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

I have had 3 lovely home waterbirths and am planning the next for early May. LIke you I was within a couple of miles of the hospital for the 1st one and I was pleasantly surprised hw supportive the MW was when I mentioned a HB - I was expecting her to advise me to have 1st at hospital and then consider home for next one, but no, she had no hesitation basically saying that as long as BP etc were fine throughout then she saw no reason why not.
I don't understand how people can sit in a car when they're having contractions - especially when there are speedbumps in most hospital car parks!!
With the 1st the MW arrived at the house at 1130, and DS was born at 1214! We had moved by the time DC2 arrived and she would definitely have been born on the ring road if we'd attempted to get to hospital - or I'd have been very stressed and she wouldn't have been the easy delivery she was.
As far as pain relief at home, MWs bring gas and air, but I've never got to use it, I bought a tens machine on ebay, and love my birthpool and cannot imagine giving birth on dry land now! I've heard of people getting pethidine on prescription but have never wanted/needed to do this.
DHs cousin is a GP and expecting her 1st a couple of weeks before bump is due - she is planning to ring a friend at her 1st contraction and have an epidural - she has seen, as you say, far more 'difficult' births, whereas all my experiences have been positive, and you sound very similar to me as regards general health. Good luck to you and baby

through the whole of my first pregnancy I was llow risk, but at the eleventh hour during labour things went badly wrong and I was sent into theatre. I was transferred within about 2 minutes from delivery suite to theatre and had 8 different medical professionals there. I know it sounds a bit dramatic but being in hospital did literally save my baby's life and it was totally unpredictable. I'll certainly be having baby no 2 in hospital again.

Thanks everyone for the replies, it's really helping me think things over.

justlemonade can I ask, and I hope this isn't rude, and please don't answer if it makes you feel uncomfortable; but what was it that meant you needed to go to theatre? In my mind I think it would help if I could find as many reason as why that situation comes to happen, so I could understand how it comes about and possibly prevent it if at all possible. It?s so hard to talk about labour with other mums as some feel like they failed etc and I really don?t hope you think I am thinking along those lines

Thanks, hope this make sense!

OP I spent a lot of time before the birth researching everything that might go wrong (not for the faint hearted!!) and the. Talked this list through with my MW to establish how care at home would be different to hospital, and under which circumstances there woul be a potentially worse outcome by being at home - I'd definitely recommend this as a way of getting comfortable or not with a home birth.

I will say dr friends will have all the horror stories, this is of little help to your thread but I have for a while now intended to start a thread on here along the lines of

If you work for the MHz do you think your labour delivery was more screwed up than usual?!

It's not cause and effect (is it?!) but of the top of my head all the screwed up deliveries/pregnancies/neonates I know have Dr/nurse/other hospital staff as parents

(and I do know some people who don't work for the NHS!!)

I had a home birth with my first and I'm planning to have another one with DC2 due end of October. For some reason some of my friends are surprised by this - I had the least intervention out of my NCT group (I was the youngest though by 5-10 years which also helps) and a straightforward birth before so why do it differently this time?

I'm not the least bit woo or lentil weaver-ish but I read a number of studies and looked at the risks and decided that I was safer at home with one-to-one midwife care than I was in hospital where I would probably labour alone and options like birthing pool etc were limited. The chances of getting a spot on our local MLU was slim and actually even the nicest, most homely MLU is not home. There are two hospitals nearby with A&E and maternity units. One is 1.6 miles, the other 3.5 miles. If there was even the faintest hint of a problem I would be whisked off by ambulance and in theatre not much longer than I would be if I was in the MLU.

I can tell you that I was repeatedly checked during labour and there were various discussions about how long each stage should be and how long I had before I would have to transfer in. It did feel a bit like being on the clock but I just tried to blank it all out and let my body do what it had to.

On the day I went into labour I had to be checked by a midwife because my waters had broken earlier and I happened to have my 41 week appointment booked for that day. As soon as I got to the surgery labour stopped and it didn't begin again until I walked through my front door.

Home or hospital birth is your decision about where you feel comfortable. If a medicalised, strange environment makes you feel uncomfortable that's not going to help labour because your body will be making cortisol the stress hormone. It's exactly the same scenario for a woman labouring at home who wants to be in hospital because she feels safe and reassured there so she gets stressed which inhibits labour.

