High risk home birth

[Grumpy19]

Hi. This is a bit long. Sorry.
I am expecting DC4.

DC1 was born by EMCS after a badly handled induction. DS was back to back, got stuck, nobody realised until a change of shift and new consultant realised he was in serious trouble. It was terrible.

DC2 was born at a difference hospital by VBAC. I had a 3rd degree year upwards but it was a far, far better experience.

DC3 was born in yet another hospital. Another successful VBAC but I was induced as my blood pressure had crept up.

Now expecting DC4 and the only real hospital option available is where DC1 wass born. I made it very clear to my consultant that I was upset at the idea of giving birth there again and she referred me to 'talking about birth' appointments with a midwife from the hospital.

So, I had a phone call today from the midwife who has suggested I have a homebirth instead. I said I didn't think I was able to due to being high risk but she said I didn't 'have to do what the trust suggested'

I am high risk due to VBAC, underactive thyroid and Low papp-a.

So, my question is, has anyone here had a homebirth when they were high risk? I feel in turmoil at the moment. On one hand, the idea of being at home, having my DH with me throughout (not being kicked out due to Covid) and not at that terrible hospital is a huge pull. On the other, I'm frightened if something goes wrong me and baby could be in serious trouble.

Any advice or experiences would be very welcome x

I think the midwife has given you dangerous advice.

I nearly wasn't allowed a HB because my blood pressure was just above the allowed limit.

I had two (low-risk) home births and would encourage anyone to consider them. BUT in your circumstances, as difficult as it is to face going back to the first hospital, I really would not consider a home birth. I really believe that the safety of your child has to come first, but you also need to find a way of coping with the delivery. Can the hospital arrange for you to have further discussions/counselling with a midwife to talk through your fears and help you to put a plan in place for the delivery.

I'm sorry, but I think your midwife is being irresponsible. I'm all for home birth in the right circumstances, had my third at home at my midwife's suggestion, but I was considered low risk due to my obstetric history and problem free pregnancies. In your shoes I really wouldn't want to take the risk.

I was a completely low risk pregnancy & barely survived a hospital birth. I think it would be dangerous to have a home birth considering your previous history. I understand your concerns with the hospital & regarding covid etc. I’ve been in for the last week with my baby & it’s been very hard as I only get to see his dad once a day for 30 mins, but we are strong mamas that can get through anything for our babies! I suggest you do what’s best for you, but I would consider the risk element of having a home birth, if I had one I would be dead right now

That midwife shouldn't have suggested a home birth, it's not safe for you. Can you email your consultant about it?

I think the advice your midwife gave is dangerous. You need a hospital birth

How late could you stay home before going in?
How far is your journey to hospital?

I'm not medically qualified to comment on your conditions.
But I do know it's your decision where to try to give birth.

I imagine Uterine rupture is the big risk, but you must know that. I could imagine just delaying as late as I dared. -Veteran of 3 homebirths

I have had 2 low risk home births (in the UK), they were amazing.

I have just had my 3rd child and my pregnancy was high risk. I COULD have had a home birth given my history but thought it would be foolish. I picked my hospital and dr very carefully, to receive woman centred care in a small, less busy hospital with private en-suite rooms (public healthcare not private, but not UK) and staff who had time for you and really cared. It was an excellent birth and went smoothly, so I could've had a home birth but made the right decision. I wouldn't risk a home birth if I was high risk and I'm a huge home birth advocate.

I’m a midwife. On the one hand I agree that no one can make you do anything and a homebirth is an option. If your only risk factor was VBAC for example, I wouldn’t necessarily think this was particularly ‘high risk’. When you say your blood pressure crept up last time, what does that mean? Were you on medication and was there protein in your urine? Are you having growth scans for low Papp-A? My concern would be that they may end up recommending induction again if baby’s growth slows or your BP goes haywire again. Is there a birthing unit attached to the hospital/s you could birth at? Would it be possible to arrange a meeting with the birth centre manager?

I also want to state categorically that telling women they have options is not dangerous as long as you then discuss the relative risks.

I had a homebirth while being considered high risk (borderline-low iron levels, POTS with chronic hypotension, underweight at first appointment, previous significant issues with placenta with my first child), though this was after I'd already had a homebirth with my second child. Birth went fine, placenta did not and I ended up requiring a hospital transfer for manual placental removal (This might have been needed anyways, I had issues with 3/4 placentas, but I mostly chalk this up the unsupportive midwife who yanked repeatedly on the cord causing part of the placenta to tear and come away from the rest).

I don't think saying one has options and doesn't have to do what the trust says automatically idiotic/dangerous, but it should be explained and the risks and benefits should be explained properly. How far are you from a hospital if an issue arises and how much of an issue would there be in transfering (is it an area that gets a lot of traffic and such)? If you had to transfer post-birth, what would happen (with mine, DH held DD2 throughout until I was awake in the high dependency recovery ward, this may be very different now). It can't just be 'well, you can do what you want', they should really have discussed what could be done at the hospital to better support you. I had my 4th in hospital (with a birth plan that was pretty much 'these are my medical risks, and this is why I'm scared) and got far better support than I had during my 2nd homebirth.

This is difficult. I would recommend whereever you feel you'll get the most support with all the risk factors considered.

How far are you from the hospital? If within about 15 mins I'd definitely consider a hb.

As I'm sure you know they are safer and because you are more relaxed there's less intervention= safer birth.

But if you're in the middle of nowhere then I'd think of a hospital but midwife-led care unit.

You should normally have the choice of hospital/unit but I'm not sure if that changed during the pandemic.

