Not a bunfight please but Home & Hospital births advice for first timer.

[shouldIbecrossaboutthis]

I'm currently 14 weeks pregnant and I know this is early but I like to plan ahead!

I was hoping to have a home birth but reading the recent study (Can't remember the name as on a different laptop, but it was linked to on another thread) and speaking to a DR friend who told me a horror story, I am now doubting my initial thoughts.

Bit of background: I'm 28, exercise for 1 hourish 5 days a week, fit and healthy with (as of yet) nothing out of the ordinary pregnancy wise. I live 1.5 miles away from the hospital. Women in my family (mother, sister, aunts) have a tendency to have 8lb babies within 9-12 hours with their first labours. Not that is means much I know!

Reading the study, am I right in thinking first time mums have the best outcomes at a MLU?

With a home birth my main concern is that the transfer time between my home and the hospital could make the difference between life and death? I know having 1 midwife with you means it?s unlikely to ever be an emergency, but if the midwife didn?t notice we were on a dangerous path would the added transfer time really make the difference between life or death? I?m guessing with your second you kind of have a feel for what is normal and what isn?t and that?s why the outcomes are the same for MLUs and HBs with second labours, you can give the midwife a heads up as such?

Any opinions would be brilliant, either way, as I really am confused.

NB: I'm contemplating a home birth not because I think a birth is something you should necessarily enjoy as such, my main worry is making sure we both live and beyond that anything better is a bonus. I hate hospitals so am just not sure I would be calm in that environment and that is why I am considering home birth

hoping it doesn?t turn into a bun fight

Firstly, I am pretty sure that most people who answer this will be firmly in one camp or the other, so to speak! Sorry for generalisation folks, but most of us have our own views on home vs hospital births. I am going to try to stay as close to the fence as I can so I don't end up givng a rant! but I have to admit I am in the hospital camp (or MLU, if you prefer).

My reasons - I'm a GP and used to work in Obstetrics. It was not uncommon that at our weekly MDT meeting we would end up reviewing births that had not gone smoothly because they were home births or even MLU and the transfer time to hospital when something went wrong was crucial. By something going wrong, it was usually that the baby had developed fetal distress and needed delivering urgently. For that reason I chose to have my first baby in hospital and will be having this one there too.

From the other side of the fence - I fully appreciate that given my profession I have seen a much higher proportion of complicated deliveries than the true figures show. Most deliveries are straight-forward and if you are healthy and have no risk factors then you are more likely to be in that group than not. Despite my personal concerns based on what I have seen, it would be entirely wrong to suggest that all women should have their babies in hospital because it is the safest place. Most home births go absolutely fine because only low-risk women are recommended to have them.

I would advise thinking about the pain relief you might want, too. I loved my epidural! ;) But if you would feel more relaxed at home, then that would help also. It is such a personal choice, I would weigh up both arguments and make a decision with your partner, don't listen to just one side. I hope that hasn't just confused you more! Apologies if so. All the best,

xx

Thanks, mummy2benji it is the tranfer time that worries me the most TBH. I don't know how accurate my thoughts are, but I'd imagine, when the baby needs to be out, it needs to be out right now? It would take less than 5 minutes to drive to the hospital of course, but 5 minutes could make a big difference I think if what you say is true. Is that right?

I know about how all the events leading up to a home birth would mean a blue light to hospital is very unlikely but it's not an impossibility is it?

I wish I had a crystal ball to be honest!

PS> i think it terms of pain relief, I'm going to do a hypnobirthing course and hope that will see me thorugh with G&A perhaps but in terms of drugs I only want an epidural I think everything else will make me feel sick and spaced out!

If your main concerns about hospitals is that you don't like hospitals, it's worth having a look around your local maternatiy hospital. You might find you find it OK. You can take your own food, music, etc in with you.

Personally, I would go for hospital because you cannot know that you'll have a straightforward birth (being healthy beforehand is good, but no guaruntee) and an awful lot of people who try for homebirths get transferred during labour, which is much more stressful than earlier on.

