Question for midwives / anyone who genuinely knows

[Thankyouandgoodnight]

How likely is it that anything that 'goes wrong' at a homebirth can be dealt with as well and as timely as if you had laboured or given birth in a hospital?

HB are usually approved on clinical basis eg low risk BUT any difficulties the mw will call 999 bluelight you to hospital. ambulance calls are triaged in order of priority.

you are off site, so not immediate access to SCBU etc but your mw will be in attendance with
Cylinder of Oxygen, a bag and mask for helping a baby and a bag and mask for an adult.
Baby resuscitation equipment

are you worried?

can anyone reassure you

The midwives know what signs to look for. My case: baby's heart rate lowering and me being absolutley knackered and too tired to push anymore. You just listen to them (at home or where ever!) as in my case I had absolutely 100% faith in them. And they were right to advise me to go to hospital, but still were calm and lovely about it!

lots of things to bear in mind here.

1. Competence of midwife and assisting midwife are key. If they are competent in homebirths and that is their niche they will get through most problems. Ask lots of questions about those you have in mind to assist you. Particularly how many homebirths, how many transfers to hospital - at what stage & for what reason etc

1. Your health/experience/attitude to birth. Are you confident about birth and in good health?

1. Where do you live? When planning my second delivery/first homebirth the fact that I am about 15 minutes drive from several hospitals was a factor that gave me some confidence and apparantly an ambulance could get to me within 4 minutes!

It helped me to think a lot that homebirth used to be the norm here, not so very long ago and still is in many places around the world. Babies are generally robust and designed to survive, similarly women are designed to bear children!

There are no guarantees though but those who do it generally are amazingly positive about it. I had the most amazingly straight forward 1st labour in hospital, I literally did not need to conciously push my body did all the work within 20 minutes of arriving at hospital. Yet the staff wanted me to get into positions that were agonizing, strap me to machines that disturbed me and then wanted to give me drugs I didn't need to speed up delivery of the placenta and then a catheter cos they assumed I would not be able to go to the toilet. they had little instinct for how my labour was progressing but just wanted to treat me according to the model of treatment they give to most women. My 2nd delivery was so different. I was left alone by a midwife that knew I could do it. And I was completely confident that all would be great and that I had good people around me who respected my ability and need to labour my own way. When my son was born he did not independently breathe for about 30 minutes. There was no drama at all. We were all calm. The midwives kept saying the placenta is pulsing, he's getting oxygen, he's a great colour. They tugged his earlobes and wafted an oxygen mask over his face and eventually he got the idea and started breathing. He was just very sleepy and relaxed. I can't help thinking that if that had been in hopsital he would have been whisked off to special care. As it was he laid in my arms and was attached to the cord for about 50 minutes after birth.

Having said that I have heard about a homebirth that happened around the corner from where I live that went very wrong and now the child has severe cerebral palsy as a result but this was entirely down to extreme incompetence on the part of the midwives. However, had they been in hospital the incompetence of the midwives would probably not have had the disastrous results it did as other professionals would have been almost immediately on hand to interevene and the correct and working equipment immediatly available (these midwives had a broken oxygen machine that did not work at all). So if you go down the homebirth route my advice is that you have to be confident in taking charge, even way before birth, in examining the competence of the people who will be helping you - don't assume they are competent. You need to ask what their experience is of various situations is, howthey prepare for each birth (eg checking oxygen equipment) and what their approach would be to various scenarios.

For me its about weighing up risks. For me I think the risk of something going wrong is so low that I am prepared to take it as it outweighs what I perceive as a very high risk that in a hospital I will not get the birth experience that suits me and mine. But this is entirely my view and only a reflection of my experience and personality.

Its scary to imagine things going wrong and take what some people perceive to be risky course. Motherhood is a lot about instinct - what does your instinct tell you is best for you and your baby?

Lots of luck, and hoping my long rant may have been a bit helpful. I don't think I've answered you question but don't know whether anyone could really.

Sorry for not replying earlier and thank you so much for your responses - definitely food for thought. I shall definitely question the midwives more closely - thanks Renaissance for your thoughts.

There are tragic stories for both hospital and homebirths which is inevitable I suppose BUT I don't want to do this because it's best for me if I am potentially putting baby at an unreasonable risk. A question that is almost impossible to answer I suppose!

