Homebirth in the UK?

[Soon2under2]

I'm having a very hard time making up my mind about this one and was hoping to get some insights from mums who've already experienced it or who are considering it as well. I'm not from the UK originally and the NHS is still a bit of a foreign concept to me. I gave birth in a London hospital to my firstborn in 2023 and my experience was dreadful/ traumatic. Long story short, I got very unlucky with the midwife on call that day, she had started literally 10 days prior and had no desire nor interest whatsoever to support nor guide me, which resulted in many complications and ended up with an instrumental birth, with many unfortunate consequences. The lack of care and continuity was appalling to me and shocks my entire family and close ones when I share my first experience. Long story short, I don't trust the NHS nor their staff. At all. This time around, I want things to be different. I hired a doula who suggested a home birth. I love the idea of it, feeling very comfortable at home, I could have my toddler and husband close to me and everything about it sounds lovely. Apparently, two midwifes would be sent to my home and would immediately send me to the hospital with an ambulance, should something not look right. They wouldn't take any risks, wouldn't wait to send me there, even with the slightest of concern. My main worries though are: sometimes, even if everything looks good, things can go wrong at the last minute and an ambulance would probably take too much time to send me to a doctor/ hospital. Even if the midwives could do certain things, sometimes you just need a doctor/hospital. The doula assured me that complications like this only happen with medications, which I wouldn't have access to at home anyway, but that doesn't convince me. The other thing is that I was induced last time around for high blood pressure at 38 weeks even though my entire pregnancy was very smooth. This puts me into the high risk category, because I'm likely to have it again, even though I'm doing everything I can to keep it down during this pregnancy and I could very well not have it this time. Also, I'm 36, which technically puts me into the high risk category as well. So many people around me tell me how beneficial/ incredible a home birth is, and then I read and see other horror stories that make me think it would be risky/ unreasonable decision. I'm so lost. Does anyone feel strongly about this subject too and want to share their thoughts?

I had 3 incredible home births but I was always sure they were right for me. You dont sound sure at all so go to a hospital. However you've already learnt that having a hospital birth doesn't guarantee a happy or uncomplicated birth.

Hi!

I had a homebirth against doctors advice because my pregnancy was High Risk with Low Papp-A and GBS.

In my experience everything went great. My midwives were on a shift changeover so even though my husband and I practiced and researched emergency home births - I ended up having 4 midwives present!!

The two who had been with me for 8 hours stayed an extra hour to meet the baby and the new ones helped out too.

They were all fabulous. It did feel like at the end (9 hours) they were thinking about an ambulance because every time I pushed my little baby would go back in!!

But eventually I pushed her out!

Glad I didn't go to hospital for the birth. It was the best experience xx

Also to add, there was nothing wrong with my baby! Completely normal even though I had low Papp-A and GBS. X

There are lots of options to explore in and out of hospital such as

A private midwife.
A doula
A trained support person who won't let you be disempowered and will stand up for your rights and wishes.

There is a big study if you ask your midwife for the research data on outcomes. What is often not compared though is the emotional outcomes based on setting when it does or doesn't go to plan.

You can always book for a home birth and change your mind anytime you want, even during early labour you can choose to go in to hospital.

I had a home birth and loved it. I was blue lighted in with a PPH that couldn't be forseen but I am still a massive advocate for home births.

Does your area have a dedicated homebirth team? Mine does and they are excellent. You get a midwife assigned to you for all appointments and build up a rapport and mine was a fantastic source of information and an advocate for me when dealing with departments at the hospital that I had to see. Even if something would have prevented the homebirth itself, it was well worth being with the homebirth team just for the continuity of care and support through my pregnancy.

Of course if something did go wrong, of course the homebirth team would recommend you transfer to the hospital, but they wouldn't advise that for nothing. I had high blood pressure and it was managed with medication and I was able to birth at home successfully. I also hated my first experience in the hospital and felt a bit traumatised by it but the excellent care from the homebirth team, the second time around was the perfect antidote for it.

Safety wise I think it is just as safe if not safer for 2nd births than a hospital? Don't quote me on that, do your homework of course and go with what you think is the beat choice for you. I was only 15 mins drive from the hospital, so that gave me some reassurance.

