are higher for first time mums because, to be blunt, your pelvis hasn't had to stretch for want of a better word to accommodate a baby's head passing through it. The vast majority of women have faster and easier labours for subsequent vaginal births because "the path has been smoothed". That's why all the stats show that interventions are more likely for first births.
Some women have straightforward labours with their first but the risk of needing help is higher.
I had an HB with my third. It was ok but it still hurt like fuck! I wouldn't advise anyone having a first baby to have it at home as no one can really prepare you for the experience of giving birth or know how it will work out for you.

Had a home birth with my first. I'm so glad I did. The risks are so tiny, and you're less likely to end up needing interventions.

Definitely worth speaking to your midwife about it.

I had a home birth with both my dc. I had an independent midwife, and felt fully supported and educated on all eventualities.

My sil had a home birth and ended up in hospital anyway. She delivered her baby at home, but had a bad tear and ended up going to hospital in an ambulance afterwards. She also had to stay in over night. I had a terrible time with dc child 1. I’m pleased I was in hospital as I fear it could have ended badly for both of us. I don’t think it’s a good idea for a first baby tbh. However, I’ve got a friend who chose to have dc4 at home after 3 straightforward hospital deliveries previously. She said it was a wonderful experience.

Thank you all for the responses - plenty to think about!

Of the 8 couples in our NCT class when having DD there was only one straight forward birth with no complications. All first babies, a range of women with low to high risk pregnancies. There was one elective CC, 4 emergency CC's, 1 baby unresponsive on birth (but fine later), 2 bad tears & for me, a retained placenta, massive blood loss & 3rd degree tear. We all gave birth in hospital, & all mums & babies survived, thankfully.

For me even a tiny risk isn't worth it
I needed an emergency crash caesarian
which happen ed v v suddenly
I dread to think what would have happened.

www.nice.org.uk/guidance/cg190/chapter/recommendations#place-of-birth

NICE guidance. Section 1.1 has a table that goes through what your chances of being transferred in are.

That's the stats at least.

I would encourage you to labour at home and see how you go but be a booked home birth so you've the option there safely. If you choose to go in then go. It's your birth, make sure you're in control. But also listen to your midwife's advice at the time.

No one knows how any birth is going to go. You just have to hope for the best but preparation is key as with anything.

Good luck!

I wouldn't because if something does go badly wrong, ten minutes could be the difference between life and death for the baby. Or at least life and brain damage. Plus, would they need to transfer you by ambulance? If so, consider the time taken for it to get to you. You're not exactly very mobile in the end stages- I certainly wouldn't have been getting into a car.

A family member of mine recently had her first after a low risk pregnancy and ended up with an emergency c section for fetal distress- baby was born not breathing. Thankfully, it was resuscitated in time and seems OK now, but the delay caused by a home birth may well have changed that outcome.

I had one with my third pregnancy. Wouldn’t have done it with my first

The pros were very straightforward delivery BUT I had to wait a long time for the mws to come out to me.

A lot of the cons seem to be with issues that relate to trying to home birth an overdue baby, poor communication with MW beforehand, staff shortages etc not just time to hospital.

Labour at home for as long possible with a booked home birth?

I think subsequent births I would, but when it’s your first it really is totally new ground.

Like others have said, labour at home for as long as possible and then go in.

My best friend stayed at home until 9cm, popped into hospital and was out within a few hours!

I had a home birth with DC3. I'd had a forceps delivery with DC1 then an easy, normal delivery with DC2.

I felt as confident as I could booking a home birth for my third because I'd had a straightforward second birth and all my pregnancies were uncomplicated and problem free. Statistically I was low risk. I'd done lots of research, I had encouragement from my midwife and crucially I had DH's full support. I knew how much pain I'd likely be in and how much I could cope with. I lived close to the hospital.

My home birth was one of the best experiences of my life, it was amazing.

No way would I have had a home birth with my first, with no experience of how your body copes with labour and birth it's just too risky in my opinion.

Have a word with your home birth unit. Most only accept first time pregnant mums if they are considered very low risk. So being over a certain age or BMI may force you to the mw unit.

I had a home birth for my first baby it was awesome! Like you I noted the very slight increase of problems from the birthplace study. I decided overall that it was a fairly negligible difference and went for it.

Lots of people shout out about their bad experiences and not many people talk about good ones (to avoid being seen as smug / upsetting others).

Prepare as best you can for birth whilst being open minded that it could not work out how you wish.

Maternity services get sued for the largest amounts of money across the NHS when something goes wrong (which is a whole other topic about defensive practice) if it wasn't reasonably safe they would never offer it.

OP, no birth is safe and uneventful except in retrospect. We doctors don’t have a crystal ball - we can tell you that some risk factors make it more dangerous to have a home birth, but we can’t predict the ones where everything looks promising but then goes life threateningly wrong.
A placental abruption, a massive intra partum haemorrhage, an amniotic fluid embolism, severe fetal distress needing urgent section- how do you fancy coping with any of those at home?
My own second baby would have died as a home birth, despite being a totally normal pregnancy at term and a normal delivery with no pain medication.
Thankfully I was in hospital with a full paediatric crash team, ventilators and ITU facilities.
DD arrived almost dead with an Apgar score of 1, and needed intracardiac adrenaline, intubation, ventilation , 3 different anticonvulsants and a week in ITU.
None of that would have been possible at home with just a district midwife.
Fair enough if you want to risk your own safety and survival, but it’s rather tough luck for your poor baby if the shit hits the fan, is it not?

I have one child and had booked a home birth but ended up transferring to hospital which is quite common apparently. Basically, my waters broke and I wasn't progressing quickly enough (only 2cm 18 hours after waters gone). They like you to deliver within 24 hours after waters go as there's an increased risk of infection. Transferred to hospital at which point I was 4cm and requested to go to the birth center (midwife led( next to the labour ward. Gave birth in the pool. The water birth was not in my plan at all but I was so immobile at that point I'm glad that's where I ended up. If I do it again, I'd like to go back to the birthing center but tbh I might book a home birth and see how I get on. Things change so quickly. One minute I was 8cm and the next I was pushing. I'd hate to labour too long at home and not get to the hospital in time. Plus everyone comes to you. None of this turning up at hospital and then getting turned away.

I attempted home birth with first but had to transfer due to failure to thrive, no regrets tho. Successful hb second time and it was wonderful, really not even that painful by comparison to first. There were many factors to that but I think a large part was being expected to be on my back on the bed for monitoring, which increased pain and led to an epidural. In my experience and statistically being in hospital increases the likelihood of interventions.

You know how contractions can slow or stop when you transfer to hospital? Mine slowed even just by new midwives coming to the house! Your body and mind are so intimately connected, that you need to be in the place you feel safest, to have the best birth. For some that is home and others that is hospital.