Home birth vs hospital birth

[ILoveMYbumpy]

Hi,

I'm having my first baby so was wondering if any ladies had any advise on home births vs hospital births? Has anyone had both ? Or has any one had just hospital or just home births? Any advise would be great

Naturally if there's any issues or complications the choice will be out of my hands.

I had already decided my first would be a hospital birth. I wanted the security of knowing i could ask for more pain relief if i wasnt coping. As it was i needed an induction so hospital was my only choice.
It was a straightforward birth with minimal pain relief, and that gave me the confidence in myself to have a homebirth second time round. Loved it! So chilled and lovely to be in my own bed straight after.

Mothers in the UK are older and more obese than in any previous generation, and have a higher incidence of complications in labour.
To deliberately increase the risk by delivering in a non medical and ill equipped setting strikes me as illogical.
Even if you believe the extra risks are small or “won’t happen to me” - why do you want your baby to take that extra risk?

[quote PinkPlantCase]@MissLucyEyelesbarrow as you say the birth centres and home birth midwives carry the first line of treatment for PPH. Their aim is to keep the mother stable as a hospital transfer is arranged. As with a stand alone MLU. I don’t think anyone planning a home birth thinks they can have emergency surgery at home and I was always made well aware of the statistical chance of transfer.

For me and others this didn’t outweigh the benefits of Homebirth even with a first baby.[/quote]
As I posted above, I think women should have the choice, and, over all risk-benefits are complex. But for the small number of women who have a large PPH, both a stand-alone MLU and a home delivery are dangerous choices. An MLU co-located with a hospital should be just as safe as the hospital itself.

Until you have seen someone dump their entire blood volume on the floor in a couple of minutes, it's hard to appreciate quite how catastrophic a major haemorrhage can be. But that doesn't mean that PPH should be the determining factor in where you give birth - (as long as you have no risks such as placenta praevia), because it is only one of the potential risks of delivery, some of which are greater in hospital.

I had both my DC at home with no problems. One thing helped me feel confident with my decision was talking to friends and hearing birth stories from the women at my pregnancy yoga class. A very high proportion of the women who planned to give birth in hospital had very frightening stories, full of crisis and intervention and comments about how they almost didn't survive and several ended up with PTSD. The ones who planned home births either had straightforward births or transferred to hospital where they received swift interventions which they were certain was needed. The most traumatic part part of the home birth experience tended to be the actual journey involved in the transfer. So it made sense to me, with a low risk pregnancy and a family history of straightforward births (many at home) along with a fear of hospitals, that given the situation in my local area, with no MLU and a very interventionist CLU or a home birth as my only options, that a home birth with a transfer to hospital at the first sign it might possibly be needed was the safest option for me.

For someone with a different body, in a different area, with a different pregnancy or personality, the hospital might be a better choice. But I'm confident that if I'd planned a hospital birth, I'd have ended up with an emergency C-section or forceps for failure to progress and a distressed baby instead of a fairly easy and straightforward birth.

I also think that rather than thinking about where your baby gets born, it's worth thinking about how and where you want to labour, and how that would change in different circumstances. Some people know they will have a ceasarian birth, or feel safer in hospital, or know that they are likely to need drugs or a particular intervention, and a home birth for them would clearly be the wrong choice. Most people are somewhere in the middle, and there are still plenty of options - an MLU, labouring at home for as long as possible, planning a home birth but being very conservative about when to transfer, planning a home birth, but having pethadine prescribed.

My first was in hospital. It was traumatic, frightening and featured a cascade of interventions that were avoidable.

My second was at home and was a wonderful experience. Dh was adamantly against it until he was satisfied with the safety measures. The local ambulance had to sign off, and from the moment that I rang the midwife an ambulance was on standby. The first thing the midwife did when she arrived was set up resuscitation equipment.

I felt very safe throughout, because they listened to me and let me labour at my own pace in my own way. In the hospital I had a monitor strapped to my belly, with no one paying much attention to the data or to me.

The second labour was more painful with less pain relief (I only used the gas for the after birth) but I really didn’t want to transfer to hospital and I found it easier to focus and stay calm.

There was no mess. Ds slept through. I didn’t tear.

I wouldn’t recommend one over the other because circumstances and individuals differ, but if it’s something you’re considering have a chat with the midwife team and see how you feel. At every stage along the way I was offered the option of the hospital so it’s not a commitment set in stone.

