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Pregnancy

Talk about every stage of pregnancy, from early symptoms to preparing for birth.

Home birth

142 replies

shaky · 11/05/2012 16:59

Hi, I am a community midwife and mother to a 2 1/2 yr old boy. The team of midwives that I work with are desperately trying to increase our home birth rate for low risk women. Do you have any ideas on how we can promote home birth? Have you had a home birth yourself or are you considering delivering your baby at home? I would love to hear your comments and suggestions please, many thanks in advance!

OP posts:
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EdlessAllenPoe · 11/05/2012 22:37

basically active recruitment at booking in - too many people still think it is dangerous. the gross misreporting of the Birthplace study last year is going to be hard to work against!

Flisspaps · 11/05/2012 22:44

The other thing to bear in mind is that whilst perhaps you may not be able to promote homebirth to high risk women, they should certainly be made aware that it is still something they can consider - they may assume they're not allowed one (which isn't the case). It should be made clear that if they choose to have one despite being high risk, the MW team will endeavour to work with and support them.

My CMW team were amazing and brilliantly supportive despite my high risk status, but it was only due to MN that I knew homebirth was still an option for me.

MoonHare · 11/05/2012 22:47

I see I missed a lot in the time it took me to write my lengthy post!

Shaky - like all of the ideas you've suggested. I help run a toddler goup and we'd definitely put up a poster/keep a stock of cards if that sort of thing existed here.

startail · 11/05/2012 22:49

I don't know my earliest memory is my dad sending me back to bed. I know that was the morning my sister was born.

Therefore, that second babies were born at home (the practice in Sheffield in 1970) just seemed natural.

The MW were delighted when I said I wanted DD2 at home and just positive and brilliant the while way through.

(DD1 had low fluid and I went into natural labour the morning she was due to be induced, so HB was never an option. I hated the lack of privacy in labour and the feeling of having to pass my BFing exam to go home. Everything about DD2s PG and birth was so much better and she exclusively BF which DD1 never managed. She was also only 6 and a bit pounds and just before her due date, so I suspect all DD1s extra monitoring was a storm in a tea cup.)

startail · 11/05/2012 22:59

Also the way DD2 was instantly part of the family. DD1 slept through the whole thing (so I never bothered to wake my babysiting friend). She walked in when DD2 was 3 minutes old ignoring me delivering the placenta entirely. She was 3 and sister was much more interesting.

The DH, DD1 and DD2 had a picnic lunch in the winter sun on our bed and then my friend appeared.

She'd brought presents and her 4th twins, who the hospital wouldn't have allowed. They admired the baby and then she took DD1 of for tea and DH, DD2 and I slept.

You can't compare that to sitting in a hospital bed desperately trying to BF a screening baby when everyone else is asleep.

BelleStar · 11/05/2012 23:03

Same as cutelittlecatlover - the local (Brighton) comm mw's have monthly info sessions to attend which cover everything you need to know, q&a's, real life stories, etc. I almost had my dd had home - transferred right at the end due to very slow second stage. But I was still so pleased to have spent pretty much my whole labour at home, rather than worrying about when to go in!

Your team and unit sound great OP!

raininginbaltimore · 12/05/2012 07:08

Sounds lovely startail

The main thing for me is wanting to use pool at MLU.

What about the mess? And if you put down loads of plastic I think that would feel weird. And I am worried I would start panicking about getting fluid and blood everywhere.

Ds has night terrors at moment. Don't want to have to deal with that at same time.

WantAnOrange · 12/05/2012 08:07

I think you need to tackle the 'mess' issue. Just how messy do people think birth is? It's not like a scene from Alien!

McKayz · 12/05/2012 08:18

I had a homebirth with DS2 after a horrible time in hospital with DS1. It was brilliant , I could do what I wanted, eat nice normal food, watch a bit of tv etc. None of the staying on the ward and being strapped to a monitor once an hour.

DS2 ended up taking 12 hours from first contraction to being born. He weighed 10lb 5oz. My MW reckons if I had been in hospital they would have intervened after 6 hours because he was my 2nd.

