anyone having/had a home birth against medical advice?

[heth1980]

I've been advised by a consultant midwife that they won't support my home birth because my bump is measuring on the 90th centile and my BMI at booking was 36.4. TBH she's scared the s**t out of me and said there is a higher risk of shoulder dystocia and implied that I will have a brain damaged baby (!)

DD1 was born at 37+1 weighing 7lb 12oz (complication free pg and birth), which they are arguing makes her a big baby, but I wouldn't have said that was big! I had a growth scan last week at 36 wks and the estimated fetal weight was 7lb 4....so assuming baby puts on half a pound a week from now til term, that would be around 9lb 4oz at term. I recognise that that's not a small baby but I wouldn't say it was ginormous either........I'm also aware that growth scans can be far from accurate.

I guess I'm just wondering if anyone else has experienced anythimg similar and has any advice......WWYD?

Hi, not experienced anything similar - just wanted to check you were aware of the homebirthing website at www.homebirth.org.uk - the "You can't have a homebirth because..." section. Also www.plus-size-pregnancy.org.

AFAIK shoulder dystocia is less likely at home, as you are more likely to be able to move around freely, and less likely to get trapped labouring on your back.

I haven't had this exact problem but I am going into my homebirth with a situation that is unlikely to but might arise during labour. It could result in haemorraghing and tearing of my cervix.

I was advised by one consultant that I should be in hospital. My usual consultant however thought I could at least start off at home but have a low threshold for hospital transfer.

Is there an agreement you can come to where you would agree to transfer immediately if certain circumstances arose? Are you close enough to hospital that you could be there v quickly?

you are more LIKELY to have a shoulder dystocia (by that I mean real dystocia, not bed dystocia) if you are overweight and the baby is likely to be big

this is useful reading www.homebirth.org.uk/shoulders.htm

7lb 12 is big for a 37 week baby tbh (it is the average size of a full term baby), but growth scans are very unreliable so there is no way of accurately predicting the weight of this one. It is certainly true that shoulder dystocia is much less likely to happen at home as you will be up and mobile (but it is not unheard of). There is no accurate way of predicting who will have a shoulder dystocia, but a raised BMI and previous large baby are thought to be risk factors. It is a very serious situation, and certainly poses a significant problem to mum and baby when it does happen.
As loopy says, it is a case of deciding which set of risks you are most comfortable with as there is no way of predicting what will happen in any labour.
The homebirth website smile mentions is great so have a good read of that.

hmm i had a 9lb 1 oz baby and was "warned" by my midwife that it put me at risk of another big one/shoulder dystocia/pph etc etc etc

i think she got the message that i WAS having a hb though, and didn't say that they wouldn't support me.
shoulder dystocia doesn't only happen with big babies though

my next 2 were both born at home, at 9lb 5 and 9lb 11 respectively and no problems at all.
there is certainly a school of thought who say that your body will not grow a baby bigger than you can birth (unless GD etc is involved)

there is nothing risky about having a big baby really. it's what is normal for you that counts. i have a friend who had an 11lb 12 baby at home!!

I think you need to find out your options and fight to do things the way you feel is best for you and you baby, once you know all the options you can use the information to back up your argument!!

I would have a hospital birth.

I've had 2 hospital births because I was classed as high risk both times, albeit for different reasons to you. Both my DCs were born at just 37 weeks and they were considered a good size for their gestation and they were much lighter than yours at just under 6 and a half pounds each. 7lb12 is pretty large for a 37 weeker IMO.

Why are you so against a hospital birth? The medics are advising you to go to hospital as you have certain risks, just as I did. I am not sure why a home birth is so important to you?

Hi Heth,
I had a homebirth against the advice of medics, because I had gestational diabetes and was thought to be carrying a very large baby (they were right - he was 10lbs 12oz).

TBH I didn't want to have to fight for support from the community team who were nervous about caring for me, because of the risk of shoulder dystocia. I ended up employing an independent midwife who had done a fair few 'high risk' homebirths, including breech, twins at home, big babies etc. I do feel for you and don't know what to suggest, other than talking to the supervisor of midwives. If you are adamant you are having a homebirth she will talk things through with you with a view to planning your care and what would happen in the case of an emergency at home.

Good luck!

lololol - it's very hard to understand why having a baby at home is so important to some women, like it was to me. People have all sorts of different reasons. For me it was more about wanting to be delivered by a midwife who I knew and trusted, and I simply couldn't achieve this with a hospital birth. Other people will have a different rationale, but feel just as strongly.

My MW has been trying to put me off a HB as this is baby no4 and there is an increased risk of post partum haemorrhage, nos 2 and 3 were born at home weighing 9lbs 3ozs and 8lbs 5ozs.

The MWs here will only cover a HB between 39 and 42 weeks as well.

