Home Birth (sorry, long!)

[WideWebWitch]

There are a couple of other home birth threads but none are recent so I thought I'd start a new one. I'm not due until November so I know I have plenty of time to make my mind up about this and the whole birth issue (and who knows, it may be out of my hands due to my health or the baby) but since it's already come up with my family I'd like some advice if anyone can help. I had a home birth first time round with ds, who will be six when this one is born. It was 8 hours with gas and air, no stitches, placenta delivered fine, everything OK. Hurt like hell but there you go. I was happy with my decision at the time and all ended well.

However, I was living in London then and we were roughly 15 minutes away from a hospital. This time I'm 20 miles away on country roads and although there's a cottage hospital 5 mins away I doubt they could cope with anything major, like an emergency c section.

My mum, my sister and Dp's mum have all said "oh you're further from a hospital this time, don't do it, it's DANGEROUS" and dp's mum threw in that she'd read recently that they won't let you have a home birth if you're older (I'm 36). I soon put her right on that since when I did it last time it was every woman's right to give birth at home if she wanted to and I assume it still is (unless the law's changed), so I told her so. I also managed to tell my mum that statistically a planned home birth is as safe as hospital birth (although I said it really childishly and might as well have stuck my tongue out and said nurr afterwards!). I've got 'Home Birth' by Nicky Wesson somewhere and Mears recommended another book on the other thread which I think I'll also get.

But my concerns are:

• I'm 6 years older. Does it make me less likely to be OK? Surely dp's mum is talking rot about my not being 'allowed to'?
• Does the distance from hospital matter? How often is speed of the essence? I have one friend who said recently 'well, if I hadn't have been in hospital I'd have died you know' (she had a retained placenta and PPH). I actually am more scared this time. I was blissfully ignorant last time and just trusted that my body would do it (bit of a hippy at the time I think, sort of) and luckily for me, it did. This time I'm far* more aware of what could go wrong and far more worried about it.
• Does the fact that I was OK first time mean that I am quite likely to be OK this time? I know no-one can say for sure about any of it but still.

All these comments have dented my confidence and made me think I am possibly being selfish and maybe I should just go to hospital since it's 20 miles away. DP will support me whatever I do but I am scared!! I haven't spoken to a midwife yet but I gather they're generally supportive of homebirth in my area (it was the highest level of homebirth in the country at one point but I don't know if it still is) so I don't forsee a problems there.

BTW I didn't ask ANY of the family above for their advice, they asked me what I thought I would do about childbirth, I told them, and all their advice was unsolicited! My mum was even there when ds was born and spent the next 3 weeks telling anyone who would listen how amazing home birth was (having disapproved previously that time too). Sorry this is so long but it's really been p***g me off.

Is there anyone who had an ok home birth first time and changed to a hospital the second time round out of fear? Thanks for listening and thanks in advance for any words of wisdom or experience anyone can offer.

No experience WWW but if you had a striaght forward 8 hour labour first time, chances are it would be quicker than that this time and given the distance to hospital etc, arranging childcare for your DS etc home might be the best option. 20 miles on country roads in advanced labour? Mmm.

Obviously this advice is only as useful/well-informed as that you've already received but thought you might like to hear the other argument.

www, maybe you should try asking on the Home Birth UK email list .

Whilst you are at Yahoogroups, you might also find it useful to ask on the UKMidwifery email list which is at groups.yahoo.com/group/ukmidwifery. There you will find midwives, mums and other interested people who may be able to give you the reassurance you require.

HTH.

To be honest the "I'd have died if I wasn't at hospital" line is very difficult to prove (or disprove). Things like retained placenta's are often caused by the medical model of management that women submit to in hospital. It is very difficult to say for sure whether it would or would not have even happened at home. And even if it did happen at home the midwives are not helpless to assist (I think they would be able to do a manual removal if they HAD to - unless my memory is failing completely) - and you wouldn't be transferred immediately to hospital - a paramedic team would be called first and they would be able to give blood/plasma/whatever it is they use at short notice in emergencies. It wouldn't be pleasant, but you would, I believe, be unlikely to die.

The important thing though is that you feel safe when you are giving birth - so you really need to run through the potential issues with your midwife, and discuss with her the action which would or wouldn't be taken if various emergencies arrive. Off hand I can't think of any likely emergency which can't be coped with at home, but as i say the memory does seem to be fading...

