Can't decide whether to have a Home birth or a hospital birth?

[mumsiebumsie]

Hi all,

I'm really looking for advice from ladies who have previously struggled, or are still struggling between the decision to have a Home Birth or Hospital Birth.

My midwife is really keen on home births and I like the idea. She says I'm low risk so there's no reason why a Home Birth wouldn't go very smoothly.

Also I really hate hospitals, I feel panicky just going for my antenatal appointments. But ultimately I want to do what's best for the baby - and wonder if I'm being selfish and depriving the child from medical equipment it may require just because I want to get in my own bed afer the birth?

Am only 16 weeks so decision isn't vital now (I don't think) but really want to know what I'm doing.

Any advice, opinions or experience greatly received.

TIA

MB

I had a homebirth. I didn't particularly struggle with the decision, it was something I was keen on from the start, but I did always try to keep in mind that although I may start labour at home I may still end up in hospital.

I think you should probably try and address your feelings about going into hospital as you may still have to go in, and if you had settled on a homebirth it may be all the more scary than if you were expecting to go to hospital.

Perhaps go for a tour of the labour ward?

Hi, all I can offer is my own experience. We had a straightforward pregnancy and a home birth which went very well - 12 hours from start to end, an active labour, no tears or stitches and dd had apgars of 9 at 1 minute and 10 at 5.

To begin with DH (who is medically trained) was quite resistant, his instinct being like yours that if anything went wrong would we be endangering the baby? A very important factor for us was that we live about 15 minutes drive max from the nearest hospital, so if we did need to transfer it would be done very quickly. Is that a factor for you?

Once we started looking into the stats about interventions in hospital birth (especially at our local hospital which is a specialist for high risk pregnancies so has a very high intervention rate even with otherwise normal pregnancies) we decided that the likelihood of a 'normal' birth (ie one without unneccessary intervention) was much higher at home. Have you looked at www.homebirth.org.uk/ ? They have a lot of information which might help you decide. Also www.drfosterhealth.co.uk/birth-guide/ which will give you information about the stats for interventions at your nearest hospitals.

Ultimately it's your decision of course, do you have a partner who would be with you during labour? What are their feelings? I guess the key thing to remember is that even planning for a home birth has a great influence on your chances of an intervention free birth, and while you can always say "Actually I would like to go into hospital, let's go" at any stage during a home birth, if everything is going very well in hospital and you decide you'd rather be at home, you can't then go back.

Good luck with whatever you decide

Sorry that should have been www.birthchoiceuk.com/Frame.htm not Dr Foster.

Wem is completely right about going to see the hospital anyway and maybe if you do plan a home birth, to put something in your birth plan about what you would like if you do go to hospital, that way you've at least mentally prepared yourself for all possibilities. This is a great book www.bloomingbirth.net/

I would send you my copy but it's gone to a mate.

For me it depended a little on how far I was from the nearest hospital.

In my case I am 10 mins away from 2 hospitals (in London) and if something had gone wrong and I needed transfer to an operating theatre (for example) the hospital transfer in an ambulance would take no more time than the transfer from the labour ward, waiting for everyone to be in place etc.

The midwives on the homebirth team around here are superb. Their training is immense and they bring a whole bunch of equipment with them including resus stuff and oxygen. My midwife talked me through the possible (rare) emergency scenarios and she was clearly confident. As she said herself, "we're not just there to scatter rose petals". And when birth goes pear-shaped there are very usually indicators along the way. The most common reason for transfer is 'failure to progress'. Noone is in danger at that point.

My first birth was in hospital and a midwife popped in and out. I was alone with my partner for quite long periods. The postnatal ward experience was horrifying

At home I had 2 midwives all the time. I felt in much better care. I felt more relaxed which obviously can help birth to be more successful. It was a fantastic experience.

You could always say yes now to a homebirth and get antenatal care with the homebirth team and change your mind at any time.

I had a homebirth with my second (I wanted to with my first but it wasn't an option).

A deciding factor for me was the ambulance response time to my postcode which was less than 10 mins (ask your midwife for the stats - they should have them). In most emergency scenarios it would take much longer than that to prep you for cs and vacate a room - so I felt that for me, the timespan from warning bells to action would be much the same, in hospital or out. Of course there are some emergencies when even 10 mins could make a difference but statistically these are very few and I felt that the difference a homebirth would make to me and the baby outweighed the very small chance of a unforeseeable massive emergency.

