Strongly advised not to have homebirth due to possible large baby - overly anxious midwife or sensible?

[NorkyButNice]

I had a growth scan yesterday and the baby is estimated at 8.5lb at 35 weeks. Sonographer predicts minimum 10lb at birth, but could be more (eek).

I'd pretty much decided to have a homebirth with full support of the midwives, but after the scan the sister at the antenatal clinic said that they strongly advise not trying a homebirth with such a large baby, and they probably won't support me going ahead with it.

Surely they can't refuse to turn up if I decide to stay at home? Or am I being stubborn for the sake of it?

I have to see the consultant next week to "discuss delivery options", and then have another scan at 38 weeks.

I had DS at home (planned), he was nearly 10lbs - twas a 2.5hr labour and a doddle compared to DD (8lbs) also born at home.

I can't remember the exact figure but at a meeting I had with my consultant just last week I was told that big babies only account for about 20% of the cases of shoulder dystocia. I experienced shoulder dystocia with my ds and he was only 7lb 10. But I had been confined to the bed, flat on my back and wasn't 'allowed' to stand-up or move around because the monitor kept slipping. So it's definitely not always about size.

Have you spoken to your midwife again? That's what I plan to do. Consultant was very reluctant to agree to me giving birth anywhere except on labour ward and yet the 3 midwives I've seen so far in this pregnancy have all told me I'm perfect candidate for a home birth!

Oh, and I also believe that your body will not grow a baby bigger than you can cope with. I may be deluding myself, but that's what I've chosen to believe in order to get me through the next few weeks

MIl gave birth to DH at home. he was 10lbs - she is not particulaly 'ard, she just wanted less fuss.

As you have already delivered a baby and have a rough idea what to expect, i don't think you'd be being stubborn merely for the sake of it -

what are they, realistically, going to do at hospital that will be different? heart monitoring? extra pain relief? - if you know you don't want these things, then why go to hospital? if you do, or think you might, then hospital may be a better choice.
If you want a non-interventionist approach, you will get that at home complete with more familiar and comfortable surroundings.- and, if you find you want additional pain relief, or if the MW finds the labour is not progressing or believes there are other problems then you can transfer in.

at the end of the day, it is your choice.

my baby was 9lb5. No-one knew how big she was going to be, I couldn't get her out. I was in hospital- failed ventouse, forceps, episiostomy. She suffered oxygen starvation and was in NICU for a week, but now her prognosis is good.

Sorry but there is no WAY I would want to be home- the transfer time to hospital would have meant my baby would have been severely brain damaged as opposed to some evidence of an "event" on her brain during delivery but a good prognosis.

That said though part of the reason I couldn't get her out was probably the epidural, which you won't be having, and also a friend had her 9lb 5 baby 8days before me and got her out no probs. So its very subjective. Since it is your second and growth scans are unreliable and you will be relaxed in your home environment and able to in a favourable position to push then probably all will be fine but I couldn't not post my story.

(oh and my growth scan 5 days before delivery said big baby- possibly 8lber. (if only!)

Thanks for all the responses - it's great to hear people's experiences (even the ones advising hospital births!).

I think the problem I've got is that my last birth was quite medicalised - DS was born in New York and it was a case of epidural straight after arriving at hospital, then flat on my back for the next 5 hours with no sensation during pushing. We stayed in hospital for 3 nights afterwards.

So from that to a homebirth was always going to be a big jump but one I was very keen on.

My next midwife appt isn't till next week so I'll speak to her then.

I'd try for a midwife led unit myself. That was my compromise for my first birth, as a test for what I hoped would be future homebirths. I had a wonderful time starting off with reflexology foot massages, loving, loving loving the birth pool for the next 13 or so hours and being as active as I could be with minimal monitoring, no pain relief other than paracetamol, cocodamol and some gas and air for the final three cms.
Other than a false alarm for gestational diabetes a month before the birth, noone spotted that my DS was going to be a whopper. 9lb 6oz and 98th centile for height.
I ended up in high dependency after my labour after DS got in an unbirthable OT position so I've decided in future I'll be very happy to labour in a hospital. I was whacked but his apgars were 9 and 9 after they pulled him out of the sunroof.
Giving birth is pretty much the most dangerous natural act a woman can do. And I too have been told that I should see a consultant about future modes of delivery. My mum was a tall strong woman but I'm a twin and I suspect the fact that I was so small at birth means my genes can build babies that I can't deliver. Apparently if there was any hint of nutritional deficencies in your childhood that risk is there. However you have birthed a biggish baby before so it's not the same situation, but I would consider an active birth type unit as a great compromise. I want to try for a VBAC with any future pregnancies and would want a pool and other minimal interventions in that sort of setting myself. But having seen that bad positionng can be a side effect of a big baby I have no wish for a homebirth anymore. Anyway good luck.

