Is it a good idea for me to have a homebirth?

[redllamayellowllama]

The birth of DS was just hideous - latent labour for 3 days, 24 hours active, EMCS after failure to dilate beyond 9.5cms due to funny positioning of DS (back-to-back, forehead presenting, lassoed by cord left right and centre), DS born with huge haemotoma.

I know that the to-ing and fro-ing from hospital, moving from Midwife-lead unit to Birth Centre, extensive internals and the sheer volume of people coming in and out had a huge impact on my state of mind and made everything feel very out of my control.

I have a history of epilepsy, although have been fit-free for 4 years+.

I think a homebirth would suit me down to the ground - I'm starting to get my head round giving birth again and am about to start a VBAC hypno-birthing number (have been superstitiously waiting till scan).

But, is it going to be in my (and, of course, DC2's) best interests, medically speaking? And, if I do want to go ahead with this, how on earth am I going to get the support to do it, with all of the above considered?

TIA for any advice.

What triggers your fits when you used to get them?

I think in your position, I'd try and get a variety of opinions from professionals. Doctors are very likely to advise against a home birth, although this will be biased by personal experience and training so I would try and balance it out by seeking out some opinions from open minded doctors or midwives, especially a midwife experienced in epilepsy.

Homebirth.org.uk is a nice resource too!

In your position I would not go for a homebirth - if something goes wrong you have minutes to correct it and if you are at home the midwife will have limited resources. I honestly think that you should think about the risk and have the baby in hospital. (by the way I had back to back unusual presentation and wanted all natural birth and would do exactly the same myself if I have another...)

I am hoping for a homebirth, but I have had 2 previous easy VBs.

I suspect that they will say you are not ideal candidate for a HB. It sounds though that a significant factor in your DS's birth was his position, and I assume that you will do everything you can to make sure that this baby is in good position for birth?

I agree that hypno birthing good idea to get over your DS's birth and to prepare for a VBAC, although not sure how you are going to persuade midwifes that homebirth is good idea - you might need to be quite mitilant?

I did have a good birth (hypnobirthing birth) with my DS in a birth centre in a big teaching hospital - but then it was quick - only 2 hours - (my DD's birth was a VB) no one extra came into room, no internal examinations, all very calm - it was this quickness and calmness that is giving me confidence to have hb with dc3.

Thank you for all the responses.

Fits are triggered by drunkenness (no problems there), tiredness and stress. However, I didn't fit whilst pregnant or during labour with DS, which were prime times to do so. My neurologist is seeing me one more time before declaring me no longer epileptic.

spottedandstriped that's what I feel is the most sensible answer. Were something to go wrong, I could never forgive myself for having made the decision to have a homebirth. I think the association between location of DS's birth and the events of his birth have become inseparable for me.

MumNWLondon I thought I had done everything last time round! Having not had the calm experience you had, maybe I am not best placed to be at home now.

redllama, it might be worth talking more to your neurologist. From your history, it sounds as though the chance of you fitting is unlikely? But that would need confirming with a doctor.

It's easy to scare ourselves from home birth with stories of 'something going wrong' - most things (not all) can honestly be dealt with at home and many complications are caused by the stresses and interventions of the hospital environment. (There's very sound medical evidence on the inhibitive effects of stress hormones e.g. adrenaline on labour.)

The trick is to be specific about WHY you are high risk and to know the probabilities involved for each specific risk and what you can do to lessen them. Then you can make a more informed decision. It's easy to just be written off as 'high risk' in general.

FWIW, my first birth was a 'failed' home birth which ended in EMCS. My second and third births were lovely VBACs - the third at home.

Don't let people put you off a home birth. From what you've said your previous caesarean was not related to epilepsy.

You need to give birth in the environment which is right for you.

If you look at the emergency caesarean rate, you may be put off thinking what if... however, the vast majority of emergency caesareans could have waited an ambulance ride away. (and to be honest a good fair few would have been avoided if at home, less medical intervention, cascade of intervention and all that malarkey)

I would definitely discuss it with your community midwife team, as at the end of the day it will be them attending your birth.

If your epilepsy did not effect you during your first birth, which by all accounts was not the straight forward run of the mill, what reasons are there that it may effect you at home? Surely a relaxed peaceful environment would only be a plus!

Good post, Alex

Sorry didn't mean to imply you hadn't done everything last time - does also sound location of cord had impact on his presentation - i made the comment as some people don't know much / anything about optimal foetal positioning - I will confess that i was quite obsessed about it from 34 weeks to birth - eg really attempted to sleep on left side, never lay back on sofas, spent lots of time sitting on gymball or on hands/knees - and spent all of early labour leaning forward or in polar bear position - I also refused during labour to get onto bed or lie on back at all - which was good as meant they couldn't do internal examination!