And also, if it's your first birth I don't think you can really predict what you will want from pain relief. I was hoping for a water birth with mine, but halfway though labour that felt like someone trying to chop my leg off and offering me a hot bath . You cannot have an epidural at home. I had one in hospital and for the first time in 15 hours I smiled and remembered I was going to have a baby to look forward to :) Personally, wouldn't want to rule that option out.

Some hospitals have midwife led units, which aim to be more homely and some hospitals let you go in just for the birth and have an early discharge (ie that same day if all is well)

A crystal ball would be very helpful! It's good that the hospital is only 5 mins from you. The complicating issue would be if you were in the late stages of labour and therefore needed an ambulance to take you rather than being driven. That would be an extra few minutes delay, although the fact that you're so close to the hospital probably means that you wouldn't have a long wait for the ambulance.

It's a hard decision to make! If a baby is in distress then every minute matters until they are delivered. But the chances of that happening, especially in a fit person with no risk factors, are very small. Maybe have a chat to your midwife? She will likely be in the pro home birth camp, but she would be able to reassure you that from a midwife's point of view you are a 'low-risk' person.

The thing I don't like about hospitals is the smells and the Medical-ness of everything, "don't like" isn't a very good adjective really; I walked around with a broken arm and collar bone for 3 days because the thought of going to a hospital actually made me throw up. I might try and go to see the MLU, it's might not be the same, I hope, it?s right next to the hospital though.

I was kind of thinking we could start at home, and then if I want an epidural we would go to MLU/hospital. I know that it can sometimes take ages to get the Anesthetist around anyway, I thought they could phone ahead, let them know I was on my way in .

homebirth site is well worth a read. Quite a few mums, especially first time mums, transfer in. This is mostly due to labour lasting a long time or wanting further pain relief rather than due to any emergency.

When you live so close to hospital (I lived similarly close to my hospital) you can bear in mind that it would generally take at least 10-15 mins to gather a team for an emergency section etc and they would be about ready when you got there. This is very unlikely to happen, there are usually lots of warning signs that things are not right - changes in heartrate both yours and the baby, unusually slow to dilate etc.

On the rare occasions there is no obvious warning, it is mainly due to something catastrophic that being at home or in hospital would make no difference to.

When you are choosing where to have your baby - make sure you are comparing them fairly - compare the risks of homebirth against the risks of hospital birth. Hospital birth carries its own risks, you are not comparing homebirth to a risk free option.

You need to choose the risks that you are most comfortable with. FWIW I felt that the risk of birthing in hospital with MWs popping in and out, being monitored by machines rather than people, was less safe than one to one care from a MW in a relaxing(ish!) environment where I was genuinely mobile and able to eat and drink as I needed.

don't like hospitals, really hated the idea of going to one.

two babies later, wouldn't consider anything else!

whilst on the floor on all fours, mooing like a cow and haemorraging like a stuffed pig, i suddenly realised that i wouldn't have made a good homebirther.

i would have worried about annoying the neighbours, staining the carpet and pannicked that people visiting would have put me off my stride.

for me, hospital was a revelation. everything was clean purpose built and in my mind, safe (away from friends, phones and passersby)!

i then had the pleasure of a BIG hot bath afterwards and someone else to clean up the mess.

the perfect scenario is to arrive two hours before delivery, straight into delviry suite, into bed rest and home first thing in morning, as happened with my second dd. best of both worlds in my mind.

mummy2benji, my Midwife is a homebirth & breastfeeding Nazi! She has already said it'll be straight forward and the thing I might get transferred for is likely to be slow progress.

But I would hate for anything to go wrong and to feel like, if only we had been that 5/7 mins closer it could have made a big difference IYSWIM.

I like to think of things from all angles. really I was hoping someone would say, it'd take 5 mins to get you into a theatre so 5 mins transfer time is not a lot really

I have a friend who had an amazing home birth experience, v relaxed, could go straight into her own bath/bed and have some peace afterward, without the hurlyburly of the ward. However I didn't want to rule anything out, iykwim, so went for hospital birth. 'twas right for me as I needed epidural (very long labour), dd was distressed, and they had to crack the forceps open. Our births were both right for us. My thinking? Go with your gut. I know this is your first, but you'll probably have some ideas about where you're at in terms of how you cope w/ pain, for example.

