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.

Riven, am I right in thinking that you had an HBAC?

If so, then like me you were an unusual case: a high risk mother delivering at home. I was also high risk because of gestational diabetes and macrosomia, and also ended up with a baby who needed resucitation because of shoulder dystocia (though we were luckier in that my baby came away from the birth completely healthy).

I'm not sure what our experiences can add to the argument, as I suspect the OP is low risk.

That said, if the OP is interested, I came away from my homebirth feeling like the outcome was better than it would have been had I gone into hospital. The shoulder dystocia would have happened where ever I gave birth. At home I had a highly experienced midwife who knew my obstetric history (I had a homebirth because I wanted to be delivered by a midwife I knew, and this wasn't possible for me in hospital) who was well prepared for the birth and who handled the emergency when it happened in an unusually competent way. I feel that for me the physical as well as the psychological outcomes were far, far better - I am one of the few women I know who's had a significant shoulder dystocia with a very large baby, who came away from birth with insignificant perineal damage and no mental trauma.

I do think that you have to accept that you can't control all risks. Yes - if you have a significant PPH, a cord prolapse or a placental abruption during birth you would be better off to have chosen hospital. On the other hand in hospital you are much more likely to end up on an operating table having major surgery, and therefore more likely to have a big PPH, end up with a thromboembolism, or a bad infection. Statistically speaking, overall the outcomes in terms of neonatal morbidity and mortality are similar for hospital and home.

Chilly. My hospital mw 'caused' my pph.

hi mintyy no, don't think so, doesn't it depends on whose guidelines you read, where they exist? in these cases, there was clear obs team panic, which to me is the primary distinction. according to other halves, first lady could't have surgeon, busy, and second had a splash prepped surgeon and no anaethetist for 45 mins. seems first lady had improper use of monitoring tech issues, but 2nd thought she had transverse shifted baby and distress ?genuine loss of foetal heartbeat, baby needing resus. havent kept in touch, don't know for sure.

chilly i had a right big baby and shoulder dystocia. hospital woundt have taken me on as home birth even if they covered my patch, as i was fat and forty (but no gd)
. i feel same way you do about getting better vcare out of than in hospital. even to the extent that seeing the same MW more than once allowed us to discuss my proposed 9lb7oz baby (who was actually 60cm long and 11lb11oz...) and how i would be expeted to manage shoulder dystocia with her.

riven i am sorry to hear what happened to you and your dd and hope this thread isn't causing you to worry open great pain of 'what ifs'

and daisy5, when we were weighing up risks ourselves for homebirth at 35 weeks, we checked out the performance of our local ambulance service. our MW had us call bluelight help as soon as she realised we had shoulder dystocia, first response took 5 minutes to arrive, by which time we were sorted and baby was fine. But of course, the stats linked above don't tell you everything, like the bike paramedic who didn't know how to take neonate heartbeat, or the ambulance crew who took the most bonkers route possible from ours to hospital, being based on other side of london

Merryberry - we had one ambulance outside the house in 3 minutes flat, the second within 6 minutes. We live very close to the hospital.

Hello everyone,

Thank you so much for your stories and thoughts. I have been offline for most of the week so am not going to get a chance to read this all thoroughly until tomorrow.

I have experience of hospital environment slowing down childbirth already. Upon ringing the hospital to alert them that I was getting contractions 7minutes apart they said to 'take aspirin' and 'take a bath'. I had already read a book on waterbirth which advised not to get into warm water too early as it slowed down contractions and a friend of mine had contractions that stopped completely when she got in a bath.

Then my contractions slowed considerably on our drive to the hospital. I was examined at 4am and was 3cm dilated with contractions every 6mins. They had been every 2-3minutes for over a minute when I left home. They suggested we go home - I knew this was not a good idea and ignored the advice.

I seemed to be in more pain than woman giving labour but was told I could only have pethadine at that early stage - I was horrified, as I thought it also was something inclined to slow birth, and asked for gas & air. They said I had to be 5cm dilated before being offered gas & air. I made a fuss and eventually got it at around 5.30.

We were sitting in a dark room, dp half asleep, me locked to the gas & air. There was a staff changeover between 6-7 and so it was absolutely dead quiet. I felt suicidal as so grim compared to my lovely warm home and got up to walk around, as a friend had told me to 'keep moving' to hurry it along.

The new midwife found me at 7.30, and after a bizarre half hour they realised I was in labour and I gave birth without any medication and with just one push at 8.20. I would have given birth at 8.05 when we went into the labour room and I could feel the head trying to come out as I walked along, but I was told to 'breathe' hard as the midwife filled out the paperwork (??) - personally I couldn't have cared less about the bloody paperwork!!! My baby wanted to come out.

They said to be careful I didn't give birth in the carpark next time.

So, home birth seems very appealing to me, and we wouldn't need to send our daughter away, except to neighbours for an hour or two.

However, I am weighing this up against, being 42 and wanting to play it safe as I know I could not try again if anything went wrong. I would blame myself forever if I had a home birth and anything did go wrong. We have moved and the local hospital is pretty good and I know people who work there.

I shall read all your posts in full tomorrow. Thank you.