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?

I don't agree that the high risk label always means that. I was booked the otehr day by the midwife that did my last homebirth - I am on paper a high risk, I have hypothyroidism which is treated with thyroxine and I am over 40 - these factors alone make me high risk..This baby is my fourth and I have had my last two at home quickly and without any incidents whatsoever. My midwife is more than happy because she knows me and my history to do a homebirth with me but on paper I am high risk - does anyone think as long as everything remains as it is, that i shouldn't have my baby at home?

High risk is not always actually so. I really resent the inference that somehow my choice is a selfish one.

I am aiming to have a home birth against medical advice, due to this being a vbac attempt and me having big babies.

It makes me sad not to be supported, however at least this way I should have an 1 to 1 midwife, you don't get 1 to 1 care in hospital.

I really hope things go well at home, but as I know they won't at hospital, I have no choice.

Just 4 weeks until the consultant meeting

"High risk is labelled High risk for a reason not because doctors are evil or something"

I'm sorry, but this is all a matter of perspective. In my view a malnourished mother having a baby, having had no antenatal care, cared for by untrained attendants without access to even basic medical equipment, where the only emergency obstetric care is hours away - that's 'high risk'. An instrinsically healthy, well-nourished mother who's had good antenatal care , carrying a full-term, healthy baby and being cared for by highly trained and well equipped health care professionals, usually little more than minutes away from obstetric care and operating facilities - that is not what I'd call a particularly 'risky' scenario.

Women are labelled 'high risk' because the risk of something going wrong in their labour is higher than that of women who have low risk of complications. It doesn't mean that something is LIKELY to go wrong with their birth. The vast majority of 'high risk' mothers have normal labours and births and healthy babies - particularly when they're cared for properly. In my particular case I felt I was more likely to receive safe care for me and my baby at home - because being at home assured care for me from a highly experienced midwife with a good knowledge of my obstetric history.

If I'd been in hospital I would have been cared for by a stranger and subject to certain obstetric practices which I felt would have compromised my ability to birth my baby safely.

And in my case I feel completely vindicated that choosing to have my baby at home resulted in a safer birth.

I had a homebirth after the consultant wrote on my notes that she did not recommend a homebirth. I had a fibroid so risk of PPH.

However, the fibroid was tiny and the consultant was not concerned enough to do any further scans to check if it was getting bigger. It was only when I mentioned a home birth that she decided I was high risk.

I did my own research, employed an independent midwife and had a homebirth. I chose a homebirth because I knew it was better for my baby if I was as relaxed as possible and in the best care - my local hospital has a terrible midwife to patient ratio so I would not have got great care.

In the end I did have a PPH but not because of the fibroid - it was my third degree tear that did it and two hours of pushing as DS had his elbow by his face (also causing me to tear). However, I wouldn't have changed my decision with hindsight.

I'm not sure that high risk is always applied consistently, but it is foolish just to ignore the advice you are given without being able to make a very good case as to why in your situation things may be different from the standard, or what flexibility there is and when you have to acknowledge that what you want may not happen. So for the OP, it may be that she could have it agreed that if she goes into labour early when the baby is smaller then a home birth is OK, and if it's later she will go into hospital. I would also try to read up on shoulder dystocia and understand why it is an issue, and what could happen, so that you have a better understanding of the risk you are considering.

I had a hb against advice - hbac - all went fine. imo though you need to do the research yourself and decide for yourself what level of risk you are happy to accept because it's not a decision you will be able to buck pass on if things don't go according to plan. I was happy not just with the level of risk but also with my ability to live with the consequences should things go wrong - I'm personally happier to live with things where I made the wrong call rather than other people making the wrong call (bearing in mind all the horror stories about births in hospitals going wrong and knowing personally someone whose hb ended in a hospital transfer that should have left plenty of time for her baby to be delivered by c section but medical incompetence -in- -the- -hospital- meant her baby sadly died during the labour)

nooka I agree. I did not make the decision lightly and did a lot of research before going ahead. I was terribly upset that the consultant had not bothered to think about it and just decided I was high risk only after I said I wanted a home birth. Before that, she did not mention these words. If she had handled it differently (said I was high risk before I mentioned home birth), I probably would have had a hospital birth.

"If there had been a supportive atmosphere at the hospital and an proper understanding of vbac plus some freedom of choice I would have done it there."

I think this is extreme common reason why many mothers have a homebirth.

This is why my friend is having an unwanted homebirth next month and I will be having an wanted one in summer. There is no flexibility or understanding at the local hospital, the only choice we have is too opt out of the hospital system.

I just wish I had a magic ball and could tell what was going to happen then, now IYSWIM.

If I go to hospital I will have an increased chance of emergency CS and therefore 7 times the chance of dieing, increased chance of CP for my child, increased chance of losing my womb etc.