Hmmm, I wish I could say that things are that organised in hospital that they would phone ahead to let the anaesthetist know you want an epidural...! I agree that going to have a look around the MLU and the hospital would be a good idea. Labour wards aren't like any other ward, they have big rooms with a bathroom in and some have a birthing pool. Try to work out what it is about hospitals that terrifies you, as if it is a certain thing - eg fear of people pouncing on you waving instruments - then talking to the midwife might help allay that fear. Births are meant to be as mum-led as possible - apart from necessary assistence with delivery, if required, it should be your choice about pain relief, whether you lie on a bed or pace the room or bounce on a birthing ball, and how much intervention you want. You shouldn't have people pouncing on you wanting to "do things" that you don't want.

Your MLU is sounding good, right next to the hospital. You might be able to convince yourself that it is actually a little hotel for having babies ;) Maybe have a look round and see what you think. The down side to viewing places is that you might hear a woman in labour bellowing like a cow and be entirely freaked by the experience! Don't let it terrify you though, it really isn't that bad. I know I am speaking from the comfort of my epidural :) but I managed without it until 8 or 9cm dilated, I was more knackered from no sleep for 3 days.

Hi,
Just to offer my experience....
I wanted a homebirth with my first (also do not like hospitals and knew I would be more relaxed at home). My nearest hospital is also about 1.5-2 miles away which I felt comfortable with.

I ended up staying at home for the majority of the two days worth of labour but ended up being transfered in after two hours of pushing...bubba got a bit stuck (found out after she was back-to-back). Although the ambulance drive was NOT my favourite part I must admit (being told not to push when your body is doing exactly that is hard) the whole experience was very quick (think I was blue lighted) and fine (she arrived within the hour at hospital and I discharged myself 1.5 hrs later!).

Although hospital right at the end was the right thing for me first time round I am definitely going for a homebirth again this time (am also 14wks!). Basically....my advice is to keep an open mind as anything can happen. For me personally doing most of the labour in the comfort of my own home (in and out the pool) was amazing and am actually looking forward to doing it all again! :-)

Sorry if I have just babbled on.
Good luck x

MoaningMinnieWhingesAgain thanks for your post, that has cheered me up a lot. I did think it would take some time for them to get an emergency team together; I will clarify the timings with my midwife.

The story my DR friend told me is what had me worrying about the transfer time. A baby lived similar distance from me but sadly died, all because it came out hand first which I don't think a midwife could know? My friend told me not to consider HB, but I realise her view is distorted as she only sees bad cases.

The thing is about risks, is I understand that a MLU and hospital birth generally have (in some respects) more risks/interventions which may lead to ?negative? outcomes. But the really big risk is probably higher at home? For eg. The same woman at home and in hospital, no interventions in either place, but at the last minute something goes wrong, it?s the HB that will have the worst outcome I?d imagine? Purely because they don?t have all the right equipment in your house; I?m hoping as you say in my case the fact I live so close will help.

In some ways you can't really compare the risks in a true sense, because hospital and MLU birth are a little bit chicken and egg like.

Sorry this is long and rambly but hopefully makes sense!

I had my 1st baby at home 6 months ago

I knew all along that it was my plan, and i made it for certain at 7 weeks when i was in the maternity hospital with HG.

I live 45min drive on a good day from my nearest hospital, though i am about 20mins way from a midwife led unit where if there are problems they transfer you to that hospital.

That study may have shown that BUT there are many many many more studies that conclude different things.

I gave birth in september and read extensively on the subject....
as I recall homebirth was significantly safer for many reasons.... essentially me and baby were less likely to die, successful breastfeeding = much more likely, infection risk is much reduced, own rating of birth experiance is typically higher.... at home you get 2 midwives who are focussing there attention on you and only you.
If there are even hints of problems, then the midwives will make the decision to transfer early on (though of course its YOUR decision, they just "advise")

other things to bear in mind...... the way we birth is influenced by hormones, and its all most likely to go well when we are relaxed / in familiar places / not surrounded by lots of people.
Stress is NOT good, and nor is it when you dont feel at ease.
To me, the idea of a 45min + journey in labour would be hell = stressful = not good for a positive birth experiance......
IF i needed to go to hospital i wanted to go in an ambulence, with a midwife and blue lights to make the journey as quick as possible, and mean the 20ish or so speed cameras that we would pass would not matter etc.

