Home birth for first time mums

[Viletta]

Hi all, can I please have your opinions on home birth for new mums. Did you feel safe? did you end up transferring to the hospital? Were you happy with the home birth experience?

I watched hipnobirthing video pack and asked midwife about home birth. She said it was a great idea to kick start the labour and I can always change my mind and be transferred if needed.

Then I had NCT course that mentioned the Oxford study where outcomes for the baby were significantly worse for first time mothers delivering at home and transfer rate was 48% (only 10% for non-first mothers). This really worries me.

I wanted to have a chance to talk to the home birthing team before making up my mind but it seems that the only option to see them is being transferred under their care.

I also don't want to be in maternity unit on my own without DH for the first part of the labour and not being able to have a birth pool due to covid. These choices really confuse me as I don't know what to expect and I'm in the process of being transferred to a home birthing unit and haven't spoken to a person who could give me a good idea about all 3 options... sorry for the long rant, really confused here. I want my labour to be as natural as possible but monitored so if anything goes wrong it'll be picked up and the right care would be given. I'd do it in the hospital but the interventions rate is almost 50% for obstetrician unit birth..

I wanted a home birth for my first, went two weeks overdue and started labouring at home about an hr before my induction appt. Very slow labour, called midwife out after about 18hrs - she turned up with no pain relief for some reason. Options were to wait for her to return, or to transfer into hospital - about 10 mins away.
Booked taxi, went in - long story short, 18 hrs later having EMC.
I'm glad I started at home though, and gave it a go, and midwife was very supportive. Was reassuring knowing I could get to hospital quickly if needed.
With DC2, had a hospital birth partly because midwife recommended it but mostly because DD would be at home with DM and I didn't want to traumatise them! Had VBAC and was fine, over much quicker than first.

I had a home birth with my first and it was the best decision i've made. It was so relaxed and I wouldn't have been in hospital (i'm a bit phobic.)

I had quite a quick labour at around 5-ish hours. Completely straightforward and no complications. For the first few hours my partner, the cats and I lay in bed watching movies. I loved that i could be in my own bed - I even fell asleep at one point about half an hour before DS arrived.

I know things can take a turn for the worst at any point, even in healthy pregnancies and the thought of that can be terrifying - but i'd take that risk in a heartbeat if I ever had to give birth again.

It’s just not worth the risk, in my opinion. The potential horrific cons FAR outweigh the pros. When I had my first (in a hospital), I was of the naive opinion that it’s a natural thing, my body can handle it etc, how wrong I was and needed urgent intervention.
I always think of how would I feel in the future, if the worst happened, how would I feel about my decision to be much further from help?

My friend and SIL had home births for theirs all went fine (although both's husbands had to clean up afterwards! Not done by MW as mentioned upthread)

Another SIL had her baby in hospital 6 weeks ago. She was assessed by herself and then hubbie called in as she was in labour. All went very smoothly, had the water birth and then he had to leave but collected her within 6 hours. They are keen for u not to be in long at the moment.

Haven't had a home birth and personally wouldn't, but did give birth late June during covid after having an induction, spent from 9am till midnight by myself till I was transferred to labour ward and my husband allowed in. It sounds scarier than it actually is, we FaceTimed for most of it, so I didn't feel completely alone.

I went for a home birth with my first, only 5 mins from the hospital and midwives were very supportive. It was great I laboured in my own bedroom for around 12 hours with two midwives and my husband with me. The pushing phase lasted a really long time but they monitored baby throughout and eventually called the ambulance and he was delivered by ventouse in the hospital. I don’t regret being at home at all, my whole birth even the end was a very positive experience. With my second I went to the midwife les unit which was about 20 mins away and had to spend a lot of time pacing hallways hoping to dilate more so they wouldn’t send me home at 8pm. Thankfully I did but it was a much more stressful experience. The nice things about being at home is you don’t have to guess when to go in or not

I had home births for both my DC. Relaxed and comfortable experiences with 2 midwives. Had to transfer to hospital after first birth as I needed stitches and the midwife wasn't happy to do them as it was a bad tear. Couldn't wait to leave hospital.

@Cantbutwill

It’s just not worth the risk, in my opinion. The potential horrific cons FAR outweigh the pros. When I had my first (in a hospital), I was of the naive opinion that it’s a natural thing, my body can handle it etc, how wrong I was and needed urgent intervention. I always think of how would I feel in the future, if the worst happened, how would I feel about my decision to be much further from help?

Conversely, if I hadn't had a homebirth my baby would have died. Guilt trips are not useful or helpful.

Just food for thought that covid might not be the only reason you cannot have a waterbirth. I'm pretty sure waterbirths are still an option in all hospitals/MLUs anyway? It's more likely you would not be able to have one because of complications like meconion in waters etc.

