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

@Ezra123 That's your prerogative, of course.
As it is mine to cite the research which states that: "For women and birthing parents who have given birth vaginally before, it is as safe for the baby to be born at home as it is in hospital." (NCT)
My biggest personal regret in terms of where I chose to birth is not having at least the last two of mine at home.
I am categorically not having any more babies but if I was to and was again deemed low-risk, I would again chose a home birth with the same Independent Midwife as before.

@Ezra123 Mother's choice.

@Nursemumma92 My first pregnancy was induced (I should've refused), followed by failed forceps finally ventouse.
Still classed as low-risk for my second.
We all know NHS maternity services are sadly lacking. Ockendon report?

No, I'm not. But you don't have to be a medical professional to make choices about your pregnancy in this country. Thank God. People have choice in healthcare. Forcing someone into an induction or caesarean would be assault.

Thank you very much for this.

There are certainly some respiratory conditions which aren't always (or even often) detected before birth, that would require immediate intubation by a specialist team.

@Lexibletheflexible Absolutely this. I don't think my IM touched me throughout the vast majority of my labour upon my request. The only time was to Doppler under the water, and each time she asked for consent first. Not sure when else she would really have felt the need to?

What ones? How rare are they? It's best to talk in numbers so we know if there is a 1/50'000'000 chance of this occurring or 1/50.

That isn't the case in my trust. It wouldn't be classed as low risk with assisted delivery, and you didn't previously have an EMCS either so it's a different situation.

You are entitled to your opinions but consistently quoting NCT about having a previous vaginal delivery being low risk but failing to acknowledge the previous c section before and blood loss after assisted delivery, you are not taking on the full facts.

Of course home birth is amazing and I'm absolutely for it in the right circumstances but OP isn't low risk and wanting a home birth for childcare reasons is also not a reason for this decision. There is also no guarantee she would get a c section the minute she was transferred to hospital either as it would depend on the activity on the delivery suite at the time. They would try and do it straight away but if her and her baby are stable and safe and there were other emergencies then she may have to wait and it not pan out as she hopes.

Not necessarily a reason for her not to do it but you seem unable to acknowledge all aspects of this scenario and belittle other posters at the same time.

People don't understand that the actual experts say they is very little to no predictive value to the monitoring they do in labour. It's just the best they have.

I've posted the relevant links on this thread. The whole thing about a baby's heart rate dipping and this meaning that a bad outcome is likely isn't really proven. New interpretation techniques are being studied but the main issue is that you cannot ethically trial fetal monitoring vs no fetal monitoring. Most studies that compare intermittent auscultation to CTG show no significant differences.

How rare they are is irrelevant when you are telling people absolutely that they cannot know their baby would have died if born at home, without even knowing the circumstances. There are situations where people can be certain. It just doesn't fit with your philosophy for those to exist

Your extensive research should have picked them up given 10 minutes was all it took for me.

Why would that make you high risk? The induction carries an increased risk of an instrumental delivery last I checked.

And let's consider the current questions around the safety of maternity NHS services if we may @Nursemumma92 ?
While most babies are born safely in the UK, recent high-profile reviews show that NHS maternity services are not consistently safe.
Potential TW - baby loss discussed.
Government-backed investigations and reports from the Care Quality Commission reveal systemic failures, staff shortages, and poor workplace culture across many trusts, prompting ongoing national safety overhauls. 1, 2, , 5] (NHS)

Yes I have researched this. That's how I know that the risk is so low that most rational people wouldn't use the risk of the baby having an undiagnosed respiratory condition that requires immediate life saving treatment to decide where they should give birth.

You'd think more about where people like you are most likely to have a successful Labour and spontaneous vaginal birth. Research actually shows that for people like the OP, that is at home.

This is not relevant to the points I have made. Of course the system is flawed and I haven't denied that but the majority of women that have unfortunately come to harm have had complex situations that absolutely wouldn't be better managed in a home birth scenario.

I do not wish to argue with a brick wall who cannot acknowledge anyone else's point of view especially people's lived experiences.

With two births that went very wrong? You think that is safer at home?

Goodness you've drunk the cool aid with this..

If it's what the op wants then I'm supportive of it, but it's clearly not true to think it's the safest option.

@Nursemumma92 I am sure you can, however, acknowledge the lived experience of many women and babies who have been failed, and continue to be failed, by NHS maternity serivces.
You can't blame women for looking at the alternatives as is their absolute right.

1 was an induction, 2nd was poorly managed by midwives. Nothing about OP's body says "can't do normal births". Maybe the thing she should change is where she has babies

I’ve had 3 different birth experiences - horrific first with a failed induction, followed by epidural and forceps delivery - really brutal. Second was a planned home birth, prompted by me not wanting to be anywhere near a hospital - couldn’t have gone better, with two lovely midwives, gas and air, shortish labour and not that much pain, as I remember - very relaxed! Number 3 was an emergency Caesarian after haemorrhaging, which thankfully had a happy outcome. I wouldn’t have chosen to have a Caesarian, though. It’s classed as a major operation, not a minor procedure, with all that implies, as far as risk and recovery goes. I think it’s obvious which birth I preferred, but what’s most important is that you feel happy and confident in your decision. Whatever you choose to do, hope all goes well, op!

Clearly you were not supported well during your first two births and the care sounds like it left a lot to be desired. But the ‘constant dopplers’ during the second labour was to make sure that your baby’s heart rate wasn’t having decelerations due to your scar coming apart, which is definitely a small but real risk when labouring after a section.

You’ve got a really good chance of having a straightforward vaginal birth this time so if being left undisturbed at home feels the best option you could speak to a birth choices service at your hospital if they have one to go through all the risks and benefits.

Sounds like OPs PI is normal which is great and percentile growth, providing it wasn’t on the 90th and has had a downwards growth trend, which is reassuring.

Just talking from experience that when the PI gets too high, the growth drops off to below the 3rd percentile it would be classed as IUGR for example. 50% of all still born babies have IUGR, the medical professional will want to deliver as soon as possible for severe IUGR, in mild cases they will want to try to get to 37/38 weeks.

If the PI is too high (above 1.2) with any reverse blood flow then it would be delivery that baby on that day. The placenta is failing its not watch and wait situation….well you can but I wouldn’t gamble with my babies life.

Hence I mentioned this as in the orginal OP she talked about growth scans and PI.

No it won't be delivery that day unless the mother consents to giving birth that day. It isn't out of her hands. It is firmly in her hands.

Of course everything is consented, you can refuse cancer treatment and try herbs etc. But there are times in my opinion you need to weight up options of what if we do nothing, what if we wait, what if we intervene.

In my case if we did nothing there was a very high chance of still birth, luckily like I said this doesn’t seem to be the case for OP at the moment looking at the updated and data.

Yes, mum needs to weigh up options and make a choice..nothing is out of her hands. There is no point where you have capacity and choices are made for you. That's illegal.

I had independent midwives for my second and third home births. I had a home birth with DC 1 but I was lucky that it was straightforward and found the midwives contradictory and unsupportive. My independent midwives were fantastic. All care and appointments at home - just two scans in hospital and just quiet support. No internal exams, no having to explain my choices. DC three was over two weeks late and there was no pressure to induce. It’s not cheap but I paid in instalments and it’s less than lots of people pay for family holidays or cars. It’s hands down the best money I’ve ever spent.