Low intervention - homebirth

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Hi. Just wondering if any ladies are currently pregnant and planning a homebirth?

I have self referred and noted on my form that I’ll be having a homebirth. I have my first booking appointment in 2 weeks.

Just looking for some positive stories on the process so far and how to navigate avoiding landing on the intervention conveyor belt.

not looking for opinions from people who are against homebirth/haven’t experienced it

Congratulations on your pregnancy and I hope you have the birth that you want.

As a mother of three children I want to say this: when you are pregnant it can feel like giving birth is the ultimate moment of motherhood. But actually, it’s only a tiny fraction of the time that you will have together with your child. As I sit here cradling my lovely 10 month old baby, what matters most to me is that the birth was safe for him and for me and gave us both the best start in our lives together.

Birth is important, but don’t get too fixated on it, because it’s just one step of so so many as you bring up your child.

Oh, so for clarity, you don't actually think a 'don't intervene unless it's an emergency' plan is a good one, but you are supporting the OPs right (under law) to bodily autonomy, even if it results in her death, or that of the baby?

Because it's really important to be clear on this difference. When Jennifer Cahill died, no one told her properly what the risks were, so far from supporting her autonomy, it meant she couldn't give effective consent to the risks.

If you are a midwife and you are saying the OPs choices are fine and fine no increased risk, then you risk preventing her from being able to give informed consent.

There is an assumption that hospital is automatically safer than home and that its therefore always riskier to deliver at home, not least because we have all been raised with that expectation. The reality is more complex and across Europe cultural assumptions around birth vary widely within modern health care systems. A normal healthy woman and pregnancy in the UK still has a lower risk of complications and postnatal infection at home than in hospitals, however not every birth is suited to home.

My first was a hospital birth in a flagship maternity unit. Despite being ideally placed to have a normal delivery it was badly mismanaged and put both of us at risk and DC1 ended up in special care and I ended up with an infection (the post natal ward was filthy). I had a succession of different staff looking at me, not listening to us and looking at the machines not the person. Looking back the timing couldn’t have been worse - it was middle of the night just a day or so after the (then) SHO rotation with a junior doctor who had bugger all experience and was not listening to the midwife. I know many women from that era with similar stories.

I had my others at home including my ten pound back to back DC2. The labours went more smoothly, I had continuity of care from the two experienced community midwives from the home birth team and I was up and about feeling full of energy the next day. For me it was the much lower stress environment which helped and I can see why there is a lower incidence of complications in a calm, relaxed environment with two very experienced practitioners.

BUT - I had a lot of discussions with the home birth team, including the “what if” scenarios. If my BP had risen, if a lie had been transverse, or there was any other contra indication I would have gone to the birthing unit for the “just in case” scenario. I was also within ten mins by ambulance in the event of emergency needing blood or surgery.
I didn’t make a hard and fast decision early on and if my experienced midwife had said “probably not one for home” I would have taken her advice. It would never have occurred to me to refuse my home midwife’s examination and checks which helped her to assess progress. I wouldn’t consider it fair either, to have a midwife standing accountable whilst refusing to let her do her job. Those checks are used by experienced midwives to help them form an early view of likely problems. I would not have considered home birth sensible if I lived hours from the nearest medical facility.

In reality what we need is better maternity units/birthing units which provide continuity of care (and cleanliness) coupled with a more home birthing teams so that women can make an informed choice based on their individual factors.

Really?

So if someone's plan is to free birth, then that's a good plan and the right one for them?
If someone wants to get drunk off their face to the extent they pass out, then that's a good plan and the right one for them?
If someone wants to give birth whilst in a hot air balloon, because that would be co, that's a good plan and the right one for them?
If someone has had huge PPH for her previous 5 pregnancies and in each case only survived as she was in hospital, would her choosing a homebirth for her next still be a good plan and the right one for her?

This is a deeply concerning attitude from a purported health care professional, if you were truly to advise a woman who was planning a homebirth after 5 nearly fatal PPH that having her 6th at home was a GOOD idea.

I think the law would likely call that negligent, and I hate to think what would happen if this hypothetical woman were to die.

You can support a woman's right to make risky decisions whilst still acknowledging that they are risky decisions.

I just hope that you aren't actually a midwife.