Sorry I'm going to talk about myself but I don't think anyone can really tell you what to do, this has to be your decision and hopefully my experience will be reasonably relevant.

I just had a home birth despite some minor risk factors (previous shoulder dystocia and PPH but neither were severe and we carefully considered managing risk of them happening again). As it happens the birth was so fast that I wouldn't have had time to go to hospital anyway, so it's just as well I planned a home birth. Midwife only just made it. No complications, just a second degree tear which they were able to repair at home thankfully.

My first birth was in hospital and was traumatic mainly because of the way I was treated by the midwife who insisted that I lie on my back on a bed despite the fact that I absolutely didn't want to. Luckily my complications weren't as serious as yours so I still hesitate to call it a "traumatic" birth but the feeling of being disempowered and unsupported (while in so much pain) was traumatic for me.

For a long time I hesitated about a home birth and even though I had planned for one, it was with the intention of seeing how I felt when in labour and going into hospital if I felt like it. I had discussions with the community midwives and the consultant midwife at the hospital, we considered the risks and agreed we'd have a low threshold for transferring in.

Obviously your risk factors are different from mine and probably more serious so your decision might be different.

I found this website helpful and you might do too:
www.homebirth.org.uk/
You could also look at the RCOG website as they have fact sheets about birth (I read the shoulder dystocia one).

If you decide against a home birth, and really have no other option but the hospital where DC1 was born, I recommend that you request an appointment with the consultant midwife to discuss your past experience and options for this time around including ways to manage/reduce your triggers. On my birth plan I wrote that if going into hospital, I request that [named midwife I had first time] is not involved in my care. The consultant midwife said I could make this request and it would be respected. I felt much better knowing she'd be nowhere near me. In your case there might be different deal breakers but you could consider what they are and make sure you discuss them with the midwives and write them clearly on your birth plan.

(NB a lot of Mumsnetters are very anti birth plans, because births don't go to plan, but I considered various scenarios in mine and glad I did one.)

Thanks for all the replies. The MLU won't accept high risk women so that is not an option sadly.
My experience sounds similar to yours @NameChange30. The midwife put monitors on me to check on baby and refused to take them off even when I cried that I needed a wee! I was given a bed pan and told if I really needed it I would use it
The monitors didn't work though and nobody bothered doing anything about it.
The idea of going back there is just terrible!

I'm 30 mins away from the hospital.

I am going to be having regular growth scans for low papp-a and the consultant is managing my thyroid.
The chances of another successful VBAC I have been told is around 90 to 95%.

I feel the care was so crap there that the idea of being there with limited support from DH is just horrific.

That sounds awful
Is there really no other hospital you could go to?
It's definitely worth seeing if you can talk to the consultant midwife or someone similarly senior to see if they would agree to MLU. Given that you are actually within your rights to have a home birth (even if they advise against it) surely they would prefer you are in the MLU.
The consultant midwife told me that she would advise the delivery unit but when discussing the reasons and risks, her answers were more nuanced and didn't concern me. I think they have to advise delivery unit to cover themselves, it was in all my follow up letters that they had advised it and discussed the risks with me.

Something I would recommend if you can arrange it is to have a birth trauma rewind session. I did this with my doula (I decided to hire a doula second time around after my first experience) and I found it very helpful.

I've just discovered this website too which might have some useful info/advice?www.makebirthbetter.org/birth-after-trauma

Also see
www.aims.org.uk/information/item/choosing-place-of-birth#post-heading-5

One more link (and then I'll stop spamming you )

www.birthrights.org.uk/factsheets/choice-of-place-of-birth/

Your midwife is correct in that you’re ‘allowed’ to give birth at home- any and every woman is, it’s your choice to step foot into a hospital and it can’t be forced.

But obviously the risks are for you to consider and decide whether or not it’s a wise decision.

Are there no other hospitals in nearby towns you could go to? I went to a different mat unit for my 2nd birth, it was an extra 10/15 mins in the car but worth it.

Thank you @Namechange30 the links are great.
Sadly, the alternative hospital is the 'sister's hospital of the 'rubbish hospital but it only offers MLU and I've been told by my community midwife I can't go there.

I need to do lots of reading!

@PolarBearStrength, I wasn't medicated formy blood pressure, and there was no protein in my urine, the consultant just said at 39 weeks because it had been raised for a few weeks she would advise an induction and I agreed to it. I am taking aspirin daily this pregnancy for the low papp-a.

"I've been told by my community midwife I can't go there."

Definitely speak to someone more senior about it.

My doula told me that consultant midwives can suddenly become quite willing to allow you into the MLU if you tell them you want that or a home birth!

Thanks @NameChange30 I think I might try pushing for that.

They will have thresholds where they will insist you go to hospital, if you need an emcs in hospital, unless it is a category 1, it usually takes them at least 30 minutes to get everything organised. I would have a further discussion with the midwife, you have given birth twice since you needed a section so your risk factors may not be that big.

I was told by an independent midwife that I wasn’t high risk and didn’t need any additional care at all. She wasn’t my midwife, she was the MIL of a mum at a baby group, but I knew her DIL well and the MIL knew my background. Just to summarise, DS1 was born at 24 weeks after a failed cervical stitch and with DS2 I was being cared for in a specialist high risk pregnancy unit and had already had two stitches put in and was on twice daily progesterone, and was having appointments every two weeks. But according to her I didn’t need any of this at all.

Not midwife bashing in general, just saying that if you’re unhappy with a comment or suggestion made by any individual healthcare professional, always ask others for their opinion too.

Hope you manage to find an outcome you’re happy with OP.