Home birth

[shaky]

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!

my HB was rather messy.
You wouldn't know it though - by the time I got back from being malnourished and stitched up, all the mess was gone.
in fact, it was cleaner and tidier than before we'd started! and i had clean sheets on the bed
the MWs brought about 8million inco sheets, and they followed me around the house (I think I managed every single room!)

and i was pushing for about 2½ hours before they decided they needed to do my episiotomy - there was no way that would have happened in hospital (cs would have been out of the question because she was too far down)

One thing I am wondering is what happens when you have a water birth for internal examinations?

My first hb was just a normal birth so MW examined how dilated I was every now and then.

How do they do that in water?

I had a wonderful HB. I didn't get continuity of care, as the trust here I their wisdom have a HB team so you don't get your community midwife, unless the HB are too busy then the community on call MW comes out. So I had 2 community MW who weren't mine, but we're fantastic.

Re suggestions, I think giving student mw opportunity to attend HB is important, as the more MW supporting it the better. I had a student at mine, it was her first ever birth and I was pleased that her first was very unmedicalised.

I think the fact that people, even medical folk, think it is a risky and selfish thing to do is a problem which puts people off. I never told my inlaws that we were having a HB, they are a GP and a nurse. We had a conversation several years ago about maternity services, and both had said HB were dangerous, and about the mother putting her comfort before the baby's. Asking why you would take a risk with something so important. I wouldn't want to be a woman wanting HB at that surgery!

Lovely thread.
I've also been lucky and had 2 babies with the same Kings, London team mentioned by others. First was a transfer due to meconium (they explained beforehand that this was one of the things they transfer for). BUt still happy to have stayed at home as long as poss. My MW from home came in with us and was there for birth, which I think is amazing care.
Almost didn't 'try again' for hb for no. 2 as I thought it would be stressful to transfer again, but the wonderful MWs talked it through and said my chances were higher this time, and in the end I just wanted to be under their care.
Second was an amazing waterbirth, didn't need any examinations as baby was on way by the time we'd decided to call MWs (just had been calm and coping well, then it all sped up).

Shaky, I am interested in why your team is trying to up the hb rate - obviously I think it is great but is it about health outcomes for women / babies or maternal choice, or is cost a factor at all?
Although I would always prefer to stay home I think it is very hard for women to make that choice as it hard to get to the bottom of evidence about safety and there is always a nagging doubt about 'what if' scenarios when hospital facilities might make a difference. So clear unbiased evidence on risks and benefits would be my no. one ask for new mums. You should also be up front about transfer rates for 1st/2nd births so that people are prepared should they have to go in, and so that it feels like part of the plan not 'failed' hb.

McKayz if you want internals you have to get out if the water. Or you just don't bother with them - they're not something you have to have

Ah right then. They seemed like such a normal part of my first 2 births that I wasn't sure how it would work.

I'm not getting out of that pool once I'm in it!!

Just recalled my last nagging doubt was the 'what if' emergency thing. And it wasn't until I realised that an 'emergency' c section does not mean there and then, but rather several hours later that I realised I could transfer in in that time anyway. That's a really important bit of info that I've never seen communicated in info about hb.

Things that put me off a homebirth:

The fact that I have seen "my" Community Midwife twice this pregnancy (38 weeks), that she is always busy, needs at least a month's notice to make a solid appt, never answers the phone and has told me both times that her team are rushed off their feet. I feel that if I asked for a HB, I'd have total strangers, who may or may not actually be free at the time, anyway.

Horror stories of other people's births... I don't think that we hear enough positive birth stories, just the dramas.

Honestly, I'd rather know the anaesthetists/doctors/surgeons are right next door. I would feel more vulnerable at home for this reason, probably more anxious.

I'm sorry if I've put a dampener on this thread - I'm just being honest. Maybe I'd feel differently under a different team...?

mrsplug I think they are the main issue which need addressing if they want to increase HB rates :)

• resources and people so that you know what you ate getting
• helping people feel confident in HB as a valid choice. Making sure the facts and statistics are properly conveyed so that women can make a informed choice rather than just a (seeminly logical) sense that hospitals must be safer.

Kayz- I had my final 'internal' actually in the water. MW got me to kind of float in my back (pretty hard when i was in transition!) and she just went in under water otherwise getting out for the exams was pretty traumatic in my memory. Going from the support of the water to lying on my back on the sofa was hell. It did make me wonder how and why people birth lying on their backs!