I chose a homebirth (and did natal hypnotherapy) and im SO glad i did.... I asnt sure if i was in labour or not..... i thought it was early stages.... midwife decided to pop in to see, and i was 7cm ... 20min later i was a mummy!.... i would NEVER have made it to hospital, and the alternative (giving birth on the road side without a midwife present) is in contrast one of the most dangerous scenarios)

My midwifes were supportive.... I had the best / easiest birth of anyone who i have ever spoken to (except my friend who has her 3rd birth at home, she had an amazing experaince too), and my midwifes followed my birth plan to the letter.... I am the only person i know whose midwife made such a big deal about it!

The BEST bits which IMO arnt important as in for health, but are perks of homebirth.... going to bed in your own bed with DH afterwards
having a bath in your own clean bath (how mant stories do you read of people reporting manky hospital bathrooms covered in other peoples blood / fluids etc etc)
access to a whole kitchen full of food whenever you want it, for both you and DH and visitors.
Not having to make the "going home" trip... I cant imagine how stressful i would have found that.... our first car journey was nearly a week after birth to mum-in-laws, 5min drive away.... that was long enough for me.

I suggest do what makes you feel comfortable, and remember there have been lots and lots of peer reviewed studies done, and most have concluded that homebirth is not only as safe as a hospital birth, but in some instances safer.

Also should you want a water birth you know your pool WILL be avaliable (ie no one else in it) ... saying that mine wasnt as we didnt have time to fill it.

Oh and i had no mess at all to clean up either.

Good Luck

It goes without saying that my number 2 will hopefully be a planned homebirth too

I was desperate for home births with both my babies but long non progressive labour meant I was transferred to hospital both times....not too critical...
Not trying to scare you, but tell you my experience. After my 2nd child I had a massive haemorrhage, about 30% blood loss....if I'd have given birth at home then I'd not be here now...it happened so quickly and I'm 7 mins from hospital (flashing lights)...obviously this isn't extremely common, but it is a definite risk.

I had 2 home births and one blue lighted to hospital one

I have 2 hospitals 30 minutes away in either direction. Addenbrooks being the best known one (didn't go there by the way)

I was surprised that the midwife and paramedics thought that i might make a fuss being transferred to hospital.

I did want to be at home but not at all costs.

(The paramedics didn't want me to give birth in the ambulance either, I thought it was because of safety reasons. They have to stop apparently but they told me no it was because they don't want to have all the mess to clean up )

And doctors always tell you horror stories. Doctors don't seem to like home births!

I had Pethidine available at home (all in a syringe ready to go!) but I'm not sure they allow that anymore!

As Midge says Go with your gut. My first was induced and I really didn't enjoy the experience at all. I had to be really determined with my first home birth as it wasn't the done thing then (1995) and most people thought I was mad.

I had DS in hospital, but only just really. TBH Things went so quickly and smoothly, that I only got 20 mins pushing in hospital and that was it. I wish I'd gone for a homebirth, it wouldn't have made much of a difference to me, but recovery would have been better. I got stabbed 11 times by doc trying to take blood, hitting nerves all over the place, and ended up with nerve pain and weakness that lasted weeks. They never did take that blood.. I made them stop. I had to stay in ward overnight, wanted the 'hotel' but had very very slight temp. Would much rather have stayed at home and rested.

Next time I'd have a homebirth without question. I'd even fight for it if I had twins or something.

TBH I think the transfer time would be about the same time they'd take to get you ready for theatre/get everyone there etc so it wouldn't make any difference. For that distance, I'd say negligable.

mummy2benji I was being a little ironic with my post, shame though right, it could be magnificent, dial an epidural, ahhhhh bliss I'd imagine

JessTT, congratulations on your PG, hope you aren't too poorly?! Thanks for your post, it's good to hear about first timers who have had home births, I haven't spoken to many. I think you're advice about keeping an open mind is going to be helpful, I'm a control freak so trying to investigate everything now, so when I need to I can just roll with it when it happens. I hope!