That said, if the baby's breech or there's any significant problem they can put me under with a GA and take me straight for a c-section. I'd rather that then they have a go with forceps (never) or ventouse (only if no other option). And if I have to transfer in I will be requesting an epidural before the call for the ambulance has even finished so they can find me an anaesthetist!

Ina May Gaskin might be worth a look? She makes a comparison between men getting an erection and birth that is quite interesting. I prefer the "where would you rather do an enormous shit? At home or in a hospital? My body prefers home

Not rude at all. Baby got stuck and I ended up with a Kielands forceps job. They had been trying to get me to push her out naturally for a while, but as her heart rate disappeared it became a bit panicked. Maybe I shouldn't have been left to try for so long and it wouldn't have been such an emergency.

Having said all this, of all my friends, I had by far the most 'emergency' birth so if you take a law of averages...

I like the poo theory katie

Thanks Katie for the reply, it seems e thinking about labour in the same way, I?m also a no way to forceps, if you have to for Ventouse.

I have read Ina May, found bits of it a litle odd but the overall thory good, like I say, I was all decided until my DR friend said, literally, ?don?t do it your baby will die? :( That day she had been with a baby that had died, and the mum was just like me, even with a very quick transfer time to the hospital. So sad.

I think I will ask my midwife how long it takes to put a team together, I got DP to drive to the maternity ward and it took him 7 minutes door to door with 1 stop at traffic lights. It?s actually 0.9 miles to the hospital.

justlemonade that must have been so scary for you, glad everything ended safely for you and not you now have a beautiful child. Can I ask if you had labored ?naturally? (hate that phrase!) up until then? Were you induced, or did they pop your waters or anything like that? Did you have quite an active birth? Again, hope these questions are ok?!

I think (but am not sure, need to clarify with midwife) that at home other than forceps they do all the same things as a hospital if the baby is stuck and I?m hoping that the midwife would transfer me if things were taking too long, before it got dangerous IYKWIM?

0.9 miles is nothing and you would be blue lighted so even quicker than 7 minutes. Probably more like 4 and if your mlu is stand-alone you may be closer at home to the clu or A&E than the mlu is - but no one seems to worry about that so much.

You would be transferred at the first sign of any problems. Probably when there isn't a problem because they are overly cautious. If the baby seems stuck they will almost certainly blue light you in. For shoulder dystocia (sp??) they may try different positions to move the baby but ultimately they won't risk it.

Depending on the hospital you may not even be able to have any other pain relief other than gas and air, tens or birthing pool and you may want to transfer in for pain relief. All home birth teams carry a resus kit but you hopefully won't need that. Some teams will stitch you at home if necessary, others would transfer you in.

Yeah bits of Ina May are nutso but other bits just seem obvious. Her intervention and success rates are hard to argue with. I do think I would have more intervention in a hospital because of the stress - but that's just me. I'm
not evangelical about hb. I'm evangelical about good evidence, information and informed decision-making. I would no more press someone into a home birth than I would a hospital birth because stress and unhappiness is not going to be good for labouring.

If you are interested in reading about a sensible, normal person who has had a home birth have a look at Sali Hughes' article for The Guardian.

I've had a straightforward labour and water birth in a hospital MLU birth centre, and am planning a home birth for this one, due end of September.

Just wanted to say that you don't actually have to decide either way until you're in labour. My midwives have even said this to me. Plan for a home birth and keep in mind that you may decide to transfer (for pain relief etc). You'll start off at home anyway won't you, and it's always best to stay home as long as you can. It's absolutely fine to keep things open and to plan for both outcomes. You sound like you're aware that either place would work for you, dependant on your circumstances at the time.

Be aware though that even the transfer can complicate things. My contractions stopped in the taxi over to the hospital, and even though I was 6 cm when they admitted me (I'd only been in active labour for 4 hrs), it took a further 7 hours to dilate the remaining 4 cms! I attribute this to never fully relaxing in hospital and remaining slightly "on alert" in strange surroundings.

Having said that, I'm very glad I had a hospital birth for my first. It's a very personal thing, but I felt it was right for me. I didn't doubt my chances of having a straightforward birth without intervention, in a hospital MLU, but I did doubt my confidence as a first-timer, to remain at home.

Have you had a chance to visit the MLU yet? It might be helpful if you could arrange that and wanted to. Then you could assess yourself how much like a hospital it was.

In my county we have two MLUs attached to acute hospitals, and other MLUs attached to community hospitals. IMO they feel entirely different, with the latter being much more relaxed and homely. (To the extent that, as someone who wanted to be near where the maternity theatre and obstetricians were, just in case, I chose the hospital-y feeling one down the corridor from the consultant-led unit.)