Good luck with whatever you decide 🙂

I have two experiences with home births, first I was transferred to hospital, second I gave birth at home.

2003 - baby 1 - laboured at home, v happy at home, very long labour. Once I was fully dilated, I didn't experience any urges to push. The midwives waited, but as this urge didn't come, they got me an ambulance to hospital. Consultant said baby was back to back (his back towards my back) and I'd need a C-section. Had C-section, baby fine. The following morning I'd lost too much blood and was found nearly slipping away. Had to be taken back to theatre, given a blood transfusion, was very ill for about six weeks after. Was very badly treated on the ward, shouted at, and my baby was forced to have bottled milk which I didn't want. I was traumatised by my hospital experiences and too scared to have another baby for a long time.

2007 - baby 2 - private midwife, laboured at home, birthed at home, no problems, great experience.

Personally, I would choose home birth every time.

I had a traumatic first birth (partly because I was left on my own and by the time a midwife came it was too late for me to have an epidural) and when I was pregnant the second time round I was sure I didn't want to go back to that hospital.
I was then advised (!!!) to "pretend" to want a home birth, which would mean I would be under the care of the home birth midwives, would meet all of them and would be guaranteed that two of that midwife team would be present at the birth.
I was further advised to "change my mind" about two weeks before my due date and those two midwives would then come with me to the hospital. I didn't find out if that was true.
In the end I actually decided to have a home birth. Being looked after by two midwives at all times made a massive difference.

Your doula is talking bollocks about complications only arising if you're on medication.

Speak to the homebirth team in your area. They'll be able to advise you on whether you're suitable - they won't do it if they think it's too risky. You can ask your regular midwife to refer you I think.

I had a home birth with DD1, and was induced with DD2 (due to my waters breaking at 34 weeks). Both were fine, the induction wasn't worse as far as the actual labour went. But it was lovely being at home after the birth and not having to move anywhere.

I attempted HB with my first and got transferred in in the end as she was taking so long (40+hrs). But the experience at home was great and while I wish I’d been able to stay at home as some bits in the hospital weren’t fun, it was an ok experience overall.

Second time was a successful and quick HB in about 3hrs. Absolutely wonderful experience. Very straightforward, intense at times but not even a thought of pain relief, I was so comfy and able to just let my body do the job. Tucked up with tea and toast after a couple of hours, it was lovely.

I will caution, you may even find on this thread, that the idea of HB inspires strong emotions in some people, and some will project their fears onto you. I found it much better to speak to few people about it, so I didn’t have to manage their feelings. Ie my MIL didn’t get told how I was planning to Labour second time round.

Agree with @YellowHairband - ask your doula what medications cause cord prolapse, shoulder dystocia, APH, mal presentation.
With Homebirth it's is entirely your choice to weigh up the risk of course but your doula is wrong.

"The doula assured me that complications like this only happen with medications, which I wouldn't have access to at home anyway"

Well this is obviously complete bullshit. Historically there were no medications and everyone gave birth at home and guess what... There were occasionally complications and babies and mothers died.

I wouldn't have a home birth because I wouldn't want to be in the situation where my choice to be at home meant that I wasn't near medical care in time to prevent death/injury to myself/my baby. I'm sure being at home is a nicer experience almost every time but I couldn't live with the guilt if something went wrong.

I've had 3 amazing homebirths to 3 big babies and everything was straight forward and all I could hope for. I would have had more if possible but it just didn't go that way for me but I highly recommend one. Congratulations and good luck.

My home birth of my dd 14 years ago went really well, two midwives supported & dh. I’d done my research so knew what to realistically expect with pain relief and best positions for the stages, some of the old books are fascinating I don’t expect there are many home twin & breech births these days! I’m fortunate to live 10-15 minutes drive from 2 large hospitals, even then family members did question my decision. Good luck with the rest of your pregnancy!

Find another doula because the one you have is talking rubbish. Dangerous rubbish.

How you feel about home birth is a very personal thing. I didn't feel safe knowing I would be 40 mins from the nearest hospital, so I opted for a hospital delivery. During a long slow labour, they lost ds' heartbeat, and I needed help urgently. It arrived in under 20 seconds. DS was delivered safely as a result. Thank you Salisbury Odstock NHS

As far as I was concerned, a positive birth experience is when mum & baby go home healthy. That's what really matters. 'Continuity of mid-wife' etc always seemed trivial in comparison.