I'm another one whose baby wouldn't be here if I had had a homebirth. Between them deciding it was an emergency and my baby being pulled out was probably under 5 mins in total. He was also unexpectedly born unwell and ended up in the NICU that evening. It took until the 5th midwife to look at him and realise something was wrong. If we were at home, particularly with lack of medical visitors because of covid, it might not have been spotted.

But congratulations and all the best for your little ones arrival which ever way they make their way into the world!

for FTMs the risk of complications is only slightly higher for a home birth than a hospital birth.
Cannot comprehend those that know there is an increased risk, however small, and decide to still put their baby through it.

As a FTM, you have no idea how you and your body will cope with labour.

First birth was at home. 5.5hr labour, it was so much less stressful being in my own surroundings and I think this significantly contributed to avoiding the cascade of intervention. I had the undivided attention of a very experienced midwife (two of them for the latter stages) which certainly wouldn’t have been the case in hospital, and this alone meant that a minor problem didn’t become a major one as it was spotted and resolved early.
We were also less than 10 mins from hospital if needed and I did a LOT of research during the pregnancy to reassure myself it was a safe option.

(Second birth experience was a multiple pregnancy so a very different situation and I knew in advance they’d be prem.)

Midwives I talked to really encourage HB, they say it's a great way to kick start the labour even if I decide to get transferred later. I think they wouldn't have encouraged it if it wasn't safe, would they? I read NICE and NHS guidelines and they say midwives can handle resuscitation and hemorrhage at home. The only urgent thing that is really dangerous is cord prolapse but it's as dangerous when in hospital as doctors need time to prep the surgery and gather the team so it's not instant even when you are already in the hospital.

In the survey there is higher risk of complications and brain damage in hospital presumably as mainly it's for higher risk pregnancy and also due to interventions. I just find it's so hard to decide what's best..

But one thing is true if something happens at home versus hospital you'll be blamed... which I find is so sad as the decision is taken by midwives as well and they wouldn't let HB if they weren't sure it was safe.

Cannot comprehend those that know there is an increased risk, however small, and decide to still put their baby through it.

This is exactly the kind of judgmental opinion I’m talking about.

Every single decision made by a pregnant woman carries potential risks for her baby. You can and should assess those risks and make the right decision for you. I can guarantee you will make decisions about your pregnancy that other women wouldn’t, and that doesn’t make you wrong, or selfish, or a bad mother.

If you labour in hospital the risks of tearing, episiotomy, forceps, ventouse and C-section are all higher. It’s much more likely in the present climate that you will get Covid. The risk of infection generally is significantly higher in hospital. There are studies indicating that establishing breastfeeding is harder in a hospital environment. Your baby is less likely to be removed to a neo-natal unit if you labour at home. It is completely valid for a woman to chose to mitigate those risks by having a home birth.

Many midwives actually encourage home births, and they are the experts in this field. Guy’s and St Thomas’s hospital in London also encourages home birth for uncomplicated pregnancy. Their insight is significantly more useful than a horror story on an anonymous forum, or a judgmental comments from somebody who is mistaking the decisions that she decided were right for her for universal truths.

I agree that it is an individual decision and am only providing some facts....

Obstetric haemorrhage is unpredictable and can be massive. It is rare for this to happen, but you can bleed to death within a few minutes. It cannot be managed by a midwife in the community as they do not have access to the equipment and blood products required for resuscitation. They will arrange a blue light transfer to hospital, which will inevitably lead to some delay in your treatment.

Clearly they will transfer you early if you are not progressing etc (and by virtue of the fact you are not progressing normally, you are more likely to need an interventional delivery, which then skews hospital figures). You are correct that there is a risk of injury associated with instrumental delivery. There is also a risk of hypoxia brain injury through delay in delivering.

Neonatal resus - yes, the midwives are trained, but they are not a neonatal team who would appear within seconds should a hospital delivery result in a baby needing support. They cannot intubate and ventilate a struggling infant. “Only 5 mins” to hospital is never only 5 minutes and a baby sadly cannot hold it’s breath for that long!

A hospital stay for a uneventful delivery can be a matter of hours if you wish.

Yes, arguably you are more likely to pick up Covid via going to hospital than staying at home, but I am assuming you have attended your antenatal care in hospitals, which probably carries a similar level of risk.

My reply is informed by the fact that I have dealt with many obstetric disasters as an anaesthetist. Some of these were predictable, in high risk patients. Some in uncomplex pregnancies who would have met the criteria for home delivery. Maternal and neonatal mortality is low in the UK, and has been driven by advances in obstetric care and the majority delivering in a hospital.

All three of mine were born at home. I had to transfer into hospital after the birth of my first as I’d had an internal tear from his poor positioning which couldn’t be repaired at home but I wasn’t admitted.