Riven, with respect, those of us who are high risk who choose to have a homebirth also feel our babies are 'the most important thing'. I'm sure you also felt that way when you opted for a homebirth as a high risk mum. You were very unlucky and I'm sorry for you, but each one of us needs to make this decision for ourselves, based on what we know about our own very particular situation.

riven, your baby was brain damaged due to the MWs not giving you adewaute care not because you were high risk? is that right/ you were high risk dur to previous c.s ?

i think it is entirely appropriate to share the stories of home births going awfully wrong, women need to make informed decisions about where to give birth, and thatn includeds looking at the negatives

however, most women going for a homebirth will have done some research at least into the pros and cons

sadly, baies are born damaged or injured at birth at home and at the hospital.

i do not wish to detract from your experience, riven, not at all.. however if your issues were due to lack of care, then that does not mean homebirths per se are dangerous

ifyswim

and i hope i have not offended you

i really hesitated before posting this but thought i shuold. i konw of (my friend was the mw advising ahead of the birth and being there with her afterwards tho not there at the actual birth- a mw who had 2 of her 3 children at home so was definitely pro home births) one lady who insisted on having a home birth despite advice against it for similar reasons to yours. it is very sad that the baby died during labour. it might well have happened in the hospital as it is totally unexplained (no shoulder dystocia) even still. but the woman blames herself completely for going against medical advice. she used an independent midwife for the birth itself. really not trying to scare you but just wanted to post this to make you aware. it prob wasnt the location of the birth but that woman will never accept this as the truth. i was desperate for a home birth too so know how you feel. i had to be induced first time and my dh wasnt happy about it second time so i didnt do it.

Riven does have a point. For some women home is just not appropriate. We cannot simply agree to every woman wanting to birth at home or we would not be safe practitioners, operating safely within our sphere of practice. Independent midwives are somewhat different in that they have much, much more experience of home births.
Having said that, I will treasure the memories of having dd2 at home and hospital is no guarantee that bad things won't happen cos they most certainly do.
Riven, I am very sorry to hear about your experience.

but within high risk , there are variations

being high risk due to previous c.s or due to BMI or previous GD does not necessartily mean that there is grave danger to mother or baby

babies are born damaged in hosoital too, being in hospital is not a gurantee all will be well

very sadly learnt recently of an acquaintance having a stillbith in hospital. sometimes awful tragic things happen for no discernible reason

but if a woman says, ok, i have high bmi and a large baby, i understand and appreciate the increased risks to the baby and myslef, but i am still making an informed decision to give birth at home.... should she be stopped?

pregnant women are still sentient beings!

i do agree homebirths are not apporpriate for everyone, i have declined to doula births where i feel there is not enoguh attention being paid by the mother to the possible risks so i don't blithely go along with things just becuase that is what the mother wants

from what i hear and see, homebirth are refused left right and centre for any and every reason

i hear women being told your labour will be complicated/ you';; need inducing because you are"

too tall
too short
too thin
too overweight
too old
too young

it is not necessarily the case that you would not be able to transfer in quick enough if there was an issue

sometimes, problems are picked up quicker at a home birth as there is one to one care !

DD1 was born at home against the hospitals's advice. She was breech. We used IMs to get MWs with breech experience - for us it came down to a choice between CS or homebirth with IMs, as the hospital would only give reluctant support to a very medicalised vaginal breech delivery.

All any of us can do as parents is to make the best choice we can based on the information available to us. That should include what the risks are, how big the risks are (both quantatively and relative to an "average" pregnancy) and what the consequences could be. That information should be supplied for births in both a home and hospital environment. If the circumstances are such that the risks are elevated by the same amount at home and in hospital, how is that a justification for recommending against a homebirth? The benefits of a homebirth are rarely mentioned by HCPs - very few women seem to be advised to have a homebirth even though, for a low risk pregnancy, they would reduced their chance of either an instrumental delivery or a CS by about 50%

Pointing out the risks of homebirth without giving the risks of a hospital birth does not allow women to make an informed choice, it frightens them into making the conventional choice.

I was vv low risk and had a homebirth. But it went wrong and my DD ended up in the NICU. She is fine now, thankfully.

However the reason that my baby (and me)ended up in trouble was nothing to do with it being a HB. The midwives were grossely incompetant and made a catalogue of 'what you learn on the first day' mistakes.

I dont tell anyone that I had a HBGW in case they blame me without knowing the whole story. So you should be aware that this might happen if something goes wrong even if it isn't connected to the location.

Btw I am still pro-HB and will have another one if I have another DC but I'll hire an independent midwife regardless of how much debt it gets me into. I don't trust NHS midwives anymore.

I think anyone considering a NHS HB should take into account that most NHS midwives aren't sufficiently experienced in HBs.

Sorry you don't trust NHS midwives foreverastudent, although I agree there is a wide variation in experience of home birth that is inevitable in a society which has only 2.5% of babies born at home.
I agree with Lulu about the 'grades' of low/high risk. Some of the exclusion criteria for our Birth Centre or home births make me ashamed. Of course much of this 'steering' is as a result of CNST (Clinical negligence scheme for trusts) the insurance scheme trusts buy in to. Obviously, the less 'risk' the trust takes the lower their insurance premiums are so go figure...Midwives and childbearing women are left trying to fight the good fight in a very imperfect system where we seek to blame the individual (whether mother or midwife) for failings in the system.

I agree with what Riven is saying
I had 3 homebirths all low risk but it was really all about my desire to avoid being in hospital and to make me feel more relaxed rather than it necessarily being right for my baby.

Apart from my midwife, everyone who I spoke to thought I was mad to attempt a home birth with DS, not because I was especially high risk though just because homebirths weren't the done thing then.