You'll have to ask health care providers about homebirth, I suspect you'll met some resistance - you need to start with neurologist to say that unlikely you'll have fit etc.

Perhaps another attempt in a MLU would be safer for you - perhaps take a doula to help prevent some of things that didn't go right last time eg unncessarily people in room.

Thank you carmen and alex, I think that researching every avenue and possible obstacles I may meet will be the way forward if I decide to go for a homebirth. DH is a bit sceptical and will also take some convincing - he is a worrier and DS's birth has left him very traumatised, I think.

It's very hard to know what the 'right' thing to do is. I know I would feel most comfortable at home, but I still worry about my body's ability to give birth (I'm working on this). If I'm going for a homebirth, I need to be very confident in my body's ability.

MumNWLondon - my post sounded a bit snotty, I didn't mean it to. I was the same as you in terms of optimal positioning leading up to and during labour; I'm someone who researches everything I do very thoroughly! DS was simply revealing his stubborn streak very early.

I think I need to wait till I've been along to the VBAC clinic and had an appointment with my consultant before coming to any conclusions.

(please pretend I haven't written this...)

If you ask for book a home birth, you can always transfer in if so be it. The community mw will stay with you (even if you do go in) - therefore your guaranteed 1-1 care with someone you know....shhh don't tell anyone!!

"DH is a bit sceptical and will also take some convincing"

Try getting him to read "The Father's Homebirth Handbook" by Leah Hazard?

i cant advise,. you need PROFESSIONAL MEDICAL ADVICE, not sure if you get that here! you might get some natural pro borthers inadvertantly giving you the wrong advice TBH

Thanks for pointing that out portamiseroa - I hadn't thought about seeing a doctor..!

I was looking for a more holistic whole picture from women who may have experienced something similar. I am, of course, under the care of medical professionals.

Homwbirthmummy - sorry to say that it is unheard of in most trusts for the CMW to say and provide intrapartum care.

I am 32 weeks pregnant with our first child, in a similar position in some ways to you - I have a history of seizures, albeit 13 years ago, triggered mainly by drugs and drink - not issues now. I also want a homebirth, for many reasons, but mainly because I think being at home will make it even less likely for me to have a fit - as stress is definitely a factor too. Also, using water is important to me, and I cant guarantee that in hospital. I have had a completely trouble free pregnancy, but have found I have a fight on my hands getting a homebirth. I was told I was more likely to have a fit in labour, theat afterwards, with the baby I should be supervised for 48 hrs afterwards - all sorts of rubbish. The consultant could only give me one reason - the risk was that if I have a fit in labour, that the babys heartbeat could go down, due to a short time without oxygen, and that I would then be monitored - my response - fine, my fits last 2mins max, I have one, I don't mind being monitored, and I will go to hospital - 10 mins away. They cannot refuse to give me a homebirth - so I am just calmly staing my reasons and going ahead with all the planning. If someone could tell me exactly what the risks are to my child because of my epilepsy, and exactly how that would be dealt with differently at home than in hospital, then of course I would listen - but all the reasons so far just point to the fact that one consultant (one other consultant already agreed that it wasn't a problem)doesn't want the hassle of having to actually advise me, and would rather make a descision based on her own dislike of home birth, or whatever - nothing to do with what is best for my baby, which is to avoid intervention, and stress (and then possible fits) to me.

I met up with a local homebirth group, and took into account my specific circumstances, before we made the decision that it is for us the best choice. I am now in the process of writing a letter explaining my history fully to go into my notes, as most consultants (and the three midwives I have had so far) have seen the word epilepsy and made their judgement without considering my situation. The other thing I am doing is choosing a pool with a seat, so I can get myself supported in the water if I feel like I have an aura, and like making sure I have someone (DH) with me the whole time - something that wouldn't happen in hospital if I have the baby there and then am left in a ward unable to sleep due to noise/distractions), or am in prolonged labour and he has had enough of being stuck in a room with me...

You do sound like you are in a much stronger position than me, having already had one child, I would say you have to weigh up all the risks in your circumstances, and then decide.

And no, I don't think, in this stuation, 'medical advice' is always to be taken completely as the rule - you know your body, and when you have experienced seizures, you know yourself how long they last, and how much of a risk they may be during labour.

Good luck though - I would ay you seem to be doing the right thing in researching all the choices - and I would love to know what you decide and how you get on.