I'm sure Mears or someone else will be able to shed more light on the subject...

www - I think the best thing is speak to your midwife about the problems associated with home birth and transfer to hospital. 20 miles is actually not that far away in comparison to the distances women in my area might need to travel. You mentiones London before - you may be physically closer to a hospital but it could take a long time to get there due to traffic congestion.

The main thought to remember is that pregnancy and labour are normal physiological events. If you are fit and healthy and your pregnancy progresses well, why should anything go wrong. As someone pointed out already, retained placentas etc. are usualy a result of unnecessary interventions.

I think it is imperative that you if you decide on a home birth you are 100% confident in your own ability. If you are concerned then you might run into difficulties because anxiety can inhibit labour.

You did it before, you can do it again. You are definately not too old - you are experienced

I'm not pro-homebirth (I'm pro-choice) but here's something I was sent:

"Every woman has the right to choose where she will have her baby. Fewer than 2% of all births in the UK take place at home, yet evidence shows that a home birth can be as safe as giving birth in a hospital. Mothers tend to need less pain relief during a home birth, you are guaranteed privacy and comfort and will get continuity of care from your midwife. Here are some other facts about home birth, taken from an article by Angela Horn.

You have a 50% less risk of caesarean section than with a hospital birth
Your baby is 50% less likely to be born in poor condition
Your chance of contracting a postpartum infection is reduced by about five times
You are 50% less likely to have an instrumental delivery
You are less likely to have excessive blood loss after the birth
It may be easier to establish breastfeeding
You may avoid transferring from a familiar environment to a strange one in active labour
You have a significantly greater chance of feeling in control during the birth
You increase your chances of feeling satisfied with the way the birth happened. "

At the end of the day, you have to be comfortable with your choice. Not your mother, MIL, sister... If you are scared about being at home and would prefer to be in a hospital, then go for a hospital. If you opt for a homebirth now, there's no reason you can't change your mind right at the last moment and go to hospital - they won't turn you away.

www, have you thought about doing the hospital tour?

You might go - ooh, this is so nice (well, you never know, ever the optimist, me), I'll come here and set my mind at rest. Or, you might look at it and go - well it's all right if I'm desperate, but I'd much rather be at home. You could time the trip too! And then if you decide at the last minute you would rather go in, at least you won't be stepping into the unknown scary world.

Personally, I had an easy hospital birth the first time and would definitely try and opt for home the next time, but I can understand you are feeling out of the threads that whinge about hospital food and want to be part of that experience too.

I expect it's generally better to opt for a home birth and then change your mind rather than visa versa...

Best friend just had her second at home and LOVED it! She is 37, so you are definitely not too old. My sister is a midwife and she says that if you had an uncomplicated first delivery chances are no 2 will be even better - and most midwives are happy to support you in this. but talk to your Midwife first, not your GP lots of them can bedisparaging about home births for no good reason. Best of luck in whatever you decide, whatever it is if YOU decide then it will be the right choice....

WWW, I'm also due in November with #3 and I'm planning a home birth, for the rather prosaic reason that dh doesn't drive, so I always get very anxious about how I'm going to get to hospital (we have the world's nicest taxi driver, but what if he's in London on a courier job? We have kind and practical next-door neighbours, but do I really want my bodily fluids on their BMW's upholstery?)
Ds and dd were induced, and I'm convinced that if I stayed away from the hospital I could have a better shot at doing it myself (tho obviously I'd go in right away if anything went wrong). I haven't seen my midwife yet as she's on study leave for a month, but she's a very calm and supportive person. I'm 38, so unbelievably ancient, but I really think it's the most practical option. My only worry is that I have biggish babies and #3 may be just too enormous to squeeze out on my own, but I'd like to give it a go.

WWW:
Remember no doctor or midwife can tell you what you're "allowed" to do; NHS midwives have a duty to attend you wherever you choose to give birth. That said, the fact you've already had a child should keep most of the pressure off, anyway.

Funny enough... a friend woke up one December midnight in the midst of an almighty contraction. She lives in rural Norfolk, and her husband driving to hospital had to face extremely icy roads. They nearly didn't make it; she had to pant the whole way to hospital. Perhaps they would have been better just going for a planned homebirth? I have another friend who nearly had an unplanned birth in her kitchen last May. Her first labour was 28 hours and she was astonished to go from mild contracx to birth in barely more than 4 hours with 2nd baby. Heck, most people I know had 4 hour labours 2nd time (mine was 2hours...!). If you have any hunch it may be a fast labour, definitely try for doing it at home! Better than a carbirth, that's for sure.