Alot of the success of homebirth depends on the baby position and size/ maternal health risks. If your MW has assessed you properly and you don't have any abnormal risks then it is fairly safe for you unless the baby presents OP. Thats what happened to me with DD1. I laboured for 33hrs at home but was transfered when she failed to descend and I didn't dilate beyond 9cm. I would say if getting to 9cm takes more than a couple of hours, from say 3cm, I would ask to transfer because not dilating/descending can indicate a problem such as cord around neck, OP, breech (although a good midwife should be able to palpate the last 2), obstruction due to a full bladder through urine retention etc.
That is just my personal experience, not a professional opinion btw.
You can do OFP to try to minimise the chances of the baby being badly positioned and do the inversion technique to try to turn a breech baby. HTH

To be honest there are things that can go wrong with no warning whatsoever that can not be delt with at home as quickly as at a hospital. And a good m/w should make you aware of that so you can make an informed decision. You could have a severe PPH after the birth - they m/w don't have blood with them to give you, you would have to wait to get to hosptial. Where I work a lot of comm m/ws at home births can't even cannulate - you would have to wait for the paramedic to get there. Cord prolapse or a shoulder dystocia are other possibilities.

But then cord prolapses are very rare and over 70% of shoulder dystocias are easily resolved by simple manoever that any m/w should easily be able to do.

Remember that its not as simple as saying "I'm only 10 mins from the hospital" like I've heard a lot of people say. It could be 10mins before an ambulance gets to you, then another 10 mins to hospital.

I'm not meaning to sound negative about homebirths at all as I am a big supporter of homebirths and even nowing this I do believe that a homebirth is the safest option for a low-risk woman. You would be away from all the possibility of a "cascade of intervention" in a hospital. Also you would be much more likely to ust get on and do it in an environment where you feel most comfortable.

Thanks again - I am considered low risk but as you say - never say never and that sometimes things just happen. My first birth was in a birthing centre on the same floor as the labour ward - just across the corridor. It was straight forward really, with the only thing to note being retained placenta due to an over full bladder (no urge to wee during labour at all and they drained almost a litre out of it!). Suffice to say, cathetirisation sorted that out.

It is very difficult isn't it and it would be one of those 'in hindsight' things, which is always a difficult position to be in.

I think you have to do what you feel comfortable with. Its great that you're considering all angles and weighing up the possibilities.

If you decided on a homebirth do you think you'd feel relaxed or would you be feeling a bit on edge "just in case" something went wrong?

I don't know how man yweeks pg you are but hopefully you have a bit of a time before you need to make your mind up. And there's no reason you can't hold off on a decision until near the end of your pregnancy - you might find your heart is telling you one thing over another by then!

I think you're right in a way that whether its putting the baby at unresonable risk or not is nearly impossible to answer - some women would think it was a risk, others not at all. Its only you that can answer that question.

Good luck!

I'm not a professional but thought I would share my view. I used to like the idea of a homebirth, and thought (illogically I know) that I'd have a hospital birth for my first to 'see how it went' then consider homebirths for future lo's. I suppose the thing I was most concerned about being at home was would I be able to cope with the pain (which I know might sound negative) and what would happen in an emergency? As it was, I went in to my midwife unit, and because of various concerns the midwives had I had to be transferred to the hospital - 20 minutes away by ambulance. Dd was absolutely fine - although I had an epidural, ventouse, episiotomy, post-partum haemorrhage and dd had shoulder dystocia and needed immediate attention to stabilise her breathing when she was born. On reflection, scary as these complications were, I realise that if I'd been at home with a midwife in attendance the situation would have been very similar - I'd have been transferred to hospital. The ambulance was very quick to get to me as I was already in a hospital of sorts - that was the one difference I can think of between midwife-led unit and home. So, if you follow my logic, if anything my experience has made me more 'pro' home-birth, as chances are I would have been more relaxed at home and could have made better progress, and with the right support... I'll definately keep an open mind for next time - I've been told it would 'have to be' a hospital birth because of the complications last time, but various other people on MN have suggested that I don't have to, and could push for a homebirth.

Happynappies post is a very good example of the cascade of intervention.

Been in a strange, less relaxing atmosphere can make it harder to cope with the contractions, you're more likely to have an epidural, labour is likely then to be longer due to been on the bed, ventouse is more likely. Having a ventouse increases the chance of a pph and a shoulder dystocia.