They are also very cautious and will usually recommend transfer or hospital birth from the outset if there's even a hint of problems.

However I agree with wem that you do need to address your feelings about hospitals because unfortunately only a smallish proportion of women who hope for a homebirth ultimately get one, either through complications in pregnancy or labour. I also hate hospitals and always hoped for a homebirth, but planned and prepared myself mentally for a hospital birth. It didn't happen with my first, but did with my second.

oh - and I should have added that the homebirth was wonderful and everything was much smoother. I felt DS2 had a much better start in life with less trauma and less intervention, and bfing was much, much easier. Obviously that may have been partly because he was my second, but I'm sure a lot of it was me being well-rested, well-fed, in my own bed and completely relaxed.

So it's not a simple as a choice between your comfort and the baby's well-being, the two frequently go hand in hand.

Jumpjockey and Wem thanks for your advice.

Especially the part regarding the fact that even if I begin with a Home Birth I could possibly end up in a hospital anyway so really should prepare for it.

Tours of the labour wards are offered at my hospital. However I was present while a friend was in Labour at said hospital and hated it! It was dirty and the staff whilst efficient were not friendly. So that's really put me off.

I live 7 minutes from the hospital so if need be could get there quickly.

My husband would prefer a hospital birth (normal reasons such as all the equipment being at hand if need be) but he's happy for me to do what I'm happiest with. He'll certainly be on hand at home (although what help he'll be I'm not sure!)

Haven't heard of those websites before so I'm gonna take a look now.

Another question - if I do tear, does the midwife stitch you up at home? Or do you need to go to the hospital to do that?

Um...homebirths for low-risk mums are statistically safer than hospital births, so you are making a choice for your baby by having it at home.

Births that go smoothly aren't just nice for the mum, they are good for the baby too, very good for the baby.

if you tear it depends - often they can do it at home but if it's a bad tear they may ask you to transfer.

If you book a homebirth, you can transfer to hospital at any point. Extremely difficult to do it the other way round, ie, decide to stay at home.
Mine were all planned homebirths but had to transfer to hospital for c-sects. I'm so so glad I got to labour at home, though.

Tambajam and theyoungvisitor thank you both.

It's really nice to hear from people who have had a home birth. Sounds like all in all it was a postive choice. Given me a lot to think about.

As mentioned - if I'm relaxed, it will ultimately help the baby. I really like my midwife and like the idea of her (or a colleague) being on hand all the time unlike hospitals where they pop in and out and change shifts etc.

Can I ask what may be a sensitive question I don't know. "Was there a lot of blood?" My property is rented and cannot afford to stain the cream carpet! Say I deliver on my bed - will blood fall on the floor? I have no idea how much a woman bleeds when giving birth so sorry if stupid question.

you may want to look at the 2008 homebirth stats for your chosen hospital on Dr Foster as they make pretty sobering reading.

I'm not sure how accurate they are - but as an eg, one of the hospitals near me had more than 3000 women deliver in hospital, yet only 15 planned homebirths, according to Dr Foster. This was the same number as delivered at home accidentally.

Sorry, x-posted!

there is usually quite a lot of mess but the MWs are very, very good at dealing with this. They bring special absorbent pads for leakage, and my MW suggested I get a couple of cheap shower curtains (£1.50 at ikea) for spreading over the bed and floor.

At the end it looked like carnage, but they bundled the whole lot up and put the towels in the wash and you would seriously not have known what happened. They were truly marvellous, the place was spotless.

Mumsie, I've had four homebirths. All lovely. First time I had a 3rd degree tear that I transferred into hospital for after the birth to have it stitched under a spinal. Came home the next morning. 2nd time had a 2nd deg tear that was stitched at home. 3rd and 4th times didn't need stitches.

Blood: The mw will bring inco pads, but best to get loads of towels from charity shops and/or a cheap duvet from dunelm. Then get some of those thick plastic 'dust sheets' (wilko sell them cheaply) to go underneath them on the floor/bed.

You may well not birth in bed, though - more likely on the floor on all fours/on knees leaning on sofa. Or, of course, in a birthing pool if you hire one.

And yes, the midwives clear nearly everything away. On the homebirth website there is info about cleaning up blood.