Midwife told me a lot of women in my town opt for homebirth precisely because the hospitals are all 20-30 minutes drive away. I know someone who lives 45 minute drive from hospital and did 2 homebirths. Come to think of it... I heard that on some of the Scottish isles that are difficult to leave during the winter, women are advised to go to the mainland at 7 months pregnant for a first birth, but generally ok'd for home/cottage births for second and subsequent births.

I wasn't 100% confident (which Mears suggests might be essential) about giving birth, esp. at home without mega-pain relief options. But it was a fantastic birth. I was on an adrenaline high for days afterwards. Good luck, whatever you decide.

WWW - I can't answer your original question about choosing a hospital birth second time around because dd is only 5mo and number 2 isn't even a twinkle yet. However, dd was a planned homebirth, and it was a great experience.

I went into labour spontaneously 13 days after she was due, and labour proceeded very slowly - my first stage was nearly 42 hours. However, I had a very experienced midwife who was confident that I was OK and that the baby was OK, and I think that that was the key point in making it such a success. If I had been in hospital, I would have ended up with a lot of intervention and the outcome could have been very different, even possibly a cs.

When I was pregnant I found myself reassuring people that I only lived a mile from the hospital - but I know that that was for their benefit because I didn't think of it as a big issue.

I hope you enjoy your birth whatever you decide!

Thanks everyone. You're right, all who said it's to do with confidence and I must be confident that home birth is the right thing before going ahead. I absolutely was last time so I think I need to talk to my midwife, read a couple of books and decide in a while. I've got months and months and months to make my mind up so we'll see. I spoke to a friend yesterday who had called me about 3 hours after giving birth and she says I was ecstatic and was going on and on about how wonderful it all was. I don't remember that at all but it gives me hope that it really wasn't that bad and if I did it once, I can do it again. I may ask for more advice nearer the time but thanks so much to everyone who replied, all these comments were interesting and helpful. And I will tell all doubters to bog off and mind their own business!

Just to add my own experience to all the other comments. I had a home birth first time around and had to be transferred into hospital afterwards (dd didn't breath). For some reason the ambulance gave us the scenic tour of the surrounding countryside and the midwife who was travelling in her own car got to the hospital before us! Everything was fine, and the problem with dd was not related in anyway to the homebirth. I'm now due with my 2nd in October and have got the same midwife and we're on for a homebirth again (this time I intend to stay at home afterwards). Although it is possible that the hospital my put some pressure on me to have this one in hospital (my midwife said expect a phone call), it's highly unlikely that the same thing will happen again and as other messages have said, the second should be a lot easier - I hope so because I had 36 hours of labour last time! Just get yourself informed and see how you feel nearer the time. Good luck!

WWW - I hadn't picked up on the fact that you were pregnant - congratulations

Glad you started this thread and hope you don't mind me coming in and asking some of my own questions.

DD was born at hospital after almost 30hrs of full (every 1.30 mins) labour (induced) and both she and I were highly stressed. I ended up with pre-eclamsia and was given 30 mins to push her out of I was off for an emergency cs. In total during that time I had 11 midwives attend me and some were stars and some were awful but I can't shift the idea that some of the midwives caused more harm than good. I don't want to go into all the bad things but needless to say I am now seriously toying with the idea of a home birth and have a couple of questions...

When is the ideal time to announce my thoughts to the medical profession. I'm only 22 weeks so it seems a little early yet. (vaguely told my doctor when announcing my pregnancy but think she's hoping I will have forgotten the idea).

If you had pre-eclamsia first time round I've been told that new evidence shows that you are more likely to get it second time. (I thought that if it was the same father you only had it the first time round). If yes - will this rule out having a home birth.

What books?

Hey there,

I think you need to do what you (thats right you and nobody else) is happiest doing. Giving birth is such a personal thing that there are no rights and wrongs. But your birth is likely to easier and less overwelming if you are in your own secure and safe place. If this is your home, fantastic and if its in hospital that is just fine too!

I had both my babies at home. I live 35 miles from the nearest hospital (a 25 min ride with no traffic but up to 1 hour depending on tractors and/or communter traffic). I trusted my midwifes to do their job and identify and deal with any deviation in a timely and appropriate manner.

Few obstetric emergencies occur without warning and if you trust and respect your midwife and their level of experience it shouldn't matter where you decide to have your babe.Its a tough one.

Best of luck where ever you choose - may your baby slide out healthy and happy!!

I'm confused, Wills: did you have a C-section before?