DC3 is due in 6 weeks and I'm planning on having a home water birth. Providing baby moves her head out of my hip and stops being transverse.

I've never had homebirth mentioned to me though. I've brought it up both times. The MW is the same one from DS2 so guessed this time round.

I think a leaflet or booklet talking about homebirths could be given to women at the booking in appointment. Then they know it's another place to give birth.

Flisspaps · 12/05/2012 08:19

raining you're almost never guaranteed use of a pool in a MLU - it seems a bit pot luck. At home you know for sure someone won't have beaten you to it Wink

Dillydollydaydream · 12/05/2012 08:19

My 3rd was a homebirth due to 2nd arriving very quickly.
The older 2 were upstairs playing and came down as soon as they heard their brother cry :)
They actually saw their brother before dh could get home so were first to meet him. It was lovely getting into my own bath and bed afterwards.
If all goes well I'd definitely have another HB with any other babies.

I think one of the things that put some people off are safety, they worry if things were to go wrong then they wouldn't have access to c-sections etc.
The Homebirth website is fantastic, definitely tell women to have a look on there. I wasn't told by the midwives looking after me about it but found it myself, it answers lots of questions.

Maybe a FAQ leaflet about homebirths as well?

Wigeon · 12/05/2012 08:51

Just had another thought - are you aware of the NHS Trust in south London which apparently has one of the highest homebirth rates in the country? A friend had a homebirth through them and raves about the fantastic midwives there. I think it's Barts and the London NHS Trust (I'll check with my friend). I'm sure they'd be more than happy to share with you what they did to get their homebirth rates so high.

I think a "myth-busting" leaflet would be very helpful (eg what about the mess /noise? Aren't I putting my baby at risk / my baby might die and I'd never forgive myself? What if I have to go to hospital? My partner / mum / mother-in-law doesn't agree.). Loads of info on this on the www.homebirth.org.uk website.

Indith · 12/05/2012 09:15

My dcs were all born at home.

Our rates are pretty low even though the community team is very pro HB. Things have changed since my first was born, they now hand out the leaflet with info about the hospital, the stand alone MLU (quite underused) and HB before your booking in so in theory there is no longer the assumption thgere was when my first was born that you will book inat the hospital. With him it was up to me to bring up HB as an option. With number 3 I was asked where I wanted to give birth, asking what I wanted continued through the whole pregnany, it felt far more woman centred than the previous ones.

I think people will still tend to say "hospital" when asked though because rates of HB and the MLU are low so hospital is the known, safe option. I think it would be great if when it came to discussing options the MW said "since you are low risk we can look into the MLU or HB" which leaves the hospital as the option the woman has to bring up. People will bring it up because unlike the other options they know about it but putting it that way makes them think about other options and also gently suggests that hospital is for women who are higher risk.

Wigeon · 12/05/2012 10:00

Checked with my friend - the fantastic London midwife service with high homebirth rates is Kings College Hospital - do get in touch with them to find out how they raised their rates. Think they are one of the highest homebirth rates in the country.

StiffyByng · 12/05/2012 13:27

Hello. I am Wigeon's friend who had her homebirth at Kings. I think the Trust is pretty well known for its homebirth success so you may already know about its methods. I think having very strong community midwife support really helps woman feel secure in choosing homebirth so you clearly have the right foundations in place!

I wanted a homebirth from the outset as I wanted guaranteed access to a birth pool and had heard too many horror stories about postpartum care in hospitals. So I was one of the people who responded at my booking-in appointment with an enthusiastic 'yes' and had mustered my arguments in advance if my BMI of over 30 were questioned - it wasn't at all, in the end. During my pregnancy my midwives were very clear that a homebirth wasn't guaranteed until my 37 week sign off, and that with first time mothers, they had a very low tolerance for transfer. In the end I had four days of non-dilating but frequent and intense contractions - the kind that would have had me hopping to and from hospital if that had been the plan. In my debrief, I was told that in hospital my waters would most likely have been broken and I would have ended up with a C section because my baby took her time getting into position. Once she shifted a bit, labour was five hours from start to finish. I had visits from midwives throughout this and had lots of useful suggestions on position. I was also given their blessing to get into the birth pool after a bit so I spent two days sitting in the glorious warm water watching TV between contractions.

