Home birth after difficult previous births, or plan a caesarean instead?

[Mumtotornadoes]

I am 34 weeks with my third baby. I noticed at a random growth scan I had yesterday while seeing the consultant that my PI is high and baby's size is small. Neither outside of the "norm" but not far off. They didn't say anything, they're not concerned but have booked another growth scan for in 4 weeks.

I just noticed and it got me thinking about having a plan for if something goes wrong. I have been fully expecting baby to be very late as both my others were and labour to be very long. I want a home birth and essentially to be left the hell alone. But I think I'm being a bit naive and overly positive.

My first was an induction and emcs. It was fucking hell. I will not have another induction. The recovery from the c section was incredibly hard, like over a year of pain, unable to wear most clothes level hard.

Second was a natural labour but the midwives were absolutely hell. Constant Doppler despite no issues and vaginal checks despite the fact I'd said none all of which they could only do on my back so I'd get comfortable and in the zone and they'd make me move to my back. Baby was back to back so it was so hard. Failed epidural that they denied even as I was walking myself to the toilet and squatting to push. They told me when to push, I pushed for an hour then said "oh you weren't actually fully dilated , there was a lip but you are now, but you've been pushing an hour so it's a c section. While they prepped I pushed and got him nearly out which DH had to force them to even check. But consultant still wanted to do a suction even though he hadn't been stuck or delayed. I said no, she said yes and cut me. Wouldn't let me delay cord clamping because I was bleeding so much but nobody was concerned about the blood loss and it's not recorded on my notes as being much at all. Then turned to her student and said "well that's good, now you've seen a ventous delivery "

SO I don't have good experiences.

I want a home birth. With supportive competent midwives and I want to birth my own child without panic.

But 1. I'm scared if that if we try for that then it goes wrong we'll end up with another hellish experience.
And 2. We have very limited and unreliable childcare options. Our eldest had a different dad who happened to have him that weekend but we also lived near alot of family so had alot of options for childcare with number 2.

Neither of my kids have ever spent the night with anyone but me or their dad. My youngest has never been in anyone else's care ever, not a single hour of babysitting for an anniversary dinner, birthday drinks, nothing. He's 2 in a few weeks.

We have a few not super close friends that I'm sure would help for a few hours if arranged in advanced, but not be on calls to drop everything and spend two days at your house level friendships but they are lovely people and would come in and emergency. And my mum who thinks she's super helpful but just adds so much work. The plan was for her to come and look after the kids while I'm in labour at home but it is constantly asking for stuff, asking how to work stuff, she comes to ours to see the kids sometimes and it is just like having another kid. They're up later at night then up earlier in the morning and need more from us to settle. It's just like having their friends over for a playdate. I worry that she'll just make it more stressful then the kids will be put in a situation where I'm suddenly leaving for longer and it'll be so much harder on them and me. And she gets stressed with them easily.

I could schedule a c section and have either a friend or my mum take him out for the day, on one of the weekends eldest is at his dad's. He would be best if he could go somewhere. Or he might handle it better an a weekend his big brother IS here so he has someone he knows well with him. Then DH can go get him and have him the night then they can come to hospital in the morning to get me. I would hate being alone at the hospital. And I am scared of the recovery from a c section again. But I think maybe a scheduled rather than emergency and being with a very supportive loving H rather than the abusive POS I was with the first time would change that?

I WANT a peaceful home birth. But it's such a gamble, is it worth it?

Oh this is likely my last birth. So last chance to get it right but also c section won't impact future births

Neither. I’d go for a hospital birth with limited intervention. No checks etc. Pain medication you choose. Your two options feel poles apart.

Oh I absolutely can say it with certainty and so did the surgeon who came to see me the next day ! I lost a huge amount of blood in a very short space of time and my babies heart beat was rapidly petering out. The surgeon - who only did EMCS - actually said “thank goodness you were in hospital when it happened”. Perhaps you’d like to pretend you know better than her? I thank my lucky stars every day that I was in hospital. I was in a midwife led birth unit when it happened, in birthing pool, which was nice… but crucially very close medical when needed.

You are literally making shit up to minimise the risks here. People will read your comments and may take them as fact. Very irresponsible.

@Ezra123 No you can't. For example, a home birth midwife may have identified an issue earlier on which could have changed the course of action etc. Hence why you cannot say with absolute certainty. We simply do not know.

Of course you can in some cases.

What about a baby born with an unexpected serious health condition or similar. So undiagnosed serious cardiac issues? What about a baby at 23 weeks gestation?

There are absolutely babies that require being born in a hospital or they will die. Many will be off up prenataly, but not all.

I had a very attentive 1-1 midwife in the birthing centre. It all happened very suddenly, I have read my full notes including the babies heartbeat monitoring chart and also had an in depth chat with a consultant in a birth reflections debrief afterwards. It could not have been identified earlier. You really need to stop making stuff up about my birth and dismissing the fact that there are situations where no amount of midwife attentiveness will save a baby.

@Babyboomtastic Well to take just one of your examples, at 23 weeks gestation wouldn't be considered low-risk and obviously home birth not advised in that particular scenario.
The fact remains that home birth for subsequent low-risk pregnancies is as safe as in hospital. Not me saying that - it's researched.

This might be taken out your hands anyway, a higher PI is showing the placenta is not working aswell and if baby is starting to measure small they worry about the placenta and functioning.