I tried home birth both times.
Child 1 I was transferred to hospital as labour was prolonged. I found the hospital birth hideous and the ward I was put on afterwards was grim (blood all over the bathroom and no soap in any of the toilets!). We went home as soon as humanly possible, but I accept a hospital delivery was the right thing to do.

Child 2 born at home, midwives were in the house but not in the room (he arrived super quick with the waters). It was lovely to be at home.

I asked about shoulder dystocia and what happens, and was told that the exact same manoeuvre (basically forcing your legs back against your chest and doing an episiotomy) would be done in hospital or at home so I'm not sure there's any difference there. Because the baby is so far down by then they can't resolve with a c section

At home you will have one or two midwives. They may have managed a shoulder dystocia in their career before - they may not have done. In hospital every MW in the unit plus the obstetric team will come rushing to a dystocia and as a last resort they do sometimes push the head back in and do a CS. The amount of expertise available in the two places is not comparable.

FYI Homebirth midwives carry the same drugs and equipment to deal with a PPH as a midwife lead unit

yes. and MW led units in the middle of nowhere are also dubious safety wise. MW led units are best sited next to delivery suite so you can move pronto next door if things go wrong.

For those saying 'I live five minutes from hospital', it takes about 2 minutes for a 999 call to be answered, at least 10 for an ambulance to get to you, maybe another five to load you into the ambulance, then the handover at hospital.......

@Babdoc

Mothers in the UK are older and more obese than in any previous generation, and have a higher incidence of complications in labour. To deliberately increase the risk by delivering in a non medical and ill equipped setting strikes me as illogical. Even if you believe the extra risks are small or “won’t happen to me” - why do you want your baby to take that extra risk?

yes this.

Modern obstetrics is a victim of its own success. People have forgotten how many women and babies used to die in childbirth.

There is a published study looking at birth outcomes in each setting and I took my evidence from that OP. I got the reference from the NCT.

@sparemonitor

I asked about shoulder dystocia and what happens, and was told that the exact same manoeuvre (basically forcing your legs back against your chest and doing an episiotomy) would be done in hospital or at home so I'm not sure there's any difference there. Because the baby is so far down by then they can't resolve with a c section

At home you will have one or two midwives. They may have managed a shoulder dystocia in their career before - they may not have done. In hospital every MW in the unit plus the obstetric team will come rushing to a dystocia and as a last resort they do sometimes push the head back in and do a CS. The amount of expertise available in the two places is not comparable.

I think the paradox of home birth is that, when the shit really hits the fan, it's a much worse place to be than hospital but, for the majority of low-risk women, who don't have anything catastrophic happen, the outcomes can be better.

So every woman has to weigh up their tolerance for the relative risks. I respect every woman's right to do so. What drives me insane is the peddling of lies to women about the safety of home birth/stand-alone MLUs in an emergency. Women deserve the truth, so that they can make a truly informed decision.

I actually find that the risk of home birth are spelled out quite clearly. Even just on the nhs website. I don’t think anyone goes into a home brith without being informed, it’s an active choice, against the norm that people make.

I have however known lots of women who weren’t fully informed of the the risks of giving birth in a hospital setting and the increased likelihood of interventions that come particularly with procedures like induction.

@PinkPlantCase

I actually find that the risk of home birth are spelled out quite clearly. Even just on the nhs website. I don’t think anyone goes into a home brith without being informed, it’s an active choice, against the norm that people make.

I have however known lots of women who weren’t fully informed of the the risks of giving birth in a hospital setting and the increased likelihood of interventions that come particularly with procedures like induction.

It's great that you were properly informed, @PinkPlantCase, but I know from many previous threads that other women aren't. Though I agree with you that the risks of hospital interventions (in non-emergency scenarios) are often not properly explained, either.

Hospital birth is not risk free. It comes with the increased liklihood of a cascade of intervention, instrumental delivery etc for a start.

It is not a no-brainer in anyway.

I have worked in hospitals and emergency care for many years. Staff ar enotnstanding around eating for the call. Getting dedicated care at home in my situation was an awful lot safer than disinterested and unavailable staff in hospital.

Each pregnancy is different and the risk vs benefit scenario will vary for each women each time. Malign blanket statements as to hospital being the least risky is not truthful or helpful.

I had one horrific hospital birth (on a general ward for 19 hrs with no help, midwives constantly disappearing even when contractions were very close together, traumatic late epidural, forceps delivery after 24 hours, loads of stitches).