Because of the high homebirth rates in my area, I know lots of women who had or planned homebirths, which does normalise it to some extent. My NCT group were all slightly horrified at my plans, but at least two of them are now planning to have homebirths if they have a second child. So I think you do achieve a sort of critical mass where it becomes a natural option. I think my keeness for the whole thing was one of the reasons Wigeon ended up planning a homebirth? Being so close to the hospital helps too, and the fact that Kings doesn't have a midwife led unit at the moment, although I gather one is planned, so the choice is a bit more stark.

In terms of selling points for you, I loved, loved the idea that I would know the midwives who delivered my baby. In the end, I knew one of the two that was there, and I knew she felt personally thrilled that we managed not to transfer and had the birth I wanted. So perhaps you could emphasise that point, and refer to the evidence that women do better with that continuity of care. I was also given the leaflet which included, and I think rather promoted, homebirth. I don't know who produced it.

Finally a friend of mine, due just after me, was very against all mention of birth full stop. She told me I was insane to plan a homebirth. She refused to read anything about birth etc. But my ravings about my hypnobirthing course persuaded her to attend one herself and that completely turned her around, and she ended up planning a homebirth herself. So perhaps you could plug hypnobirthing a bit? It's easier to do at home I think, and you are also more likely to have informed and/or supportive midwives. The course I did was aimed at women having babies at hospital actually, so I don't think there was any pressure to have a homebirth, but it does create more confidence in the birthing process and a women's ability to cope, and both those things are necessary I think to think of homebirth.

Good luck! My birth was the most wonderful experience and I'd love more women to have the chance to experience it. Sorry for the long post.

ISpyPlumPie · 12/05/2012 13:29

Definitely agree with getting dads on board. I'm pg with DC2 and really want to look into the option of a hb but DH isn't keen at all - thinks it's too risky and wouldn't be practical. Sadly I think he's always just seen birth as something you do in hospital, so some info targeted at partners or the chance to talk to other dads whose partners have had a hb would bw great.

Also, in this area there still seems to be an assumption that women only want a hospital birth. When I saw the mw for the first time this time round, she's already written the name of the local hospital as intended place of birth on my notes before I'd even sat down! To be fair, when I asked about hb she was very positive about it but I get the impression (based on this time and last) that they have a bit of a only discuss if the mum brings it up policy.

Finally, and probably one of the biggest things that's putting me off, is that there is absolutlely no continuity of care. I saw several different mws last time and (based on the two appts I've had so far this time) nothing has changed. This means that there's no chance to build up a relationship. I know it's probably not practical in most areas but it would be wonderful if you could see the same mw thoroughout so barring illness or holidays you'd know who would be there when you gave birth. Sounds like this is something you have sorted much better where you work op, and think your other ideas are great too. Good luck Smile

nickelhasababy · 12/05/2012 13:32

in my area, the idea of a home birth was supported, but I had to tell them i wanted one, iyswim.
they didn't put the idea to me.

and then, when I had my HB, they tried to put me off by telling me that there weren't enough midwives available.

It's imperative to make sure there are enough trained midwives in the area.

I think I mean that, in my area, they don't promote the idea, and just assume that everyone will go to hospital/ the birth centre.

nickelhasababy · 12/05/2012 13:45

one of the things that appealled to me was that I didn't have to transfer to hospital whilst in labour.
others were that I would be in my own environment; that the chance of escalation of intervention was minimal; that drugs wouldn't feel forced upon me; that I could do what I wanted in the many many hours of labour; that DH could play the piano for me! Grin; that I could eat and drink what I wanted when I wanted; that I wouldn't be left on my own for any period of time; that i could choose the music i wanted when i wanted it, and choose between record, tape, cd,radio, telly, live music, nothing at all; that i could walk around the house and especially up and downstairs while contracting; that i could have a bath or shower without feeling embarrassed; that i could have 3 birth partners if i wanted without it feeling cramped; that i wouldn't feel like one of a thousand other women;

i felt like a "patient" in hospital - having had to be monitored with the threat of induction - and being left on a bed strapped to a monitor gave me the heeby-jeebies. When I had to transfer in after the birth (to be stitched up), the food they gave me was almost non-existant, it had no nutritional value (the veggie option), and i felt like i had to ask for everything i wanted or needed, which made me feel awkward (and reluctant - pressing the buzzer felt like i was taking staff away from important stuff), and i didn't feel comfortable at all, being away from home, and having nothing except my hospital bag to pick from. (because there's always something you've forgotten - that doesn't happen at home!)