I would also gently suggest that, if you can bring yourself to, it might be worth seeing the hospital first as well. Although most births are straightforward, some aren't and need a bit more medical support. You can't always tell how it's going to go until it's all happening (I was low-risk then ended up with a ventouse delivery), and if that did happen it might be best to be prepared for the hospital experience, just in case? And then be really glad when it's not necessary!

I'm having a home birth. First baby like you. I wavered slightly too and was told that it will take the same amount of time to assemble an emergency team as it would to blue light me to hospital, and we estimated that at about 25 mins. I was also told things don't 'go wrong' quickly, they take a while to 'go wrong' with plenty of warning.

And I can counter your friend's 'but it will die' thing. I was born at home, and I did nearly die. It was being with an experienced midwife that saved me. Had I been born at hospital, as 2nd baby I would have been attended by a less experienced midwife. And it was experience that made my midwife do what she did that saved me. This was what my mum was told in the review after the event, many moons ago. Of course I may well have survived in a hospital, who knows. But it's a story to counter the other.

The thing you have to decide is that if something did go wrong, could you honestly say to people "I am comfortable with the decision I made."

This was one of the biggest hurdles I overcame choosing 2 homebirths after a hideous hospital experience. Everyone would say "but home birth is so dangerous, what if something goes wrong, how will you feel if your baby dies because you had it at home".

I knew that I would feel devastated either way, that being at home or at hospital wouldn't lessen the pain and that I had valid reasons for choosing home. I lived mid-way between the MLU and A&E albeit 30 mins in each direction, so it would have taken at least the same amount of time to transfer me from MLU as from home.

In the event that wasn't needed, I had 2 calm serene home births with other DCs blissfully unaware that their sibling was being born in the next room. Lovely MW cleared up afterwards and there was hardly any mess anyway.

I got in my own bath, my own comfy bed and with my own family around me, and was woken by the radio rather than being shouted at by Dr "Why haven't you noticed that your baby needs changing" after 24 hr labour and 3 hours sleep!

I have four children and had my first at hospital, 2nd and 3rd at home, 4th at the hospital. I also greatly dislike hospitals having had many bad experiences there; however, the most calming thing is a supportive midwife regardless of where you are. My first and third births still bring back horrible memories and these having nothing to do with the place and everything to do with unsupportive, horrible midwives. My fourth, which was in hospital due to the horrible treatment with my third at home, was amazing even when really difficult because of the staff there.

Whichever way you feel is best, getting a good midwife on side will relax you whererever you choose to give birth (if only we could all rely on them being so regardless of where we are!).

derbysKangaskhansadly, we can't pick our midwives where I live, there is like a team and you get which ever one is on duty, there is new one who is lovely and the msot experienced at HB so I am hoping to have her, but it's all luck really.

I never realised until I started this thread that you take take a private midwife with you, that is very tempting. If you do have to go to hospital do they shun you a little though for chosing to use your oen midwife I wonder?

theepilator I think if somethig did go wrong that yes, I would be able to say that I did look into everything and considered the risk so low, that it was one of those freak thngs, rather than it was because I was at home IYSWIM?

Maybe I can go for a home birth, when things get going call the MLU (which is attached to the hospital, so 0 transfer time) and see if a room is free with a pool (there is only 1) and if it is I will go to to MLU and if it isn't stay home. Assuming of course, the MLU isn't hospital like and ownt make me wibbily.

shouldIbecross Everything had gone totally normally until about 7cms. Then I stopped dilating and put on monitors, so yes I had an active birth for the first part of labour, but not after 7cms. I ended up with an epidural after that too.

I think that midwives have lots of experience of back to back births which require forceps as mine did and if it similar were looking likely for you they would send you to hospital to avoid any risks. They knew DD was back to back when they first gave me an internal examination at 1cm, but decided to see how I would do. I was shocked by how quickly they decided to stop me trying to push and get me into theatre. There was a definite sense of panic and if they wouldn't have been able to make decision so quickly had I been a home. But I think midwives would pre-empt the possibilities if you were a home birth in my kind of situation. As I said before - out of all my friends I don't know anyone who had a similar birth so it's not all that common I don't think.

Personally, I wouldn't have considered a homebirth for my first birth. Birth is such an unknown quantity when you've never done it before. Maybe for subsequent births.

