Homebirth or hospital DC4

[BourbonBiscuits20]

Hi all purpose of this thread is somewhere for me to bounce thoughts off regarding this decision!
I am currently pregnant with DC4. First DC was EMCS. I have since had two VBACs and all going well this should be another VBAC. All previous births have been in hospital which I was happy with.
However I am in a new area and have not heard very positive things about the maternity hospital here. There is also no access to a birthing pool which is a major negative for me as the water has helped me so much in my previous births.
I've never been keen on a homebirth but seriously considering it mostly due to wanting to have access to a pool for help with the contractions! It would be a five min drive to the hospital if needed.
Curious to hear if anyone else may have been in a similar situation and what decision you made!

Totally up to you.

For me personally, I wouldn't want the mess in my house and would never forgive myself if something went wrong.

It’s your choice, but there’s not a chance I’d have a home birth. I had a straightforward, low-risk pregnancy with my DS, then came the time for him to be born and I couldn’t get him out. My cervix literally would not dilate, he got distressed and dropped his heart rate and I was in theatre for an EMCS within 10 minutes. If I’d chosen a home birth, he might have been severely disabled from lack of oxygen, or he might not have survived at all. Never worth the risk IMO.

Personally I’d never have a home birth since the birth of my second child. DC2 was a crash section and had minutes to live. Born floppy and not breathing, went to nicu. Definitely would not have lived if I hadn’t been inside a hospital already

MN culture is pretty anti home birth I've found, and in general life people project their fears about it all on to you rather than help you come to a balanced conclusion based on your own circumstances. We couldn't discuss our HB plans with MIL in the end as it was all about how it made her feel.

I attempted HB with first but had to transfer due to lack of progression. Second happened at home and it was amazing. Both times pool got set up but not used, first time as I didn't want it to slow things further and second time it was too quick! If you are 5 min away you are in a great position. You get two midwives who are fully focused on you, all the snacks and drinks you want, and best bit is being tucked up in your own bed with baby an hour later.

Im going for a homebirth with my second. People have very reasonable concerns but it's not backed up by stats. NCT states homebirth for low risk pregnancy are as safe as hospital births and this is backed up by several studies including this 2010 one which showed a very slight less risk of death but significantly less risk of intervention.

The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician. Women in the planned home-birth group were significantly less likely than those who planned a midwife-attended hospital birth to have obstetric interventions.

However, thats little comfort to the individuals who did have something go wrong with their homebirth. My first choice would be a midwife led unit but they closed my local one and like you I felt the water was so helpful.

I don't know if there are additional risks with vbacs or your particular circumstances so would absolutely listen to a medical professional. Im set up for a homebirth but fully prepared to go in at the first sign of trouble.

Mn is very anti homebirth when in reality the stats very much prove homebirth is the safest place to birth. I am having a homebirth with my 2nd. Had a meeting with my homebirth midwife yesterday who went through the stats for everything and said a vast majority of hospital births end in unnecessary intervention and C-section. Just look at the rates of C-section per area per month they are absolutely ridiculous ut of course women who end up with these awful scary births are then led to believe they would have died if they were at home.

I had both of my children at home. The first was attended by 3 midwives, the second by 4.
My midwife assured me that they can usually tell if things aren't going to plan and the time it would take to get to the hospital is equal to how long it would take to get the theatre ready. You're only 5 mins away which is closer than I was.

Have a look at Kemi Birthjoy Johnson on insta. She has some great content on home births as well as VBACS.

I had a homebirth with my first and will with my second. You will get lots of horror stories here from people who will say that it’s dangerous but that’s statistically not correct. I’d recommend you speak to your local homebirth team who will be able to answer all your questions and discuss with you any concerns you may have. That will help you decide if it’s right for you or not.

Being able to guarantee access to a birth pool was a major plus for me, and I knew I wanted to labour without pressure to have interventions, which is exactly what I was able to do.

A PP mentioned not wanting the mess - there was no mess. I gave birth on my sofa, which had plastic sheeting and inco pads on it (which the midwives brought with them) and the midwives cleaned it all up and took it away. There wasn’t a spot of blood on anything anywhere. I had to throw out a single towel which got bloody, but that’s all. Then I just spent the day snuggled on my own sofa with my baby and husband. No noise, no interruptions, whatever food I wanted, unlimited tea - absolute bliss!

I would talk to a homebirth midwife for information, OP. You may find it harder to get a midwife who is willing to do a VBAC at home, but they do exist.

A VBAC would be a homebirth out of guidance in my Trust, but that just means a consultant would counsel you on the potential risks. It wouldn't prevent the midwives facilitating your home birth.

I had a homebirth with my 2nd, the labour was wonderful. I ended up bleeding too much from a tear so was transferred in. I'm fortunate though that in my area the ambulance service will attend homebirths as a Cat 1 (blue lights and sirens). I think they got to me within 10mins. It's been the same when I've attended homebirths as a midwife that have needed transfer in. This isn't the same across the country though, it's worth having the conversation with your midwife as to the current situation.

My midwife assured me that they can usually tell if things aren't going to plan and the time it would take to get to the hospital is equal to how long it would take to get the theatre ready.

prefixing this by saying I have no particularly strong feelings re where women chose to attempt to give birth - it's always lovely to hear that it's gone well, and we'll always be there to mop up the cases where it doesn't, but this quote from the MW is not helpful.