Just curious here - what would your suggestion be if the lady said 100% she's having her baby at home?
It's a legal right for women to homebirth so no laws would be broken in this situation. So what would your suggestion be?

For a situation as clear cut as the PPH scenario?

Firstly, the woman should be told the risks in clear language, including the high likelihood of another haemorrhage (that she's never NOT had one), and that if they were on the same scale as her previous ones she would likely die. Therefore if she goes ahead with her plan, the likelihood is that she would die. She would be asked to sign a document acknowledging this likely outcome.

Secondly, an assessment should be made of whether the woman had capacity to make the decision, as frankly that level of irrational decision making would be concerning enough to need this to be checked. If she has capacity but there are other mental health concerns (given she basically is suicidal) then consideration given to whether there are grounds to section her.

Finally, a very unlucky pair of midwives would be sent to the birth, and would document everything like crazy to cover their own backs, but realistically if the woman doesn't change her mind in labour, they wait to call the ambulance, and get ready to witness a tragedy.

Unless she lacks capacity, she can go down this path. It does t make it the right decision for her, just one that she has the right to make.

So you'd basically do everything that @SoIMO suggested lol

@Babyboomtasticagree with some of what you’re saying re AN discusions around risk.

I strongly disagree with what you are saying re a woman’s capacity. We have the MH act in place for complex situations that require it. It makes my blood run cold to think that the simple act of making an informed choice for yourself (that is disagreed with by a HCP, who is guided by policies very often not backed by good evidence, and who practices defensively as they are fearful of litigation) could initiate an assessment of your capacity.

That is a very, very slippery slope that I don’t think, given the chance to fully think the idea through, in depth, all wide reaching implications considered, you would want to go down.

If that was the reality of maternity care in this country I’d very quickly be hanging my scrubs up and calling it a day as I’d want absolutely 0 part in a system like that.

Goodness me what has this thread become!!!

a woman has the right to choose. A woman also has the right to be in hospital, give birth at home, birthing centres. In a car if she wants to (or maybe doesn’t have the choice on that one !)

home birthing is perfectly safe, as safe as giving birth in hospital if you are a low risk pregnancy.

community midwives are often hospital midwives as well. An ambulance would be on priority and in all likelihood by the time you are assessed by a doctor, you’d be on the operating table a lot quicker than being in hospital.

just because you don’t want / agree or wherever with home births, you do not have a right to put other people off who do.

the OP explicitly said in her opening post she wants to connect with woman who are going through a home birthing experience, not a tirade of mumsnet misinformed wisdom.

and yes - you do have two midwives throughout. And yes you can have as hands off or hands off as you require. It might appeal to some, it might not. But at the end of the day it’s YOUR own personal decision. Back off for goodness sake.

I'd really hope that if someone was making a decision with what was most likely going to result in their death that questions of capacity are considered, even if the result of that is to decide she does have capacity.

Draconian powers should never be used to subvert consent where someone has capacity, but it would be tragic for someone to die because no one stopped to think whether their decisions were the result of mental impairment.

Someone pursuing a course of conduct which is almost certainly going to result in their death is no different from someone showing clear suicidal ideation, which most people would then need assessment.

Obviously it's a very delicate balance though.

This is a really interesting area of law and medicine, maybe we should take it up elsewhere in this forum rather than here.

True, it may be less likely to happen, but if it does the risk is far higher. So overall surely safer in a hospital where they can deal with it much easier.

Tbh, it was just an example. There'll be many scenarios where because of a specific issue, giving birth at home would likely resulting in mum not surviving. We're talking hypotheticals here.

I think we both agreed that providing mum has capacity she can make a decision that will result in her death. I suspect that we both actually think it's important to ensure mum does have capacity to make that decision, where a seemingly irrational decision will have such profound consequences.

Where we differ is that you seem to believe that if mum has capacity to make a decision that will most likely result in her death, that's a good decision for her to make. My view is it's a bad decision, but the law gives us the freedom to make bad decisions.

What I worry about is that if women making clearly bad decisions that put their lives at risk are not clearly told the consequences of their decisions, then that's not informed decision making for them. This is exactly what happened with the Cahill case, when no one told her clearly how high risk she was, so she couldn't make an informed decision about whether to try for a home birth.

As I said, this is a fascinating area, but it's only tangentially related to the OP. I'd quite like to continue it, but maybe we do that in another thread if you're interested?