But had an amazing homebirth with my second. It was planned, midwives kept an eye on things but let me get on with it, 7 hours from start to finish, no stitches, no pain relief needed but there were options there if I had wanted to and we had a lovely bath together afterwards at home. It was so calm and I felt so much safer than when I was birthing in the hospital.

I had a beautiful homebirth. I had to fight for it, lots of pressure from the hospital to induce me but I opted for monitoring and had my waterbirth at home. I had no pain relief (and I take two paracetamol before I have a bikini wax!) but it was honestly fine, I didn’t even have the gas and air, just accepted the sensations and gave into them. The water was amazing, and everything was extremely relaxed. I definitely couldn’t have done it without pain relief strapped to a bed on my back with a monitor and whatever else. Definitely do some research into the cascade of intervention - the first intervention is leaving home. Even in my home there were a few times when I took myself to the bathroom or the spare bedroom to just be alone because I felt this urge to be somewhere private and safe, I can’t imagine how I’d have felt on a busy bright ward with strangers running around. I was able to walk around in the garden, lean on the stairs, climb stairs, etc. I didn’t have to worry about whether a pool would be available for me when I was ready. I honestly didn’t wish I’d be in hospital or had access to more pain relief at any point, and I don’t think I’m superwoman, I just think I felt less pain because I wasn’t tense, scared and being watched. I did have a severe pph and lost 3.2 litres of my blood, which I had no risk factors for and would have happened whether I’d been in hospital or at home. However it was all really well managed, midwives discussed whether to call it in, ambulance arrived almost immediately and the hospital was alerted so when we arrived surgeons were scrubbed in, theatre was all ready etc. Even if I’d have been in the hospital it still would have taken 10 minutes or so to get all of that prepared anyway. I had two transfusions and was fine. As other posters have said you have the undivided attention of two midwives at home, whereas the mum’s I know who’ve had hospital births seem to have been lucky to have one. I felt like a person and not just one of loads of women at home. I also feel the midwives treat you as more of an equal and are more respectful in your home than they are in hospital. My consultant actually said afterwards that it would have been more dangerous for me to have been induced in hospital than have my natural birth at home as induction tends to cause a more severe haemorrhage. It was my first baby and was amazing, I don’t think you have to go to hospital for your first at all. As someone else said if you aren’t sure I definitely think you’re better off booking a homebirth and then transferring in if you want to on the day - they will always let you change your mind and go in to hospital but it’s much more difficult if you decide on the day you want a homebirth. I would never give birth in hospital, I will cherish my birth forever. It’s so special to sit at home and look at the dining room where she was born and the sofa I sat with her on right after she was born etc. Mumsnet seems to be very pro hospital birth so may not be the best place for a balanced perspective. There’s a Facebook group called homebirth support UK which is brilliant, loads of advice and positive stories on there. Good luck whatever you decide! Even if you do opt for the hospital or MLU I would really recommend looking into hypnobirthing, really helped me :)

I had a homebirth with dd3 and it was amazing. I chose it because of covid - not wanting to be in hospital or to not have my husband there for all of it, but it was the best decision I ever made. 3 hrs start to finish, no tear or anything, a bit of gas and air was all I needed and within an hour of her coming out I was in my own bed with all 3 kids drinking champagne and eating a cheese toastie. Absolute bliss. Midwives got rid of any mess, when I came down later you wouldn't have known I'd just given birth in there apart from the fairy lights and birth affirmations stuck all over the place.

Obviously I was very lucky but I wouldnt ever want to have a hospital birth now, it was honestly the most amazing experience

@Babdoc

Mothers in the UK are older and more obese than in any previous generation, and have a higher incidence of complications in labour. To deliberately increase the risk by delivering in a non medical and ill equipped setting strikes me as illogical. Even if you believe the extra risks are small or “won’t happen to me” - why do you want your baby to take that extra risk?

For a second baby, it doesn't increase the risk.

From the birthplace study:
"For multiparous women, there were no significant differences in adverse perinatal outcomes between planned home births or midwifery unit births and planned births in obstetric units"

For a first baby, it does increase the risk from very very tiny to very tiny... but so do lots of other things. I wouldn't see anyone on here speaking this way to a woman for getting pregnant over the age of 40, or for being overweight and pregnant, both of which also increase the risk of adverse outcomes.

Can someone explain how "I had an awful hospital birth and nearly died" is an argument for hospital birth?