FWIW, I have several friends who had horrendous first time labour experiences although not ending in C-section who went on to have (relatively) very easy 2nd births. Just to prove it "can" happen.

Personally I like to plan in advance so would probably psyche myself up for homebirth and then tell the midwives, by 5-6 months, that's what I intend to do. Means you can do things like get a birthing pool booked for sure, and talk thru any legitimate issues. They may have all sorts of arguments to try to disuade you, so be braced for what they might say. The homebirth email list that SueW linked to below is an excellent place to get support.

Nope didn't end up with a c-section. Just felt that generally not many people at the hospital helped. Most of them simply panicked me.

IME telling your GP at any time will not go down well (my MWs advised me not to tell him at all last time and haven't even seen him this time).

Last time I hadn't even considered a HB until the end of the pg as we have such a gorgeous local MW unit and I was looking forward to bing there. But I was so worried about delivering on-route or DH not getting home from work to deal with DS. It was the MW who suggested it at about 35 weeks. Within days they had set me up with all the gear. DD arrived at home, with DH there, no complications just pure magic at 38 weeks. This time I told the MW I was up for a HB from the word go. I don't think there is a right or wrong time - you don't seem to get to see that much of your MW with subsequent pg and if you have concerns then the longer you have to discuss them the better.

Also if you live in a rural area with a good MW unit who conduct a lot of HB then you can take reassurance from the fact that they are more experienced and are used to dealing with all sorts of eventualities.

At the end of the day its what you feel comfortable with. I suspect most women who opt for HB have a few nagging "what ifs" lurking at the back of there minds but feel that the positives outweigh the negatives. YOu can opt for a HB fairly late on or you can switch to a hospital birth at the last minute. There is no rush to decide so just see how you feel as the pg progresses.

Not wanting to put a dampener on this pro-home birth page...but a good friend of mine had a baby at hospital recently and although the birth went well, despite normal scans etcthe baby was born with a heart defect. No-one knew about it and the midwife called for a paedeatrician who arrived in minutes. Although a team of doctors were there for the baby andwith all technology the hospital could offer the baby girl died 30minutes after being born..I know the doctors couldn't help because the defect was too great, but if hadn't been as bad, then they could have. And maybe just as importantly, if my friend had had a home birth, the baby would have died with her blaming herself for not having been in a hispital. She would never have known if the baby could have been saved.

Surely a home birth is about putting the babies health first and a home birth just cannot do that.

LiL - I think that that is a little strong - I am pro home birth having just had a brilliant one but I was aware that if necessary I was 10 minutes from the hospital - there are lots of statistics to show that babies are healthy and happy when born at home and less complications arise. It is very sad when babies are ill but I dont feel that women who opt for a home birth are putting their unborn child at risk. I do agree that the guilt would be unbearable but the fact that an ambulance or driver could reach the hospital and contact the relevant specialist on the way can surely mean there are back up plans.

I can of course say this knowing that my child was healthy but I feel it is very sad if women miss out on such a positive experience due to possible guilt associated with the 'what if'

I don't really understand the example. Isn't the point that her baby's condition was such that the child would have died under any circumstances?. Presumably a less severe condition would have been spotted immediately by the midwife and a transfer to hospital by ambulance arranged in good time. In any event, depending on the hospital there's no guarantee that a transfer to a larger hospital wouldn't be needed in the event of complications.

I have to agree with Croppy on that point. I have no personal experience of homebirths, but I think I'd consider it for number 2. 2 of my friends have given birth and within hours been transferred to a bigger hospital coz the baby needed treatment!

Ok let's turn it around..if my friend now with the knowledge that her child is prone genetically to herat defects, decides to have her second child at home, wouldn't you all think she was mad. She shouldn't take the risk should she?

so if she shouldn't take the risk this time because she KNOWS her child is at risk, then surely no-one should take the risk even when they don't know if they are at risk?

Or to put it another way, are you saying that there are no conditions when being in a hospital with a medical team/operating theatre instantly on hand will save a child/mother, compared to them being 10 mins away? I guess that's the main question isn't it? because if a mother thought that speed could have saved her child the guilt would be awful. I guess I can't understand why a mother would take that risk, for the sake of soft lighting and a duvet!!!

I'm no expert but I just wouldn't have thought there were that many conditions which literally required treatment within 10 minutes or so. In any case, whether a hospital would have the necessary staff or equipment to deal with such a problem is another issue anyway as would the question of it being successfully identified in the first place. If everybody took that approach, babies would only be born in around twenty or so hospitals in the entire country.