There will always be at least one theatre 'ready', but usually two theatres on even an average sized labour ward. The decision-to-delivery target for a real emergency (cat 1 scenario) is 30 mins. While those scenarios aren't that common, if you're at home (or indeed an off site MLU) when things start going wrong you have to factor in time to recognise the problem, call an ambulance, transfer to the ambulance, drive in before being assessed by the obstetrician, the anaesthetist, transferring to theatre etc. If you're starting in hospital, a cat 1 delivery can often be achieved within 15 mins from the onset of the problem. You might still be waiting for the ambulance at that point starting from home. The blood supply to the uterus is also phenomenal (about 750mls/min) - if you're properly going for it with a PPH an extra 10mins waiting for an ambulance/transferring in might make a significant difference to the outcome. Home births may go very well most of the time, and there are often signs that things aren't going smoothly before it becomes an absolute shambles, but if you're unlucky enough to have one of the sudden, time critical emergencies, starting off-site will be a disadvantage. That said, lots of HCPs chose home births for themselves, but with properly informed insight rather than some daft nonsense about 'theatres not being ready immediately wherever you're starting from'.

Your risk of scar rupture remains the same as for your VBAC - 1:200. The thing that is different is your 90% chance of a successful vaginal delivery if you labour spontaneously. The earliest sign of scar rupture is usually CTG abnormalities, they would not necessarily be found on intermittent auscultation (the only monitoring available at home). If a scar ruptures in an out of hospital environment there is a 50% chance of death or serious disability in your baby. The longer the interval between rupture and delivery (usually caesarean), the higher risk.

Other life threatening emergencies (need for neonatal resuscitation, shoulder dystopia, major obstetric haemorrhage, cord prolapse, meconium aspiration to name some) cannot be done as efficiently at home and the delay in getting to definitive intervention will increase the likelihood of life changing injuries to both of you in the unlikely event that it happens.

No reasonable obstetrician will support home birth in a VBAC pt, but their role is to provide the information that allows you to make (and take responsibility) for your decisions.

As above, home birth with previous caesarean is "birth outside of guidelines" which in my trust would mean a detailed discussion of the risks with the consultant midwife. The recommendation is for birth on an obstetric unit with continuous fetal monitoring, but that doesn't mean you can't decline that.

I would never consider home birth for a VBAC. Choose safety.. I’m sure you could do it and the likelihood is everything would be absolutely fine. But it’s not worth even the tiniest risk to me.

I had my last 3 children at home . 1st obe was by accident the last 2 were properly arranged home births. I found the the home births the best ever its bedn a long time abd i still feel warm inside when I think about it.

I hated giving birth in hospital the midwifes were so rude not nice at all I felt like a bit of meat and I felt what was meant to be a special time was ruined .

Choose what feels right to you op. People can share their story's. But that does not mean yours would be the same

OP just to add have a good talk with the home birth team as they will be able to answer any questions you have.
As pp mentioned you can hear all kinds of stories but not everyone's is the same.

@Greybeardy my first delivery wasn't plain sailing, I was pushing for over two hours and my baby got stuck. Little did I realise the paramedics were already on standby in my kitchen.
My Mum came and whispered in my ear that if I didn't get this baby out in the next push they were taking me in.
Obviously I had a very good team who recognised things weren't going to plan and put in the call but I suppose it's not always the way.
My thinking when it came to 'what if it went wrong' was that there were 3 or 4 midwives all focused on me so highly likely potential emergencies wouldn't be missed or spotted too late. I had no idea theatres and teams were already prepped for when things don't go smoothly, perhaps my midwife was just trying to put my mind at ease as I was already sold on a Hb.

Third VBAC = greater risk of uterine rupture which means you'd need an emergency c-section to prevent brain damage. There's no chance you can be transferred & delivered in time to prevent it.

You have to bear in mind that home birth vs. hospital stats are like comparing apples and pears because only low risk women who are unlikely to have complications give birth at home.

Please go to the hospital, or at least a co-located birth unit, I can't face another preventable damage home birth case on my desk. All the pro-home birth mums I meet before childbirth always tell me they are fully informed and understand the risks... right up until those risk materialise.

VBAC after section is already risky, please go to hospital and take care. x

No experience of VBAC but I’ve had one awful, traumatic hospital birth and one lovely homebirth. Feel free to PM.

if it’s a 4th baby it might come rather quickly so you could end up with a homebirth regardless!

if it’s ONLY the pool you’re bothered about then I think it’s a tricky one… doesn’t seem like enough reason to have a homebirth if it’s otherwise not what you would choose… but I can’t imagine having to have a baby on land! Like you, I NEED the pool

Ive had 2 home births in water they were fab, painful but then child birth is and it was a much better environment to give birth in. Less stressful more and relaxing. Im not keen on hospitals, i swear my blood pressure goes up by walking into one😆
You will get undivided midwife attention which you wont get in hospital.
You can only have gas and air as pain relief though. The water is a relaxing environment but not really pain relief.
There isnt any mess really..if your OH is practical and can put up birthing pool, fill it and drain it it will be ok. Mine actually likeddoing something useful and felt less of a spare part.
Midwifes also clean up and will change your bed if necessary. Any mess wont be your problem!
You will be tucked up.in your own bed with a cup of tea afterwards.
If medically you are ok to have a home birth id say go for it.

This came up in my watched list as I posted on it…last March! Zombie thread people, baby will be here. Op I hope you had a wonderful birth if you read this!