Also.. I remember NCT saying diamorphine is available at home (may 2010)

PS. mummy2benji I have watched every episode of every series of one born every minute and was at the home birth of my 2 nephews, bit of screaming won't phase me! The thing about hospitals is the people and the poking and the prodding and the noise!

I wanted a homebirth twice - and bottled it, twice. We're 25 minutes away from all 3 hospitals and I didn't want to risk it.

Tbh, giving birth in hospital was fine. I got to labour how I wanted and with ds, was only in the delivery room for 6 hours of labour. With dd, I may as well have stayed home, as I was in the delivery room less than an hour. THe main benefit was that dh ws calm; he wouldn't have been at home.

The only drawback in my experience, was having to sleep on a ward, eat in the canteen (on the ward) with a bunch of miserable sows who wouldn't even smile back at me, and having to wait to be discharged.

I have just under 9lb babies. If I was to have a 3rd, it would be at home.

the only person that can choose what is right is you after you have been told you are a low risk pregnancy and a good candidate for homebirth.
get seccond oppinions on if homebirth is a good idea for you from different doctors and midwives if you can so you can feel as certain as possible in the descision you make.
dont forget the maternity wards in hospital generally consist of your own room with bed birth ball and en suite etc so it wont be like being on a ward with 5 other women trying to give birth at the same time.
if you let your mw and hospital know you dont want any unnecessary intervention and no random people coming in to poke and prod you then they should listen to you.
most mlu dont have epidurals as you have to be an anesthatist (think i spelt that wrong) to give one. you can still get gas and air and pethadine and in some you can have a small shot of pitocin (generally one or two drops not a whole seringe) if your labour is taking days

so reasearch get seccond oppinions and go with what you think is best. you can always transfer to hospital or to a MLU if you feel you need to even if you initially choose homebirth.
remember that your baby getting into this world safely is the most important thing but its always a nice bonus if you can have good memories of the experience

I had a wonderful home waterbirth with my DD (1st baby). However, I did use an experienced independent midwife and I think if I was relying on my community midwifery team I would have been less confident. Our plan was basically that I would labour at home for as long as I felt comfortable with it and I asked my MW to have a very low risk tolerance I.e. Transfer me at the first sign of any trouble, not to wait it out and see. I too was worried about the risks but after doing a lot of research it seemed to me there are very few situations that something bad happens with no warning. You might find this interesting: hackneydoula.co.uk/?p=492

On the flip side, of my NCT group of 4 ladies that went to hospital, 3 of them had the panic button pressed, 2 ended up with a CS and one an assisted delivery in theatre. They felt abandoned during labour and I'm sure that I was more closely (although non invasively) monitored than them.

I think at the end of the day though, a homebirth is only going to work for you if both you and your DP feel completely comfortable with it. If you're worried maybe a MLU is a good halfway house. Some MLUd have to blue light you in an emergency anyway though remember so not very different to being at home.

My first birth at home straightforward 4.5 hours in pool and I am planning second home birth (35 weeks).
The main reason I chose home birth was due to staffing levels. IMO "danger" within healthcare arises due to inadequate staffing.

At how many patients per midwife do they deem unacceptable and close the Department?

Maybe I have just been unfortunate in working in large busy london A&E depts but before they close and declare major incident they are very scary places.
Home birth you have your own midwife and near the end two of them. In my head this is safety.

I planned a homebirth for DD (first and only). I live 5 minutes from the hospital and ended up transferring in after a prolonged second stage. There was no drama. The problem with discussions on here is that there is always someone who would have died if they hadn't been in hospital. What about all the women who ended up with unnecessary interventions because they were in hospital and weren't really in control of what was happening? (I am not claiming that homebirth is the right choice for everyone).

I think a previous poster mentioned www.homebirth.org.uk/ which I would advise you to look at; there's lots of good advice on there about taking control of labour / childbirth and dealing with medical professionals.