Hospital vs home birth - what are the possible life threatening situations to bear in mind

[daisy5]

I'm seriously considering a home birth but I just like to be clear on all the facts before I make a decision like this. I am going to talk to a midwife in a fortnight about this, but want to do some research first. I've read a few articles online but they tend to be pro:hospital birth or pro:home birth and I just want to come to terms with the core facts.

What are the possible life threatening problems (both to myself and the baby) that can occur at home that could have been avoided by being in a hospital?
Already I know two:

• bad haemmorrhage or rupture
• if baby stops breathing after midwife has left

And also, what are the problems that could occur in a hospital that would have been avoided by being at home?

• life threatening hospital bugs

Our hospital is 10mins away when there is light traffic, 25minutes away in peak travel time.

Many thanks for your help.

I'm pretty sure for a 'normal' pregnancy home birth has been proven to be just as safe as hospital birth, also far less risk of instrumental delivery at home.

Shoulder dystocia, cord around neck, genuine failure to progress, distress in general affecting heart rate, and so on...

The thing is, with the exception of a few things, many life threatening situations may be avoided by labouring in a relaxed environment. The things that would not be avoided wherever you are probably - suh as cord round neck - would be happening not because of your location but anyway and then it is a question of how effective and reachable to various medial interventions are. With a cord round the neck then the midwife has fingers but not an operating theatre to whip you off!..

I had two home births but I work on a que sera basis and am very fatalistic in a very philosophical 'sliding doors' sort of way.

What I mean is, you could be at home and the bbaby get stuck and need forceps or a section. The time delay could pose a serious rrisk. You could be in hospital and the baby didn't get stuck but instead a more serious complication arose. Either scenario, the baby is compromised - the outcome the same, just a different route to it, a la Gwyneth Paltrow!

A hospitaldelivery might not stop haemorrhage / rupture but yes, you'd be there fr help if it happened

have a look at th4e AIMs and homebirth.org websites;lots of suggestion that chances of sections etc reduced anyway if at home, which balances a lot I think.

MW's don't leave immediately,they sticka round until they feelcertain all is well; mine did anyway. But a hospitalcan discharge you at that point anyway if full,my Ant was refused a postnatal bed for that reasn.Also in the current climayte may I suggest delievering planned at home is better than driving around looking for an open unit and being taken by surprise by a quick delievery?

Ultimately if all is welland MW is in agreement its down to preference I think. You cant insure everything but you can balance the numbers and I think a HB does that.

First baby I had was born at home, water birth, DH cut cord. Idyllic delivery.

Second baby planned home birth ended up transferring to hospital as baby was undiagnosed breech. Still delivered vaginally unhindered but not so idyllic (7 people at the end of the bed as breech seen as obstectric emergency!)

My point is that if you asked me about risk etc and child birth, I would still have another home birth.

My personal view is that risk is a relative thing. I would recommend doing your own research, google home birthing on the internet and make yourself aware of the risks. Wherever you birth there will be a risk to be honest. Obviously in hospital it is easier to intervene, but that can be a good and bad thing! (For example I delivered my daughters placenta naturally, no injection to speed up delivery. When I was in hospital following breech delivery I was not given a choice and MW just injected cord and delivered placenta!)

Depending on the MW they will have their own views too. I think if you read around the issues it makes you more aware. The midwives carry all sorts of kit with them to assist in home birth and are trained to deal with most 'emergencies', excessive bleeding, baby no breathing etc.

As for your distance from the hospital I would not worry as they will 'blue light' you in if they are worried. We live at least 40 mins away from a hospital, on a good day and we made 'record time' apparently (were there in 20 mins!!!)

Best of luck!

I've had two homebirths and two of hobgoblin's list of four, including a baby resussed at home!! See here, and both my babies were fine. But you do need to be sure you are aware of the risks and understand them, and can accept them.

Homebirth and community midwives train and review their emergency drills regularly, and will not risk their careers just to keep you at home. Homebirth really is at least as safe as a hospital birth for a normally progressing pregnancy and healthy mother. The homebirth.org site is fantastic - pro-homebirth as you'd expect but she does some serious literature and research reviews on all these worries and more. Please have a good scout round that site, it will put your mind at rest about most things I suspect.

Bugger! See here and here

Oh for goodness sake I neeeed more sleep!

daisy I have just been cleared for home birth for my 1st dc. I think that if your pregancy has been straightforward the risks are no diff (poss even better) than laboring in hospital. I found that the midwives were brilliant in laying down the facts and the homebirth questionnaire raised the situations where transfer may be needed. As others have said the midwife will be aware of any complications arising and won't take any risks to you or your child. We have decided to try at home due to apparent effects of relaxed mum on labour and therefore less chance intervention.
like you our hospital is close so seems reasonable to try at home and see how I get on! if you haven't found it there is a first time hb's thread you might like to look at?
Also its a bit of a hippy book but look at Ina May Gaskin Guide to Childbirth, lots of inspiring stories... I must admit tho I am slightly fearful of my ability to do this at home with nothing more than some lavender oil !