MrsPlug - the MW who started off my home birth was a different midwife from my "normal" one.
I had 3 shift changes during my labour.

My final number 1 MW was someone I knew vaguely from church.

It really doesn't matter who delivers your baby, as long as they're professional and personable.

and in hospital, you are sooo not going to see a person that you already know!!

I also think that you are more likely to need those surgeons/doctors etc next door if you're in hospital - they don't give you as much time nor as much freedom to give birth in the way you want.
I've seen OBEM, it was the furthest thing from what I wanted from a birth - strapped to a monitor on the bed from the moment they walked in, no freedom to walk around the place (outside of the room), none of your home comforts, certainly no food unless you brought it with you/have enough money to buy some, the fact that as soon as something wasn't textbook, they'd whip you off to surgery rooms! (and the panic that goes with it! even when the MW made me consent to the episiotomy, there was no panic - it was all routine (I know she was worried, but never let on to me))
If I'd been in hospital, they wouldn't have given me the length of time they did, they wouldn't have let me try all the different positions (including at one time on the toilet), they wouldn't have let me try to push, and they wouldn't have just stuck with the cut - they would have rushed me out into the theatre and used forceps or ventouse straight away (DD came out after the episiotomy, but wasn't happy about it!)

Point being, they would have really made my birth into a proper crisis.
because we were at home, every angle was tried before the intervention - the baby was safe and monitored the whole time. (they also had an ambulance on standby just in case - which is why when I needed to transfer to be stitched, we didn't have to wait).
DD was stuck because the cord was wrapped around her neck and was clamping her hand to her head. That's not conducive to an intervention-less birth in hospital.

nickel I didn't mean that having strangers in my home would put me off, rather that if I was familiar with my community MW team then that would be a positive for HB that just isn't there.

Agree with OBEM comment also - perhaps there should be a legal ratio of natural/event-free births to the dramas :)

SHakey, I think you're in my area - although I'm right in the middle of teh hospital triangle.

I really wanted a HB this time round, but I was put off by:

*dh scared of complications (weren't any with ds, so don't know ehere that came from)

*my colleague has 5 kids and had one accidentally at home and she said sh'e never plana HB.

*distance from hospitals if anything went wrong.

*stories abot women who had the baby at home, then ended up hopital anyway.

Mind you, if I'd listened to the mw in Glan Clwyd, I'd've ended up having this one at home anyway!

I definitely think having women that have experienced HB taking to prospective hb mums & dads helps...

Since commenting on this thread, I have discussed it more with my DH & DMIL, who mentioned her friend who home-birthed her 2 children. DH has since talked to her (& her husband) and this one, brief-ish conversation has changed him from a 'we'll consider it' to a 'do it' man!! He knows I want a water birth & appreciates that this is far, far less likely at the MLU/hospital (they are the same for us, separate MLU ward rather than building iyswim). Also, our friend had to transfer due to muconium issues with her first & DH sees that this isn't impossible in itself (we're maybe 15mins drive away from hospital w/out blue lights).

DH is going to come with me to see the MW at my 16wk appt & find out more :)

I definitely think a hb will be a gentler, safer, quicker way for my DC to enter the world, which wasn't quite the case with DD, although it was a fairly 'textbook' first labour in some respects (although we were both safe & well).

Good luck Shaky, I think you're doing a great job.

Oh and, I would be interested to understand the reasoning, as queried by another poster. My MW said it was just because numbers were dropping & it was a good option, particularly for 2nd-timers.

Going to the hospital for scans was enough to put me off the 'medicalised' route. And issues around infection were also important as I don't have a spleen - worth educating people on the hazards of hospital births (as such)? Also the idea that it's easy to get a labouring woman to hospital if needs be - a plan B basically, for reassurance? We were only 4 mins away and I was aware that we might have to go in if it didn't work out how I wanted.

But I'm afraid I didn't trust the NHS to be 'all right on the night', so to speak (our services are v stretched - SE London), so I went with a private midwife.

Had an amazing water birth in our kitchen. Used hypnobirthing. Labour lasted around 6 hours without any events - v peaceful. Everything completely natural, and I had turned 38 the previous autumn, so no spring chicken.