See if you have a local home birth team and talk to them.

You have had one tricky delivery - and a clueless doula by the sound of it - so talking to a qualified, experienced professional who knows about home births would be a good idea.

Homebirth is wonderful if it goes well - and it usually does, because the midwives are very competent, screen you before they accept you and are very alert before, during and after labour and delivery.

I'd be concerned that your doula is giving you inaccurate information.

It's true that the midwives are more attentive, you'll be more relaxed and the chances are they will transfer you if you need it.

It's true that there's a small chance you will need emergency care and there won't be enough time to get it.

I had two home births after a not great experience in hospital with dc1. My planned home birth was great and I had much better care than I received in hospital.

But given you had lots of complications with your first birth and are considered high risk, I think I'd be really cautious about going for a home birth.

I think the doula is incorrect to say you only need input from doctors if you have medication, and the fact they have said that would make me question their level of knowledge.

There are LESS emergencies at home (not none!) and the evidence shows that it is safe for women who's pregnancies are uncomplicated. Perhaps that's what your Doula meant.

You will always hear negative stories - eg above here the fetal heart was 'lost', a home birth midwife will not panic at having trouble locating it briefly - they use their experience of physiological birth to know that if it was previously normal - it hasn't just suddenly stopped beating, that's just not how it works. When using continuous monitoring in labour ward, you're under massive pressure to constantly monitor it therefore you have to raise the alarm when you can't hear it - yet there's no good evidence to support the use of CTG. Therefore a perceived 'emergency' occurs.

There are always multiple people on homebirth threads who claim that they or their baby would have died had they attempted homebirth. It's absolutely impossible to know that.

Labour progresses spontaneously without intervention at home - this massively reduces risk. In the rare case that an emergency does occur, the midwives are equipped to deal with it.

Someone above said medication doesn't cause cord prolapse - actually it's much more common with induction of labour.

I would chat to your midwife and your partner and take it from there op.

I had two pretty rough hospital births and one incredible homebirth with an Independent Midwife. The difference between my hospital and home birth was phenomenal!

Please be careful with taking advice from your doula. They can provide great support but you should professional advice when making decisions. Some women hire independent midwives and some have homebirths through the nhs. True they are well trained at looking out for issues, but do bear in mind that the ambulance service can be busy and transfer times if needed may vary. Homebirths are great but if you do get high BP then take advice from medically trained staff about the risks.

@Meadowfinch A "positive birth experience" is far, far more than a healthy mother and baby.

Apparently, two midwifes would be sent to my home and would immediately send me to the hospital with an ambulance, should something not look right

Do you not read the news? People who have had a stroke or heart attack are waiting hours, those with a broken hip 12 hours. You know that they won't keep an ambulance on standby for you?

You will never get an ambulance in time to save your baby's brain if there is a complication.

I’ve had one planned hospital birth & one home birth (hospital one had no complications & it was my community midwife who said ‘that went well, consider a home birth next time’).
I had a lovely experience with my home birth, I feel proud of what I did. I struggled massively with breast feeding so give me that 😐
A couple of things to take into consideration
1: age, like it or not stats show increasing age (over 35) = increased complications. I was 32.
2: Do you live near a large hospital with obstetricians? I live in a large city, I am close to a number of hospitals should the shit (or meconium 😊) hit the fan. I have friends who live very rurally & not having the same quick access/ infrastructure to get to hospital in an emergency has put them off HB.
Good luck!

@Hellodarknessmyfriend In the grand scheme of things, which is more important? Focus on the home environment and having an 'incredible experience' or bringing the baby safely into the world?

What is the ultimate objective?

A long time ago on Mumsnet there was a lady who had chosen the incredible home birth experience. Something tragically went wrong and they didn't make it to hospital in time to prevent damage to the baby. She knew she'd got side tracked by inessentials and I felt so desperately sorry for her every day.

The OP has two risk factors, high blood pressure and age. Her gynae will advise her. All she can do is take that advice.