Do the midwives have oxygen cylinders with them? I'm not sure they do but will stand corrected. My only thought would be if the baby was not breathing they might be trained in resuscitation but if no oxygen, the baby could sustain brain injury by the time ambulance arrived. In hospital there is oxygen in the walls (IYKWIM) and paediatricians nearby. A midwife trained in baby resuscitation is not going to be as skilled as a paediatrician who can intubate if needs be. I know research shows it is just as safe at home but that would be the deciding factor for me.

Mine had oxygen certainly (although slightly differs here in Wales on littlethings) but it was in the cr and not brought into the house (in fairness though she didnt have time- was 10cm dilated when she arrived).

And entonox of course,lots of forms to sign for those.

My dd would have died if we had been at home. And we live very close to Kings College Hospital (less than 10 minutes by ambulance, I guess).

I know this is rare, but there you go. Her life was certainly saved by a crash caesarian, which was performed less than 10 minutes after problems were first detected.

I take no pleasure whatsoever in dumping this on your thread. But I think sometimes people believe that there would have been some indicator in pregnancy or early labour that a home birth would not be unadvisable - that was not the case with me.

There are many good reasons why people do not wish to give birth in hospital which I fully understand. However, you DO take a risk with a home birth (although the risk is very low, etc etc etc).

Mintyy - may I ask, what were the problems which caused your Csection?

i think MWs always carry a full resus kit, inc oxygen, but you might want to check. In terms of "deciding factors" one of the most important things to remember is that in hospital you are more likely to end up going down what is called the "cascade of intervention", which is when what starts as a small intervention to help you on your way (say an epidural or induction if things aren't happening quickly enough and you are struggling/flagging a bit or things have slowed down or stopped) but one thing leads to another leads to another and before you know it you're having a crash section. It is thought that there are many people who ended up having big interventions in a hopsital setting who might have managed naturally had they been able to labour at their own pace at home.

The only medical emergency I was genuinely scared of was a cord prolapse, as they do require fast surgical intervention but they are very rare - being in hospital does not guarantee a safe result, likewise having one at home does not always end badly.

Bear in mind that your transfer time to hospital under blue lights and sirens would probably be considerably less than ten minutes. I don't know where you are but where I am, protocol dictates that any transfer from a homebirth is treated as an emergency, no matter what the cause, so you get the ambukance ride.

You can probably guess but i am very pro home birth, but ultimately it whatever is going to be least stressful for you.

Suspected cord compression. DDs heart rate down to 63bpm. 6 hours in to labour, 3cm dilated.

mm, tricky. no answers really to op, just musings on interesting experience. i had a shoulder dystocia ds2 water birth at home. had an independent miswife who sorted us out with a rotate/tip/push back move (too far gone for mcroberts...). she had had much experience of pre-noughties midwifery, and midwifery in developing world though. when we were in hospital later with his jaundice, and every midwife there and consultant we saw said they could not have done what she did, lacking the experience and confidence. even HB MWs nowadays only really tend to take sole charge of very straightforward births. you can see below, breeches treated as completely abnormal, and people having to meet very strict 'criteria' for HB teams to consider them.

so, if we'd been in hospital we'd have had some grim old time of forceps and/or crash section. trouble is on this front, that in the time we spent in for jaundice, i met two people who were told they needed crash c-sections (UCHL) one of whom had high forceps instead and the other of whom waited 45 minutes for her slot in theatre, same night i was labouring. how crasdh is crash, i wonder? due to pressures on the operating theatre. this is a conumdrum i think, not to be easily solved across the system.

with ds1 i had pretty standard nhs hospital birth, a few errors made, somewhat pointless and protacted induction, pushed baby out depsite cascade of interventions.

don't forget risks of infection from hospital which you don't have at home.. which can also lead to death of mother or baby..

merryberry has a point- with ds1 I ahd eclampsia and apparently ( cant remember ,this is from notes) ds1's heart was worrying them but there was no Paediatricain free as another owman had exactly the sme scenario going on but had 'gotten there first'.

The MW here really fought for me to have a HB (my reasons were associated with alckof childcare for my 2 disabled boys and a need to have DH with me due to severe shyness etc), as it happened had I tried to go to hosp[italeven on forst signs I wouldn't have amde it and probably dh would ahve delivered DS4 in the layby. So on balance for us (we were warned birth might be fast, ds3 3 hours) a planned hb less of a risk iyswim? At elast we had a Dolua there, and entonox / medicalassistance.

Merryberry - are you getting crash c/s and emergency c/s confused?

Riven I am so sorry to hear of your experience. The midwife that came to see us on saturday told me they carried oxygen if baby needed it and said they were trained in baby resuscitation. Maybe it is different in diff places? Sorry if your midwife had oxygen and I have misunderstood.

just wanted to say, i had a hospital birth as i was worried about being at home if anything did go wrong.
ended up in the hospital alone with dh as they where so short staffed, would have been better of at home tbh.
the the equipment in the world is no good if theres noone there to operate it.

good luck, such a difficult choice as you dont have a crystalball

oxygen is only a stopgap - if a baby is showing no respiratory effort they need to be intubated & ventilated (midwife cannot do this).

Midwives do carry oxygen

You need to consider that sometimes people will explain a situation that was 'saved' by them being in hospital, but don't always realise that it was being in hospital that caused it in the first place.