But is homebirth safe if it's your first ...

[Julie Doula]

This is a question I hear a lot - concerns that homebirth might not be a very safe option if it is your first baby, untried pelvis etc etc. "I'd love a homebirth ... but not for my first ... maybe I'd think about it for my second or subsequent babies ..."

The problem with this reasoning is that after a hospital birth that often involves some degree of trauma and possibly some sort of surgery, many women find their confidence in their bodies and in birth is so shot, they face many obstacles to have a homebirth. For example, planning a VBAC homebirth is probably harder logistically and emotionally than planning a primip homebirth.

27% of mothers in Australia who had homebirths in 2006 were first time mothers. In my experience, homebirth for your first baby is a more than reasonable option because it sets you up with a positive "obstetric history" and is much less likely to end in surgery (4% c/s rate compared to 40% for primips in most hospitals - that's one tenth of the chance - just because of the different location).

But that was just my subjective impression - until I came across this research paper from New Zealand about first time mothers and homebirth.

First Birth at Home or in Hospital in Aotearoa/New Zealand: Intrapartum Midwifery Care and Related Outcomes

First Birth at Home or in Hospital in Aotearoa/New Zealand: Intrapartum Midwifery Care and Related Outcomes
First Birth at Home or in Hospital in Aotearoa/New Zealand: Intrapartum Midwifery Care and Related Outcomes en_NZ
Author Miller, Suzanne Claire
Advisor Moss, Cheryl
Advisor Skinner, Joan
Unit Graduate School of Nursing, Midwifery and Health en_NZ
Copyright 2008

Abstract
A woman's first birth experience can be a powerfully transformative event in her life, or can be so traumatic it affects her sense of 'self' for years. It can influence her maternity future, her physical and emotional health, and her ability to mother her baby. It matters greatly how her first birth unfolds. Women in Aotearoa/New Zealand enjoy a range of options for provision of maternity care, including, for most, their choice of birth setting. Midwives who practice in a range of settings perceive that birth outcomes for first-time mothers appear to be 'better' at home. An exploration of this perception seems warranted in light of the mainstream view that hospital is the optimal birth setting. The research question was: "Do midwives offer the same intrapartum care at home and in hospital, and if differences exist, how might they be made manifest in the labour and birth events of first-time mothers?" This mixed-methods study compared labour and birth events for two groups of first-time mothers who were cared for by the same midwives in a continuity of care context. One group of mothers planned to give birth at home and the other group planned to give birth in a hospital where anaesthetic and surgical services were available. Labour and birth event data were collected by a survey which was generated following a focus group discussion with a small group of midwives. This discussion centred around whether these midwives believed their practice differed in each setting, and what influenced care provision in each place. Content analysis of the focus group data saw the emergence of four themes relating to differences in practice: midwives' use of space, their use of time, the 'being' and 'doing' of midwifery and aspects relating to safety. Survey data were analysed using SPSS. Despite being cared for by the same midwives, women in the hospital-birth group were more likely to use pharmacological methods of pain management, experienced more interventions (ARM, vaginal examinations, IV hydration, active third stage management and electronic foetal monitoring) and achieved spontaneous vaginal birth less often than the women in the homebirth group. These findings strengthen the evidence that for low risk first-time mothers a choice to give birth at home can result in a greater likelihood of achieving a normal birth. The study offers some insights into how the woman's choice of birth place affects the care provided by midwives, and how differences in care provision can relate to differences in labour and birth event outcomes.

I had my first baby at home (with a single midwife, in Ireland). 24 hours of labour, in and out of the birth pool, hands-off midwife, 7 pound 2 ounce baby girl born at 2 am, perfect apgars, intact perineum.

Of the 19 primip women I've been doula for over the last two years, 6 had homebirths. 5 had spontaneous vaginal births at home with no tears. 1 transfered to hospital and had a vaginal birth with the help of ventouse.

How about you? Did you have your first at home? How did it go? How did you handle the pain, effort or intensity with no pharmaceutical pain relief available? If there were any complications, how did you and/or your midwife handle it?

[HotI]

Thanks for posting this.

Just subscribing so i can come back and take a look at the whole article.

[Laranna]

Thanks for sharing this. For my first, there was no way I would have considered a homebirth - fear of the unknown. Although that is a bit odd to say because being pregnant for the first time is an unknown in itself, yet I wasn't afraid of that!

As I go through my second pregnancy and read more and more about VBAC and homebirth, the more I think it would be great to have a homebirth and I find myself secretly hoping at times that this baby will come out quickly before I have a chance to get to the hospital I am VBAC'ing this time and OB is happy for me to labour at home as long as I want which is my every intention because I know once I get into hospital, I'll be monitored closely.