We had a birth pool and put a big tarpaulin under it and lots of old towels from freecycle. All the gunk was left in the water, so I went up and had a snooze with DD in our own bed while DH dealt with the mess and he said it wasn't as disgusting as he'd feared, the MW takes the placenta away.

theyoungvisitor wow thanks for that. Shower curtains are a very good idea! That's been playing on my mind as a possible reason to avoid homebirth so glad that's cleared up (no pun intended). Will also take a look at Dr Foster for the homebirth stats - gonna go look now.

flamingobingo and jumpjocky thank you for that.

Wow 4 home births!

Haven't considered a birth pool - that I think I'd like.

The midwife mentioned that I can give birth wherever I like in the flat - hadn't considered anywhere other than the bed so that's interesting. Although she mentioned someone gave birth on their stairs! Not sure I believed that.

if you are in an upstairs flat of an older building you may not be able to have a pool - sometimes the joists aren't strong enough!

Birth on the stairs doesn't sound too weird to me - they often get you climbing stairs if the contractions needs strengthening. It helps bring the baby down the pelvis I think - or something like that (not an expert at all!)

I have always wanted to push in the upright position so gave birth standing next to our bed, with one leg on the baby's cot . It's the exact place I stand now when I'm putting him down for the night, and it always makes me smile. It was a very awkward position for the poor midwives as there was only a couple of feet between our bed and the cot and I was taking up all the available room. I'm amazed they didn't ask me to move but they let me get on with it!

At what point do you have to decide? I'm 18 weeks now, have scan in a couple of weeks but otherwise I'm not seeing the midwife again until week 28. At this stage, no one has even asked me whether I'd like a home birth.... Is that normal? Or am I panicking that I've only got 4 months left

theyoungvisitor - Maybe the stairs story was true then! I'm on ground floor thankfully. I like the idea of walking round the flat knowing exactly where the baby was born too.

shoesies - Have no idea! Hopefully someone else can answer the question for us.

at what point do you have to decide?

Well, I don't think you have to decide at any particular point in the strictest sense - in that I think you are entitled to labour at home whatever.

but different hospitals have different set ups.

Some hospitals have a dedicated homebirth team and the earlier you transfer over to them, the earlier you can get to know the staff. My hospital is like this and if you transfer over to the homebirth team you can start having your AN apts at home (from about 20 weeks I think). The latest they recommend transferring is about 28 weeks iirc.

Other hospitals use their regular mws so it doesn't much matter when you sign up, in fact some places won't even discuss it before about 36 weeks on the basis that medical contraindications may arise, so there's not much point in "deciding" until later on.

You will normally have a visit and risk assessement about 35 weeks which is when you know you are on the home straight

But as others have said, it's easier to transfer back to hospital care than the other way, so if in doubt I would sign up for a home birth and then you can always change your mind at any point, whereas doing it the other way may be more tricky.

In terms of reassurance for when things don't go precisely to plan with homebirths, search my name on here. I've had two homebirths that I consider to be wonderful, easy, positive experiences, and if ever a third is on the horizon I would do it again in a heartbeat. However neither of my births were what would generally be considered uncomplicated. Ds1 had was wrapped twice in his cord, had to be cut free, and was resussed with massage and a breathing bag. Ds2 had a shoulder dystocia and a snapped cord.

Community and homebirth midwives have regular, specialised, emergency drill training. They are professionals and will not risk the lives of you or your baby just to suit themselves. Chat it through with her at your next appointment, and as others have said it's much easier to change to a hospital birth than from one, so sign up for a homebirth anyway.

As for mess, get lots, and I mean lots, of cheapy cheap shower curtains to overlap and cover the floor with - we left a couple of gaps inadvertently, and I still can't shift the stains!

theyoungvisiter - thanks for that, I really like the sound of AN appts at home. My hospital is UCH in London which I'm lucky to have anyway as it has a really lovely birth centre as well as a labour ward but reading some of the positive stories on this thread has really made me consider the home birth option.

My only experience with home births is two very good friends who both ended up having to go into hospital, one with complications that ended in a section, and the other with the classic 'failure to progress' (baby had his little chin stuck!). Obviously not what they had planned but on a positive note, both babies are totally healthy, absolutely gorgeous, mums are fine and neither any worse off for the experience So I guess you just go with the flow.

I had 1 hospital birth, 2 home births and 1 failed home birth when I had to go in by ambulance. I would do it again as I am like you and really don't feel comfortable in hosptital (although the Glenfield in Leicester has lovely parents rooms!) I hated being in when I had my dd and it was so much nicer doing it all at home. I used an old laminated tablecloth for the mess. We didn't use it for a table cloth again!