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.

The research doesnt pan out for this and shows that home birth is equally safe for low birth second time mums

OP is a first time mum.

Just to be clear the two midwives attending bring full resuscitation equipment for the baby should there be a problem.

But in my relative's case a c section was needed to actually get the baby out. Resus doesn't work when the baby is actually still inside the mother, AFAIK. Also, two midwives with a resus kit are probably less likely to be successful than a team of paediatricians in situ at the hospital, I'd imagine.

Also the birth place study compares likelihood of intervention / complications against other low risk pregnancies. Of course it would make so sense to compare it against medium and high risk pregnancies.

A low risk pregnancy that includes an epidural is automatically more likely to include interventions- did they also take out of the equation all elective epidurals and all inductions (which many low risk pregnancies end in)?

I gave birth in midwife led unit- also a lower risk of interventions (and indeed, I had none). There was a time during the labour when I'd probably have had an epidural if one was available, but I knew it wasn't an option without moving to the labour ward so I went without. I think the availability of the interventions makes you more likely to request them (and one tends to lead to another), but that's not necessarily a bad thing. However, if stuff had gone badly wrong, I was already on site at the hospital.

I had two home births as I hate hospitals. I think it was a much nicer way to give birth.
Deffo talk to your MW.

It’s really popular in my social circles although lots of friends have ended up going to hospital anyway, either during delivery or afterwards (treatment for tears, or because they had a temp during labour, and so on)-so it basically works out the same as it would have done if they’d been in hospital. Baffled by the ‘I wanted a homebirth but went to hospital because X happened and I dread to think how it would have gone if we’d been at home’ answers-err, you transferred to hospital because you needed to, so that’s ok then, isn’t it?

I’d have done it, hospital and midwives were v supportive, but I went for an induction in the end.

The only thing that would put me off next time would be the cleanup!

I feel that my friends who had homebirths were expected (by spouse and family) to be up and doing housework sooner than the ones that had babies in the hospital. I even witnessed the grandparents asking the new mother what she was going to cook them for dinner 6 hours after the homebirth! At least in the hospital you get cared for.

I thought about it for DC2. What put me off was my paediatric friend who said she would never deliver outside a hospital because she saw what went wrong.

I'd have lost DC3 if I'd home birthed as he had to be resuscitated by the crash team after being yanked out by the team ready to give me a section. It's just not worth the risk imo.

an ambulance called and here with 4 minutes and whizzed straight in to theatre.

Hmmm. Have you been watching the TV prgramme 'Ambulance' ? I think in 2020 you'd be incredibly lucky to have an ambulance arrive within 4 mins. Unfortunately, they are so understaffed and overstretched (I live in the same area it is filmed), it just doesn't get to happen anymore here anyway, hopefully we are an exception.

I haven't read through all the replies so sorry if I'm repeating anything!

I used my first at home. It was lovely and I'm planning on a HB for my second too so that's my background!

I'd advise doing lots of reading and really getting to understand your body etc. I went into it with a lot of knowledge and I had read so many journals etc! There is a Facebook group I was in which was helpful as you could search a topic and chances were that someone had put a link to published paper or useful links etc.

My daughter was born not breathing and didn't actually breathe for 12 minutes! I don't say that to scare you! Lots of people think that any kind of imperfection during a HB equals poor outcome. So lots of people will say that had they had their baby at home they would have died etc. Midwives are midwives whether they are at home or in hospital and they had all the necessary equipment to deal with our particular situation. In fact, it was preferable to a hospital environment because there were no buzzes, rush of people etc.! Anyway....this is all to get to my point of saying....downsides! For us a downsides was transferring to hospital afterwards. It wasnt actually to do with the not breathing but actually because they thought my daughter had broken a collar bone so she needed an xray which obviously can't happen at home! The ideal would have been to stay at home obviously. I wasn't a downside to the point where I would have chosen not to have a Homebirth though! No other downsides for us but a potential one would have been that I wouldn't have felt confident with the midwife. My midwife regularly attended homebirths and was all for it. Not everyone has that experience as I've seen from being in thay Facebook group. I felt SO safe and looked after and had I had so much trust in my midwife. I wouldn't have wanted to birth at home for my first if I wasn't 100% comfortable with the midwife!

There isn't information as to why that risk increases for first time mothers because we don't know why it is.

Stand alone midwifery led units don't have anything that can't be done at home yet the increase in risk doesn't seem to be present there. So why is it there for home? We just don't know. It needs further study.

An important thing to consider is that most of those differences in outcomes are not there further down the line. That means that they don't have a long term impact on the health of mother or child.

A lot of people have understandably shared their stories of near death experiences. But the very fact that you are in hospital increases the chance of being in that situation. A baby needing resuscitation after an assisted delivery wouldn't have had an assisted delivery at home. A mother who has a massive blood loss after a section wouldn't have had the section at home.

In the vast majority of cases there are lots of small signs that things might not be progressing as normal in labour and if you are at home you'd be asked to consider transfer. You might not know about all those little things in hospital because the midwives are monitoring, just as they would at home, but of course they don't need to consider transfer. So for the woman it might seem a sudden decision to have intervention but the midwife probably saw it coming.

We don't fully understand labour. We don't really know what starts it, but we do know that it is a careful balance or hormones. What you need for labour is to feel safe and supported to let your hormones flow. For some people that might be hospital, for others it might be home. Others may choose a midwife led unit.

I'd recommend having a read of the Positive Birth Book.

Also to consider, although you are more likely to transfer to hospital with your first baby, you are not more likely to have intervention. So even if you transfer in you are still more likely to have a perfectly normal delivery.

Of course if you were type 1 diabetic with a predicted huge baby and high blood pressure on top I would be urging caution but for a low dependency, normal uncomplicated pregnancy then it is for you to say where you feel comfortable.

Lastly, if unsure best to say you want a home birth so that all equipment organised, on call for midwives organised etc. You can always change your mind when you go into labour and go in.

Entirely your choice, but have you looked around some of the newer birthing centres? There are some really lovely ones popping up now, which are geared at mimicking the home birth environment, but with the hospital nextdoor. Might be worth considering, if you are at all unsure.