All three births were wonderful and stress free. I can’t imagine it any other way.

@Anaesthetist83 do you think it is immoral / unethical / professionally negligent for midwives and hospitals to promote and support home birth?

I’m genuinely curious. If the dangers are so great that you, a medical professional, think it shouldn’t be contemplated then do you think the NHS should take a firm stance on not supporting it?

Some countries don’t allow home birth, or have rendered it practically impossible if not illegal. Would you prefer this to our current model?

(I hope these questions don’t sound interrogatory or hostile, I’m genuinely interested in responses from a medical professional).

I also want to point out that things can and do go wrong in hospitals, as evidenced by the large number of clinical negligence cases brought against the NHS. I support the decision to give birth in a hospital wholeheartedly, but it’s a false dichotomy to suggest that you will definitely be safe in hospital and definitely not safe at home. I know of a woman left with life changing injuries because an overworked consultant dealing with her and several other labouring mothers at the same time didn’t pick up on an issue early enough. She is now permanently wheelchair bound and her baby has brain injuries which mean he will never be able to live without full time care. She was awarded a settlement by the NHS of over a million pounds, but it’s can’t give her or her baby back their health. Is that her fault for choosing a hospital instead of a home birth, where two midwives might have picked up on the issue early enough to resolve it safely? Of course it isn’t - it would be disgusting to even suggest she was to blame. So why people think blame can be attributed to women who make an informed decision to have a home birth and experience complications is completely beyond me.

Anaesthetists are often against homebirth it seems. when I transferred in to be stitched in theatre after my homebirth the anaesthetist said she thought only pizzas were appropriate for home delivery, not babies. Delightful woman.

If I'd taken the initial advice given to me when in labour, my baby would have been born on the pavement. Pretty glad I was at home tbh

I planned a HB with #1 and actually managed 30 hours at home, early labour, waters gone. My experience wasn't great though. I was with One to One Midwives and nobody came to check on me for the first 28 hours and I was "reassured" over the phone everything "sounded" normal. When my midwife did eventually turn up and discussed increased risk of infection she said this could be monitored at home. There was then a question of merconium and again she said we could keep an eye on things however that was the final straw for me and I took myself into hospital where it was discovered baby was actually breech 🤦‍♀️

Had I been better monitored and checked I would have had more confidence but by the time she turned up I was shot.

I wouldn't discourage anyone from a home birth but consider your midwife's primary concerns. One to One seemed more focussed on a home birth that I was (I'd planned for all eventualities and if I was transferred so be it) and seemed far too holistic and anti-medical at a possible detriment to myself and my baby. I don't think you would have this issue with the NHS though.

Good luck whatever you choose

I don’t think it is about blame, nor do I think that it is wrong for people to choose a home birth if they think that that is right for them. What I do think, is that people need to be fully informed so that if something were to happen (either at home or hospital) they can be comforted by the fact they made the right decision for them.

The reality is, many (particularly) first time mums have very little insight into what can actually happen and in fairness, why should they.... so I am all for providing unbiased information which a lady can then use to inform their decision. In the same way that admittedly I have a bias towards hospital care, midwives who are based providing home births will also fundamentally believe that that is best. So naturally their view will be skewed..

Had a planned home water birth with my first (and only one), just under ten hours altogether. I was discouraged by midwives and my GP. And some people said I was mad. However, I read a lot (really a lot!) about natural birth and did some hypno birth sessions, also hired a doula, who was a massive help.

I didn't want to go to a hospital, as I knew it would stress me out.

Took calculated risk I suppose, but my pregnancy was easy and healthy, no complications whatsoever and I kept fit as much as possible all the way through. DS was born on due date.

I personally would never ever have a home birth as a first timer. I had a very low risk pregnancy, no issues at all and was pushed and pushed to try for a home birth. Thank god I said no because, no exaggeration, both baby and me wouldn't be here if I had. I was unlucky, (or perhaps very lucky?) that I had a theatre down the corridor and amazing doctors that saved our lives. I only said no because I wanted to know that I had medical assistance on hand (and more importantly pain relief!) if I needed it.

There are risks with every birth, and being a second timer plus is no guarantee of a problem free birth but you at least know what's coming.

My own experience makes me biased I know lots of mums love the home birth experience but I always deemed it too risky. It would depend for me also on your proximity to hospital, I am 45 minutes drive away which is far too far away for comfort.

I'm a FTM and planning a home birth - my midwives were all very encouraging and my consultant also said he was happy with it. I live very close to the hospital though which made my decision easier - if I were 40 minutes away or something I might rethink but for me the benefits are worth it - being in my own space, having my partner with me, having the sole attention of a midwife and greatly decreased risk of a CS etc