Little silver - honestly - chill out!

To the OP - a story like thandeka's would be enough to swing it for me! Hope all goes well for you.

i think that thandekas post points out that if she hadn't had an epidural and had actively laboured, she recognised she may have birthed her child without that difficulty (statistics back this up) - though of course you can't know that in any individual case.

The OP birthed quite a large first baby on her back with an epidural in place in only 5 hours- i wouldn't underestimate the ability of her body to safely birth a larger baby.

I am still a bit at health profesionals that discount HB as too risky, then casually suggest a CS as though that is totally risk-free.

I think it is down to whether you trust your mw or not. If you do trust your mw, then listen to what she says (esp if she is likely to deliver the baby).

Fwiw, I've had 1 hospital birth, 3 homebirths. All were big babies, the smallest being 9lb12, and the biggest 10lb12 (getting bigger each time). The last one did get a bit stuck when it came to getting his shoulders out, the mw skilfully got him out and avoided injury, but she was worried, and said afterwards that if I ever had another one, she wouldn't recommend another homebirth! And I would go with that, as shoulder dystocia is potentially very very serious, and isn't a problem that can be transferred to hospital for.

I am a real homebirth fan, but I wouldn't put a baby at risk in order to have one, and if I was to have another baby I don't think I would have another homebirth, as it was a bit touch and go with dc4.

DS1 was 7lbs10 and he had shoulder dystocia. I won't forget the panicked minutes inbetween his head being born and the rest of him coming out. Consequently with DS2 the Consultant suggested a CS. I didn't want a CS because of the major surgery etc but he considered it the safest option for the baby. We had a full and frank discussion about the other options. I felt fully in control of the choices that I made, but at the end of the day, felt that I could not put my birth preferences ahead of the safety of the baby. I had a CS. It was fab.

Anecdotal evidence always needs to be taken with a pinch of salt - for every good experience, there will be a bad one.

So here's a good one: I had my 3rd hb with my 3rd baby who turned out to be nearly 13lb. (Head circumference was 5cm longer than average too!) I had a little gas and air during transition and no tears. I'm pretty tiny but believe that being in the water and left alone, both me and baby were able to get into prime delivery position.

Even though I was huge, noone suspected a big baby and I'm glad that I was able to give birth without any added anxiety regarding size etc. Anxiety isn't going to help you give birth and as previous posters have said, the tools used to predict size are extremely unreliable.

Read Ina May gaskin's book, Spiritual Midwifery before you decide.

link

She is a very experienced midwife and claims that unless the mother was malnurished in childhood or has gestational diabetes the baby will not get too big to come out.

Her statistics of 1000s of births prove this point - her opinion is that big babies get stuck in hospital due to poor midwifery skills and women attempting to give birth in sub-optimal positions ie labouring lying on their backs.

BTW 2nd births are easier than first births anyway and if you did birth lasrge baby lying down last time then should be easy to birth bigger baby if at home and upright.

As example - all my three DC very similar in size:
DD - was upright (birth stool and standing)and pushed with all my might for 90 mins - would def have needed "assistance" if i was lying down
DS1 - was in pool, pushed gently for 20 mins
DS2 - no time to fill pool, was standing and he shot out with no pushing in 2 minutes!

I do get the impression that some midwives are almost anti-home birth and will find any reason to put women off the idea. Perhaps they would rather have their colleagues at the hospital looking after 8 women in labour rather than drinking tea at one woman's house?!

DS2 was born at home (planned HB) weighing 8lb 10oz and it was a breeze. I'd second what other posters have said about the statistics proving that intervention is less likely if you are at home.

If your baby is big, what are they going to do at hospital that they can't do at home? If there is a problem, the midwives at a home birth won't leave it until you're in danger - they'd transfer you in. And the time taken to prep the operating theatre means that you'd probably arrive at the hospital at the same time you'd be wheeled into theatre from the delivery suite anyway.

I hope your midwife gives you some sensible answers so you can make an informed decision.

Have you had any other indications, i.e. large fundal height measurements, sugar in your urine sample etc?

