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 a Homebirth, where I live there isn't a lot of support or funding for these so I paid £5K and went to a private midwife

Very much recommended Homebirth, I had my first at home and plan the same with my second

36 is considered high risk? WTH that's crazy

This.

You need to take a massive step back and research the potential risks for you and baby in view of your own risk factors (age and previous high blood pressure).

Speaking as someone who had a shitty first labour as well, I can completely understand where you’re coming from and I know the data generally is pretty good for home births. BUT if there was an emergency there are absolutely no guarantees you would get to hospital quick enough to avoid serious harm to you or baby - the health service is a mess right now. Is it really worth it?

Your doula’s advice about emergencies is wrong, and very dangerous. If you do end up choosing a home birth dear God, get someone else to support you.

Not all home births are created equal, that’s the problem.

£5k private midwife one to one bespoke care offers a greater safety net, and is probably likely to lead to better outcomes than relying on an under-resourced over-worked NHS maternity service with no guarantee of a speedy blue light transfer to hospital if required. Obstetric emergencies can be sudden and unpredictable.

I think it's completely your choice and you should do what feels right for you. I would be nervous about an ambulance being able to come quickly enough if needed though. I've a friend who's an ambulance driver who says she is regularly stuck at hospitals waiting for someone to be free to handover the patient too. This can be for over an hour, sometimes over two.

Exactly this. Doulas can be a great help but they are not medically trained or registered and shouldn’t give any medical advice. Do bear in mind the time it can take to get an ambulance at the moment, even midwives can’t do anything about that. I’d never home birth for many reasons but ambulances time is at the top of my list. I’d neve live with myself if something was wrong with baby which could have been dealt with quickly in hospital.

It’s all I want from my birth. Couldn’t care less how I get there

Find a local midwife who’s supportive of home births. With my first, the midwife I had was awful but I spoke to the Head of the Midwifery team and she sent out an absolutely lovely midwife who was very supportive and reassuring. For the actual birth, I had her and another midwife (who I’d met before and who was experienced in home birth).

I read loads about home births; contacted organisations; read studies from other countries, etc. People forget you can have problems in hospital too, some of them being caused by unnecessary interventions (I think it’s called iatrogenic).

During my 2nd pregnancy, I developed an issue that meant I had to give birth in hospital. Frankly, I wish I’d stayed in the hospital car park and gave birth because it was a litany of poor care, resulting in a serious PPH. PPH is one reason they say to be cautious about home births, but, even though I was in hospital, they left me hours bleeding to death basically before I got appropriate help.

So, research, check local provision, think about where your nearest hospital is if you need to be transferred, and so on.

Have you considered a birth centre? Either stand alone or attached to a hospital.

Ambulance response category for maternity emergencies are category one btw.

And is a MW going to have an ambulance in her back pocket?

3 births - 2 HB in different part of UK - very different experiences.

Community MW team in first location was great.

Second area different set up - you went to them no home visits - they were supposed to be promoting HB in area but think there were ideological disputes in department.

Lies - including test results to try and make me high risk - pressure undermining us then insisting on consultant appointment- who sneered at everything implied HB would kill me or baby or both- it did get Dh on board with somethings not right here - so finally complained.

Was supposed to be sorted as management were keeping an eye on us but care stopped- when I went into labour - they were incredibly rude to DH and unhelpful. Ended up just me and him - and DH was panicked.

When they finally turned up I'd already given birth and was bf - they were upset we'd failed to call an ambulance as we'd finally been told they were on the way - tried to bully us into hospital that night - refused though did agree to go next day - where a younger MW was rude and older MW stepped in. Debrief from management and they disputed timings - as medical notes said MW were therefor birth - pointed out neighbours saw them arrive much later.

Last pg was stressful due to HCP behavior and while we managed the luckily straight forward birth we couldn't face going though it alone again so stopped at 3 DC. It was a complete contrast to care with first HB and even first birth in MW led unit attached to hospital - bit bit of that was fine it was pnd ward that was unpleasant.

AIMS were helpful when we were complaining.

However this was well before current NHS crisis with ambulances - we've had to call them for older relatives and delays post covid have been scary experiences.