nextphase · 12/05/2012 13:51

DS2 was an unplanned homebirth (very nearly unsupported).
I'd always said no to homebirth due to the mess. DH would also have been anti (he was reluctant for the MLU I wanted, but was declined for with DS1).

If I were to have any more (and I'm not) I'd have another home birth if poss.

The friend I know in this area who planned for homebirth was given a very negative response, and told to wait til 36 weeks and it would then be discussed. she was also warned that the chances were a midwife would not be available.

So, and most of this has been mentioned several times:
*get the midwives on board
*get the ball rolling early enough to allow for the prep etc
*get the partners on board
*find a way to mention the mess is containable (especially if one paramedic cleans the bathroom while the other monitors Mum and Baby!)
*get homebirth kits for midwives equal to or better than the paramedic pack - the midwife (when she got to us!) was amazed and jealous of the paramedic kit.

lalabaloo · 12/05/2012 15:08

I had my first baby at home yesterday morning, it was a fantastic experience. I found it so relaxing being at home. I would recommend home birth to anyone. Main reasons I think people are discouraged from having a home birth are that they think there is no pain relief at all available, loads of people told me I wouldn't be able to have anything more than paracetamol at home, and a fear of something going wrong and not noticing in time.

nickelhasababy · 12/05/2012 15:22

that's bad - i had tens and the option of a bath, and then gas and air when i needed it.
i remember my mws kept trying to get me to have a bath - cue me wailing "but i don't want to get weeeeet!"

shaky · 12/05/2012 16:39

Thank you all for sharing your stories, it's great to see the enthusiasm for home birth is out there. There have been some really great suggestions which I will take back to the team. I think sharing our enthusiasm and spreading the word is crucial, trying to make home birth the norm rather the exception. We have a challenge on our hands and exciting times ahead, we have a lot of work to do and I have found your stories inspiring. Thank you again, I'm very grateful and I'll keep you posted about our progress!

OP posts:
Yorky · 12/05/2012 18:40

Shaky - I think what yiu're trying to do is great.

I have had 4HBS, youngest now 2.5wks :) and would love to talk to people about my very positive experiences. Unfortunately, I have been very lucky and have a few friends who have spent longer in labour for their 1DC than I have for the combined total of hours for all 4DC Blush so many people discount me and say, 'but mine won't be that easy' or similar.

I suggested the idea to the MW early in my 1st pg, and was surprised by how positive her reaction was. And once that 1st birth had gone so well I wasn't going to give birth in hospital without a good reason - despite finding out during pg2 that I was GBS+, or DC3 being 11days overdue!

One recurrent theme I have noticed on this thread which I am slightly Hmm about is people talking about continuity of care. A home birth does not include an independent MW. You have the samr chance of knowing your MW in hospital as you do at home (or you do here) I had excellent contunuity of care this pg and saw the same MW each appt, but she wasn't on call when I went into labour so I had never seen either of the MWs who arrived before, it wasn't a problem.

openerofjars · 12/05/2012 22:16

Congrats, Yorky, btw! I was on the May thread for a bit but couldn't keep up the pace.

Re continuity, where I am there are only 4 HB midwives so I have now met all of them. They all seem v nice!

openerofjars · 12/05/2012 22:19

PS can I just add I picked my pool up today or rather DH did because it is mahoosive and got my cheap shower curtains from IKEA. I am v excited about the whole thing now, but daren't put the pool up too soon in case DS knackers it by using it as a trampoline or dinosaur fortress. Grin

How do you keep a 3yo out of a birthing pool?