I had both of those at my 40-week appointment, and was advised by my MW that she wouldn't be happy for me to have my planned homebirth due to increased rick of shoulder dystocia.

I went to hopsital on her advice, laboured in the pool with just G&A, pushed for 2 hours, did not stay on my back AT ALL and still ended up with a shoulder dystocia. It took three MWs to pull him out of me in the end.

This is only my experience - not advising you by any means - but personally I was glad to be in hospital.

I'm now 22 weeks pg with DC2 and planning a hospital birth; I saw a consultant who said that due to slightly higher risk of SD happening again, all MWs in the unit will be briefed when I arrive on the labour ward and a consultant will be waiting outside while I'm pushing.

She also said that shoulder dystocia is not always/solely to do with baby's size - as pevious posters have said, position of the baby and position of the mother have a lot to do with it too.

In a nutshell, if it were me I wouldn't let a 'big baby' be the ONLY factor in putting me off a home birth

I would dispute what Ina May says - I don't think I could physically get a bigger baby than dc4 out - it was pretty panicky as it was. And I had a very active and mobile and upright labour. It was entirely down to the skill of my mw that she got him out safely (McRoberts manoeuver). If the shoulder does get stuck, you have about 5 mins before consequences are catastrophic, and you can't transfer to hospital at this stage, as the head is born. It is quite scary when it happens!

And just to add, I loved my 3 homebirths, but I wouldn't risk another (I almost chose to have dc4 in hospital, because dc3 was quite tough to push out, and I figured dc4 would be bigger - which he was). I'm not planning any more children, but would definitely go with hospital if we did have any more.

I had an 11lb 0.5oz baby at home.
Had a planned c-section for number 3!!!

MumNWLondon what I would have done for a 90 minute pushing phase... I'd have got him out on my own if it would have only taken 90 minutes. I tried pushing standing, then doing deep squats slamming down onto my haunches while holding the side of the bed, then lying on my side with one leg in the air we tried it all.
I had an undiagnosed deep transverse arrest, which is about as painful as it sounds, and my midwife telling me to push harder when in fact as I kept telling her I had no urge to push at all because he was well and truly stuck.
I laboured actively the whole time. And only got on a bed for a spinal for the c-section.
You really can do everything in your power to get it right, read the Ina May Gaskin book, spend your last few weeks surgically attached to a birthing ball, do yoga, sports right to the end and still end up needing assistance. I'm now much less judgemental of women needing a c-section and don't suggest they labour actively the next time or read x or y book. Chances are they were doing that in the first place. Sometimes shit happens, and if you and baby make it through the other side more or less okay then I'm very grateful to modern medicine.
And as for the OP I don't suggest any of this will happen to you - you've birthed one bbiggish baby on your back and in a short time too. You'll manage this one no probs.

I also dispute the Ina May theory - no childhood malnurishment, no gestational diabetes but I can't get my babies out.
DD1 8lb 11 EMCS failure to progress even though I was 10cm dilated, labour started spontaneously at 40+8 (no epidural just gas and air)
DD2 - had growth scan at 38w as was measuring big however scan measured her at 7lb 5 and 75% percentile. Consultant advised that there was no reason why I couldn't deliver naturally ....at 40w I was given the choice of induction at 40w+5 or elective section. I chose elective section and surgeon said that baby was 3/5th engaged and her head wouldn't have fitted any further down my pelvis. She weighed 11lb 1oz and head circ 38cm. All of those pushing me for VBAC suddenly announced I had made the right decision!
Anyway FWIW I agree that growth scans can be hugely inaccurate and were in my case.

smac, my DS's head was 38 cm at 3 days although he only weighed 8lbs 12. At birth his head was so moulded after 3 days in labour that his HC is recorded as 33cm- the midwife measured around the moulding. So he could get out- I guess I was very lucky that the labour was slow and relatively gentle, which meant that he had time to manoeuvre himself from OP at the onset of labour into the best possible position to exit. I think if the labour had been fast and furious the outcome could have been very different.

OP- growth scans can be very very wrong. How big do you feel this baby is? Is your abdomen very tight- does it feel "all baby"?

Lots more replies - thanks again.

Fundal height has consistently been 3-4 weeks ahead throughout. I feel as big as I was at term with DS so I can believe that the 8.5lb estimation is on the right ballpark.

The scan report said liquor volume was normal, so I think it's mostly baby in there!