I'd ask a lot of questions and try and gauge how supportive the are about HB not the party line and do take on board medical advice (though we were lied to we found this out by asking many questions and it all came out in the end for management to see)

Yeah not a chance are you getting 2 midwives with 2 paramedics in the chance of an emergency. You might get 2 paramedics, or you might get 1 paramedic and one emergency technician or you might get a car paramedic

Or you might get no one and your husband and doula will have to either transfer you to hospital in your car or deliver as best they can at home.

Shoulder dystocia will not be treatable at home, neither will cord prolapse or a variety of issues.

Your body. Your baby and all that but you need to be happy with the consequences of your decision.

This completely

@Peonies12 How many births have you experienced so far?

@Meadowfinch How old is OP? Can't find it it in the original post.

@Meadowfinch Ah just discovered she's 36. Not higher risk category (unless it's changed since I had my homebirth in 2020 - I was 39). Higher-risk was 40+. I'd have still opted for IM homebirth.

Please ignore anecdotes and read the "birth places" study.
For low risk pregnancies, 2nd and subsequent births are safer for mum and as safe for babies at home than hospital births.
For 1st (low risk) pregnancies, hospital is marginally safer for baby but home is safer for mum. Birth generally, including home birth, is very safe.

For all the "I would have died at home" stories, macro analysis indicates that there would be the opposite - ie someone who would have had something happen in hospital that wouldn't have happened had they been at home. Evidence shows interventions are lower in planned homebirths.

Anecdotally (I know, I know) had I attempted to get to hospital, my first baby would have been born in a refuge area of a "smart" motorway which isn't an entirely safe scenario. During my second pregnancy which was a planned homebirth, I received amazing continuity of care from a specific midwife and team which is often the case for homebirths and makes a huge difference to the standard of care. I had fantastic births.

I was all set up for a home birth with my 2nd. Chose it for very similar reasons as you - inadequate care with my first and lack of trust. I ended up changing my mind in the end because of the distance to the hospital (45 min). I gave birth in my nearest midwife-led unit instead, which was closer to the hospital. It was a genuinely wonderful experience and the midwives were fantastic. So it’s not necessarily a choice of hospital vs home birth only.

I would be concerned about that comment from the doula - it doesn’t sound like she is giving you accurate evidence-based advice.

I had all three of mine at home, last one in 2003. Given the current parlous state of maternity services I would be even keener. My best advice is to get an independent midwife. Then you know they are fully on board. I trusted mine and if they had advised transfer to hospital would have done it instantly. No hospital visits apart from two scans, no pressure t9 induce with DC3 who was 42+4. Best money I ever spent.

Hi OP, hope this thread has been helpful so far. Ignore all the high emotion fear-mongering, usually these comments come from people who are not fully informed.

if you are having trouble making up your mind check out books by Dr Rachel Reed eg. Homebirth Matters or Induction matters or Sarah Wickham. They are brief and readable and discuss the research in relation to birth and midwifery, a lot of this is not fully known to obstetricians who are more versed in high risk/emergency scenarios.

FWIW I also had an unpleasant experience with my first resulting in forceps delivery. After lots of research and prep (Pilates and hypnobirthing were really helpful for me) I went on to have 2 successful Homebirths.

One of the midwives at one of my antenatal appointments recommended I had a homebirth with DC2 because DC1 was fast. I refused to even consider it. I don't want all that mess at home.

I was far happier washing all the blood down someone else's drain and leaving a pile of bloodsoaked towels and everything behind me.

Mess (and noise!) would be downsides I would consider too.

I had two HB - mess and noise were mentioned by many who had no experience of HB and in neither case was it an issue for us or our neighbours (noise wise).

It was nicer to be in my own home for me as well.

My point was as well as pg and labour being different sadly support in different areas for HB can widely vary - and also sadly not being in hospital doesn't remove risk of poor NHS practice. Hence my advice to talk to MW and ask a lot of questions about how it works in OP area.

Re the mess... I had a homebirth and believe me; the mess of a toddler and two teenagers is far, far worse!
Same applies re noise! 😆
In fact, there was no mess left behind at all. We binned the few towels we used that had seen better days, and my IM took the placenta home for her garden.
Our house is rented and it was left spotless.

I can well believe it all gets tidied up. I still felt far happier with none of the mess being there in the first place. Having a shower post birth in a nice big wet room with towels I didn't care about and all the blood being sluiced down a drain that wasn't mine was infinitely preferable to anything else.

I much preferred coming home the next day all cleaned up.