However if I labour at home despite the lower risks in the things I mention. Lower doesn't mean no risk and if I am that 1 in 200 person who ruptures, or gets some other complication, then my child and I will suffer.

Looking at the bland risks, I am safer at home with a dedicated midwife, but safer doesn't mean totally safe, give birth is risky business.

"despite it being stupid and dd paid the price"

I don't think your decision was stupid and I understand there was some negligence on the part of the midwifes who attended you. Based on the risks, you made the best decision you could with the facts you had at the time. That is what we all do/are doing

If you had been in hospital things might of gone the same way, if you had better midwifes at home that should of resulted in better care for you and your DD2.

"If I go to hospital I will have an increased chance of emergency CS and therefore 7 times the chance of dieing, "

Out of interest - where are you getting the 7 from?
I've heard 4 times, and 3 times more likely, wasn't sure if this was a global statistic in which case in a good(!)modern hospital with experienced surgeons and aftercare I was thinking it might be more like twice.
Even 7 times miniscule is still miniscule of course.

smilehomebirth, I did read it somewhere but I am happy to go with the lower figures of 3/4 times rate of death (unless I can find my bookmarked study)

My particular concern is rupture due to previous CS scar, I have heard the common figures like 1 in 200 of this happening. This relates to all types of ruptures many of which are minor issues which cause no issue for mother or baby, some can only be felt by hand on the inside of the cervix after an further CS has been performed for an alternatively reason.

The more reading I have done shows that for an vaginal birth before one c-section in an vbac attempt we have a less than 1 in 4200 chance of serious injury or loss of life for me and/or my baby.

But like Riven says there is a 1 in 100 chance of something going wrong with any birth, however low risk and hospital based the birth.

It is hard to take consultants seriously when our 1 in 4200 is touted as going to definitely happen whilst dismissing the 1 in 100 risk that all mothers to be have as irrelevant

Oh and I found a couple of studies which claim 'continuous monitoring' noted between 55% and 80% of ruptures, so they miss between 45% and 20% of them as well. So hardly the miracle protection against ruptures

If your particular concern is of rupture due to previous CS, why not get a late scan of the scar to determine thickness and likelihood of rupture etc? This is common practice in other countries (I've certainly had one). It would at least give you one indicator of risk.

Is the risk associated with home births after a c-section mainly a risk to the mother, or to the baby? i am considering a HB, my c-section was 5 years ago...it's 'against medical advice' but it's hard to gauge what that actually means and how risky it is.

"If there had been a supportive atmosphere at the hospital and an proper understanding of vbac plus some freedom of choice I would have done it there

I would have birthed my baby in hospital if possible - if I could have gone in with my midwife and if I could have got the hospital to agree not to try to pressure me into following protocols for GD patients.

It would have been the better option, but it wasn't available. For me the next best thing was to be at home, 3 minutes drive from the hospital.

Qeh? surely if 1 in 100 babies were either stillborn or braindamaged we'd know about it!
Oh, I suppose you mean without any medical checks or supervision. Still seems too high to me. Lots of people out there having medically unassisted births, I'm sure they'd be alot more worried about it if that statistic were true. Aaarrgh, statistics, don't you just love and hate them?

smilehomebirth - really REALLY with you were correct. Sadly, though, I can tell you that you're not. SANDS (the Stillbirth and Neonatal Death Society), 17 babies per day or 6,205 babies per year are stillborn or die shortly after birth in the UK. The National Statistics Office quotes 708,711 live births in England and Wales in 2008, with a further 60,041 live births in Scotland for the same period. That gives 6,205 deaths per 774,957 total births - which means 1/124 births.

It is something that does cause concern and is being investigated, but when 50% of still births remain "unexplained" (even with an autopsy), its difficult to know what to do to improve things.

DD2 was stillborn. Until we became involuntary members of "the club", we were unaware just how big it is

Tangle, so sorry that you lost DD2

Oh no, I'm going to ask for a homebirth, but my last DS was 9lb 5 and this baby at a growth scan was in 90th percentile.
I hope they don't use that as an excuse to not offer me a homebirth.
I'm a tall woman though 5ft8 with child bearing hips, so those weights aren't exactly big for me :-/
Why judge it on weights? surely it's relative to the mother's build?

I wonder how big too big is? My last was 8.14 and the midwives were blown away by how bug he was. I looked really small and neat , and I am 5.8 and size 18. They thought he would be about 6.5 - 7lbs and he was a whopper! I am assuming my next will be a bit bigger..... no one has mentioned to me that homebirth is not absolutely the right thing for us. I wonder what the policy is anyway? I think maybe the midwives here have a lot of discretion.

A lot of the decision is based on the cifidence of your midwife i think too - my last boys hand was above his head, I guess in theory we could have had a shoulder problem but honestly i don't feel that this could not have been dealth with here - the women who attended me are both really confident experienced women. I am really not militant about this but I just cannot see the problem is you are having a normal pregnancy.