Maybe the outcome would have been different if a home birth had taken place and the pain relief or interventions used had been different. There is no way to know, but statistically for every home birth which would have been better off in hospital, there is a hospital birth who would have been better off at home

My first birth was a hospital birth and it ended up being very traumatic. The midwives didn't believe how far along I was and wanted to send me home, it was only when my husband demanded they examine me that they realised I was fully dilated. I started pushing at around 7.30am, I remember being told they would get the consultant if there was no more progress by 8.30am, they kept buzzing for him but he was tied up with someone else. I was hooked up to machines, a midwife tried putting a catheter in me without even telling me, I was given sentocinon but it slowed my contractions down and the midwife kept shouting at me to try harder when I was pushing. It was only when his heart rate dropped almost 5 hours after I started pushing that several people appeared and I was rushed down to theatre, given a spinal and told I was allowed one try at forceps or it would be an emergency section. When he was born he was taken from me and didn't cry for a few minutes.

It wasn't until after we'd had our second baby (at hospital) that we realised how wrong things had been first time round and we now had a 'normal' birth to compare it to. By this point we were going through an autism diagnosis for our first and still to this day will forever wonder if it is that or something caused by the way he was born.

We decided we wanted a third baby but the worry of the birth being like our first was really stopping me going ahead. We had more debriefs with the head of midwifery and consultant and they agreed they would put me as consultant led so that if things did start going wrong at all it would mean they would have to get a consultant to me straight away and not be left waiting like the first time. As my second birth had been so straightforward we decided on a home birth as I knew I would feel more relaxed there than in hospital. Our third baby was a speedy delivery before the midwives or paramedics arrived, but everything was straightforward and we were still so pleased that we had decided to have her at home than in hospital.

We had our fourth baby at home in September and never even considered a hospital birth! I had a birthing pool and it was honestly the most amazing and relaxing birth, I absolutely loved everything about it. We won't be having any more babies now, but if we did we would definitely have another home birth without any doubt (unless there was a medical reason as not to).

You will always get people trying to scaremonger you, people telling you that you'll die if you have your baby at home etc, but if you're low risk it is as safe to have your baby at home as it is in hospital, and in many ways safer as you have two dedicated midwives. The people who make these comments tend to be people who have done zero research about home north! If we'd had our first at home and been transferred in, we would have seen the consultant far quicker than we did and he would have been delivered sooner before he became distressed. Having had two hospital and two home births, I would definitely say go for a home water birth!

@ChocOrange1

Can someone explain how "I had an awful hospital birth and nearly died" is an argument for hospital birth?

Maybe the outcome would have been different if a home birth had taken place and the pain relief or interventions used had been different. There is no way to know, but statistically for every home birth which would have been better off in hospital, there is a hospital birth who would have been better off at home

My first was a hospital birth, I was pushing for over 5 hours but baby was back to back so there was no way he was coming out without intervention but the midwives hadn't realised. They kept buzzing for the consultant but he was tied up elsewhere, so it took his heart rate dropping to finally get seen by which point it was an emergency. If I'd had a home birth and been transferred in, I would have seen a consultant straight away as I'd have been brought in by an ambulance and the consultant admitted to us in our debrief that he would have delivered him sooner. I wish now that we had tried for a home birth, but hindsight is a wonderful thing.

I've had 2 births at midwifery led units, and if I have another, I would want a home birth.
I found that whilst I wanted to be close to a health professional, when I got the the hospital and found I wasn't far dilated, I'd begin to panic about being sent home and not being near a health professional. With my second, I went from 4cm to her being born in 2 hours, so the fear and panic wasn't needed, but I had it, it caused more pain and I ended up overdoing it on the gas and air to calm myself down, then tore badly whilst pushing because the gas and air meant I wasn't in the right mindset.
Being at home would mean not having to worry about not progressing quick enough, being able to go into the pool when I want to, being more in control and also having the midwives full attention (they usually leave the room for long periods of time to do paperwork and other work).

@BackforGood

Hospital. I wouldn't be here now if I'd made a different decision. When we have medical services available to us, I don't understand why people would risk theirs and the baby's lives but not using them.

There was no deemed risk before the birth. This was my 3rd child.

The stats don’t back you up and in the current NHS climate there is a lack lof midwives and decent care. OP I would opt fir a homebirth but I would go for independent midwives- it’s just a lottery otherwise.