OP You can't pick on the NHS, but you'll get a feeling towards the end of a pregnancy how supportive the team is likely to be of you. It was quite clear for me that the team did not approve, but as number 2 had gone so well (a BBA, so no one) and everyone went on about how lovely homebirth midwives are, I pushed ahead for another homebirth which ended badly due to their issues (refused to let me hold my baby, yanking on the cord the moment she was out which resulted in a lot of pain and PPH). When the community midwives were even more negative the next time around (telling scare stories to my kids to get them to convince me), I went hospital where at least I could ask for someone else in the worst case scenerio (I've heard you can do this as well with a homebirth as there will be multiple on at one time, but I've never known anyone who actually did this).

What Badgerina said above - you have nothing to lose by planning a home birth and seeing how you feel on the day, you can transfer in at any time and many do.

I've had three home waterbirths, including the first (when the first was born I lived about 5 mins at blue light speed from a major hospital). I've had three fantastic normal deliveries, no pain relief (tens and pool all I needed) and no stitches or tears - I put some of this down to luck or good genetics, but some down to the environment, which was ideal for birthing (dim lights, quiet, freedom to do my own thing). Nearly transferred in after birth of DC2 due to a bit of additional bleeding - MWs gave me two shots of synto (the placenta injection) and called the ambulance (which arrived in 1 min!), but by the time the paramedics had come in the bleeding had stopped and they went away again. I have nothing against hospitals, but I figure why go there if you don't need to!

Hi,
I am on my 4th pregnancy. 2 hospital births and 1 mlu birth which was by far the best. Unfortunately I think I will have to have hospital birth this time but hey ho.
I like the idea of a home birth but there are elements which are completely non medical related that have put me off. At the end of all my pregnancies I have been pretty hormonal with a very strong nesting instinct. The thought of people coming to my house whilst I am in labour and it being a mess would really stress me out. I know it is trivial but the desire for me to have everything just so was very strong.
Not very insightful I know but a slightly different perspective x

I do remember the nesting bit. House was spotless and I think when the midwife arrived I was wiping down the table with anti-bac (again) and was most concerned that she should have a cup of tea. I was 6 cm dilated at that point!

I also insisted poor dh run the Hoover over before we called the midwife. I go a bit crazy and primal when i'm in labour.

OP if you have a private midwife she will do all your pre and post natal care, and deliver your baby if you have a homebirth. If you decide to have a MLU or hospital birth, or you transfer in, your private midwife comes with you but isn't allowed to deliver your baby, so she basically becomes a doula at that point.

t..

I read through the study mentioned very carefully.

salient things to note

'corrected' stats show a 0.4% increase in 'serious adverse outcomes' for first time mothers. (the uncorrected stats showed 'actual' risk was pretty much the same - so if you are a 'typical' Homebirther (older, richer, more white and married) your risk is no greater than the average woman going into a CLU..this also leads me to question their 'correcting'...))
serious adverse outcomes = stillbirth, encepalopathy, broken bones, haemorrage

There was no detectable uplift in stillbirth taken as a single variable.

less serious things - eg neo-natal admission, no initial BF - home birth babies fared significantly better.

HB was greatly better for mothers - 2.8% emc/s vs 11% at CLU, 2.3% vs 8% forceps at CLU

labour took on average hours...
CLU - 9.01
MLU - 7.92
FMu - 7.49
HB - 6.61

making home birth almost 2.5 hours faster...

the average baby born at home was 4oz heavier too!

the typical transfer - takes 29 mins (remember HB is popular in remote areas)
birth occurs on average 6 hours after transfer (so, most are very definitely not emergencies.)

most of the 'adverse outcomes' would probably have occurred after transfer (as per other studies) , but this is not reported...

my first homebirth was a very positive experience, and i was attended all the way through by an experienced mW (who went on to be team leader by the time i gave birth again)

My sister transferred with her first (large OP baby with hand to head) and commented that as soon as she got to hospital the care stopped. she was placed on CFM that didn't work and ignored whilst the MW did paperwork. had her baby died or otherwise taken harm (and the trace kept on dropping out) in that time it would have been recorded on HB stats.... it was going to be a tough birth anyway, but i think that is inexcusable - cord was three times round neck.

were i to have my first again, it would be a homebirth, but with an IM to act as back up should i have to go to hospital before delivery (i think the total transfer figure for first timers was 45% - this includes post-natal transfers).

I was more than happy with the MWs from Worthing area who have attended my births at home, just that going to hospital most people i know get left alone for long periods