Do you know what your PI number was? They can’t have been too concerned if they booked 4 weeks rather than a 2 week review.

Any change on movements please get reviewed

@Ezra123 I don't think you are understanding. Not all midwives are the same people who make the same decisions at the same time, for example.

What am I missing ?! Having gone over all of the information I noted above with a consultant post birth, what information were we missing that you possess? As I have said repeatedly, it happened very suddenly and the midwife acted rapidly - we looked at the heart rate monitoring chart and the full timeline.

I understand it all perfectly. And I never suggested that all midwives are “the same person” so that’s a straw man.

I would say it’s you that is “not understanding”. Possibly intentionally as my story doesn’t fit with the message you are trying to peddle.

I've known three babies with serious heart issues. All were born in hospital after a normal labour and discharged as well babies. One of them is my sibling. As it is my sibling, I also know that being born stable is very common with their heart condition and other heart conditions like it. It wasnt until they were a few days old and the "hole in their heart" is meant to close that it actually becomes apparent they are unwell.

Point being, they could have been born at home and it wouldn't have changed the outcome. They were fine at birth and during the labour.

How would it be taken out of her hands?

There is not and it's not really an option for us childcare wise. My labours have been days long. I can't be in hospital that long. We don't have childcare for that and if I was in labour I hospital I would need DH to advocate for me. Being home means our childcare needs are much lower. As would a c section. A lengthy hospital/mlu birth is just not an option .

@Ezra123 Your experience doesn't make home birth unsafe. It doesn't make hospital birth safe, either.
I've had 2 x hospital births and 1 x hospital birth and I know which felt safest to me.
I'd opt for a home birth every time for a low-risk, subsequent pregnancy. Had I opted for a home birth second time around my middle son would likely have not have to live with his significant hearing loss.
Each to their own.

If at the next scan the PI number increases and my baby's centile drops there will be concerns that baby isn't receiving enough through the umbilical cord and something is wrong. In which case I will c section. If anything is wrong at any point we will just go straight to a section.

@Airconfan the PI was like 85 and the centile was like 20. The consultant didn't even mention it, he said all the test had been done and they were fine. It was just something I noticed, I've had ALOT of growth scans. Never had a high PI before so it caught my attention. It's within "normal" limits but I have OCD and control and preparation is my thing so I tend to over plan for possible eventualities as I tend to freeze in the moment, so planning in advance gives me a chance.

Absolutely, but equally there will be conditions which were not known about prior to birth that would only be survivable in hospital. Not all low risk births produce low risk babies, and for that very low number of babies, hospital is necessary. I'm not anti home birth, but I don't think we can pretend it doesn't have it's risks, along with everything else. Then we work out the right thing for us and our babies.

Okay but to be clear, it will be in your hands. If you decide to go forwards to section because of this test result, that is up to you. They can't make you have an induction or caesarean because they think you should. Even if they are absolutely right about the risk.

It isn't taken out of your hands.

There are very few conditions that aren't picked up on scan (especially since OP seems to have had more than the routine 2) that require immediate life support at birth.

OP may have had a vaginal delivery before but it was an assisted ventouse delivery with what sounds like notable blood loss although not clear.

Yes that could be due to a cascade of interventions but we will never know.

I'm not trying to sway the OP either way but this isn't a low risk birth following a EMCS and then assisted delivery. As long as she feels informed of all risks and she has a plan with her midwifery team then that's fine, but you telling other women that they can't guarantee their baby wouldn't have survived if they were at home is bonkers. I work as an obstetrics as an anaesthetic and recovery nurse and there are many true emergencies in low risk women that come through that wouldn't have had a good outcome if they were not in hospital. And some women who have transferred in these situations who haven't had a good outcome... thankfully rare but it happens and people must be informed of all the risks and make their own decisions.

But don't belittle other posts for their experiences, that's not ok. You don't know better than them.

Are you a neonatal doctor?

Oh yeah absolutely. I mean I could refuse both even if there was an issue. It is absolutely my choice, at no point does anyone else get to override that, as much as they may wan to or think they should be able to. But if there was something actually wrong with my baby I wouldn't be weighing up any decisions, for me the choice would've made by fate/chance.

And as I have said, had I opted for a home birth for my second (low risk) birth, my child and I would be dead and my older daughter would be growing up without a mother.

I did not claim that my experience alone proves that home births are unsafe, and I have explicitly said that hospital births also have risks.

But it’s important for people reading these threads and making decisions to see examples of risk on both sides, and how being in hospital during birth can be, literally a life saver.

I hope by sharing my experience to give people information that they might not have considered or been exposed to, especially if they are getting swept away on a tide of very pro home birthing Facebook groups, for example. People do need to understand the risks that they are accepting for themselves and their children. And that “oh but you’ll be more closely monitored and if anything is going wrong calling an ambulance will solve that” isn’t necessarily true.

Nope. But I extensively researched homebirth and this was a particular concern of my husband and so we dug deep on the risk associated with this.

There is no difference or a benefit to homebirth in neonatal outcomes where there is proper prenatal care. Even in many women considered high risk.

The poor outcomes for babies never involved babies with an underlying condition at homebirths either. Where there were poor outcomes, other factors were the cause.

Yeah that's the same for most people, irrespective of their ideals. I just find it empowering to remember that you are the one ultimately assessing what level of risk is acceptable to you and your baby.

In your shoes I think you would be bonkers to have a home birth.

Except she’s not a relevant medical professional and I highly doubt you are either.