I would advise anyone trying to encourage homebirths to show lots of positive natural birth videos - plenty available on youtube, just type in hypnobirthing. And give personal stories of homebirths and why they're wonderful. I have written up my story and am happy to send to you to share if you message me your email address.

Ideally, the mother would get to meet any midwives who might attend well in advance. This was clearly not an option in my case.

Offering cheaper hire prices for pools might help - so work with a pool company if possible?

Good luck. So great to hear the professionals encouraging homebirth - it was the most magical experience of my life and I have just found out I'm pregnant again so going to go for my second homebirth and will be aged 41!

I know it's been said several times already but a group where you can get mothers who have had HBs come in and talk to pregnant women would be good. Also the MWs can talk about HB too and maybe dads to talk to other dads.

You know - I would actually love to do this but have never been asked. It would be great to get yourself on a network where you can be contacted to help prospective homebirthers by sharing your experience...

Shaky, we can't lock the pool in a separate room: the house layout rules that out, I'm afraid. Never mind: we may just have to ban all dinosaurs from the room once it is inflated. I got my hosepipe and tap adaptor yesterday, so we are ready to go! Now all we need is for labour to start...

NB Where I live the home birth team actually lends you a pool!

Just to add my experience from having DS: I nearly had an EMCS because DS got a bit stuck, the silly thing, but he was extracted by ventouse after I was prepped for theatre. Now, my memories of the whole thing at that point are a little hazy (I was off my face on gas and air at the time) but I know it was a while between the midwives deciding I wasn't making any progress in the second stage and having to sign the consent form. I was in a maternity hospital where the CLU aNd MLU are down the corridor from each other.

Perversely, this has made me feel more relaxed about having a home birth for DC2 as I now know that the time that would elapse between a decision to have an intervention and it actually taking place would be about the same whether I was in the hospital or at home. Okay, if the latter then there would be a bit more drama due to going in an ambulance - and the logistics of that in a small, nosy terraced street! - rather than down the corridor in a wheelchair (I do remember being asked to walk to theatre, with DS sort of stuck in my pelvis in the pushing stage . I may have screamed at someone a bit at that stage). So I am a lot keener to try to avoid the interruption to my labour of moving to hospital at 6cm this time and see how it goes.

I think if I lived far away from the hospital I might feel differently, though: we live ten minutes up the road from the hospital as the ambulance flies.

I also like the idea of having a midwife actually there all the time, which as I understand and partially remember is less likely with a hospital birth. And the avoiding hospital infections is a big attraction as well. And the not sharing a post-natal ward with That Family ever again...

You see my intervention was very quick. I had syntocin as I didn't get past 5cm, then suddenly Ds heart rate dropped, doctor was called. He shouted "forceps trolley" and about 12 (possible exageration) people appeared in my room!

But I still think I didn't progress as I was confined to bed etc. I think at home I would be different. I have started my own thread on how to convince dh, so if anyone has any suggestions!

I think the best bit of a home birth is going to bed afterwards. I got into my comfy bed with my lovely new baby and watched the Johnathan Ross show XH(DH at time] went to get a takeaway and it was all brilliant.

With DS1 in hospital I was told I needed a bath, DS1 and XH were taken away somewhere so when I finished in the bath I didn't know where they were. The MWs or nurses in the post natal ward couldn't give 2 shits that I had no idea how to feed this small crying thing. Plus I was given a mouldy sandwich. I wouldn't trust the post natal staff in that hospital to look after a teddy.

Most of the people I know who have had homebirths where I live give that hospital as the main reason they picked a homebirth.

don't worry about the noise of transfer
We had a non-blue-light ambulance at just gone midnight, and noone in the street even noticed (and we've got very thin-walled terrace houses)

I wouldn't have had a home birth with my first, as the sheer unknown-ness of it all scared me straight into a hospital. However, had I had a straight forward birth with DD I would happily discuss it with any MW of mine in the future.

As it is, I tested +ve for strep so needed the antibiotics. I assume this would mean I couldn't have a homebirth in the future?

I had a live birth thread going, and I kept going upstairs to the computer to update it - mainly during contractions, because going upstairs was fabulous pain relief - and now I look at the thread, it was hardly updated because each contraction took away my concentration! It took me nearly half an hour to type one post

i think you do need to be the hospital with strep b