For my next, a homebirth sounds like a very appealing option

[Julie Doula]

Hi Eluned,

Homebirth for a VBAC is definitely an option.

Of women in Australia who had a primary c/s, only 28% are given an opportunity to try for a VBAC. 72% have repeat c/s. Of the 28% who try for VBAC, 58% succeed in the hospital system.

Independent midwives have a 90% success rate for VBAC at home.

You can read here for more information about VBAC & VBAC birth stories, and also an independent midwife's recommendations for a successful VBAC.

If you go back to a similar model of care that led to your first c/s for your VBAC, consider that the likelihood of the same 'recipe' yeilding a similar result is quite high. A different location, careprovider and philosophy may yield a different outcome.

Here's a link about the safety of VBAC from the Birthlove website. Birthlove was down for a long time but now it's up and running again - great source of info. Here's their page on 'how to have a successful VBAC'. This is an American site but still much of the info is relevant to us in Australia.

Regarding the fear of the unknown wrt homebirth for your first, did you feel that same fear of the unknown wrt having your first in hospital?

Good luck!

[Laranna]

Thanks for those links Julie Well with my first a c/s was inevitable due to placenta praevia. Once I got my head around that disappointment, I didn't have the fear of the unknown of having him in hospital. This time, my first natural instictual thoughts were VBAC because well this time there is no 'medical' reason to have another c/s.

[jackrose]

Great to read Julie Doula and thanks for the links!

I wish I had more information in the early stages of pregnancy for my first, she was a surprise and it took me many months to get my head around a baby let alone how to deliver her. I just went along with the system in the beginning and then when I had more information I felt it was too late to change my arrangements. I ended up giving birth in hospital and after 40 hours of labour delivered by cs. I think a homebirth could very well have led to a natural delivery in my case for many reasons....

I'm only just pregnant with my second now and just beginning the process of homebirth/VBAC research. Very excited and enthusiastic about it too . I am now off to read your links, thanks again!

[Julie Doula]

Yes Eluned, as you say, placenta previa is one of the reasons that a c/s is usually necessary. The first woman I supported for a VBAC is here on BB and she like you had a c/s with her first because of placenta previa. We talked about homebirth and she seriously considered it for a while, then eventually went with a plan to stay home and labour at home for as long as she could before transferring to hospital. She laboured at home, got through the "oh God I can't do this i just want an epidural stage", coped by staying on her feet and keeping moving and stayed in the shower until the hot water ran out. Getting in the car was hard, but once she was in she just went into a trance-like state of deep relaxation/concentration, and travelled in the car for more than half an hour, just sitting on the back seat squeezing my hand. By the time she got to her room at the hospital, a quick check found she was 10cm dilated! That's ideal timing for a VBAC - rock up to hospital fully dilated and feeling ready to push. One way you can help figure out the timing is feel your own cervix when you're at home (as long as your waters have not broken prior to active labour starting.) You're just observing for changes. You'll find you can tell when your cervix is starting to open, when it's about half open and when it's hard to feel any cervix left at all ... but hey what's that furry walnut feel?? Izzat my baby's head??? Or you might feel something like a balloon in front of the hardness of your baby's head, which would be the forewaters. OK so NOW you're ready to go to hospital!

There's a good link here on doing your own vaginal checks called "It's Not Rocket Science"

Good luck jackrose, great you are on a mission to get informed and find out about your options, you won't regret it and you'll be able to approach your next birth with more confidence, and maybe think about hiring your own doula or independent midwife? An IM can be wonderful for helping you labour at home as long as possible, she can check the baby's heart and your BP, and make sure you and bub are just fine to continue the hard yards of labour at home. She can help you assess when is a good time to make the move to hospital, and go with you and advocate with you in the hospital. (Of course, once you're at that point, the option of staying home and just having the baby is open to you too.)

Another idea is you could hire or borrow a birth pool to use for pain relief and support during your labour at home. That might be just the thing to get you over "oh god where's my epidural!!??" hump. Seriously I've notcied several women hit a real wall at about 3-4 cm, then once they get through that 'crisis' (with loads of support), they find the rest of dilation, while challenging, not quite as overwhelming. It's like they find their groove, their rhythm, maybe it's their endorphins kicking in - and they seem to be coping better at 8-9cm than they were at 3 cm. Well, every labour is different, but I have seen that happen a few times now.

Good luck! You can do it!

[Tegam]

I'm only just pregnant with my second now and just beginning the process of homebirth/VBAC research. Very excited and enthusiastic about it too .

Woohoo Congrats on your pregnancy Jackrose.....if you need any help or support for your homebirth, just let me know....it can be a long road but its well worth it!



1st birth - hospital - 7hrs - easy, no trauma, no fear, great experience, home in 4days!

2nd birth - hospital - 2hrs - easy, not trauma, on fear, great experience, home in 4hrs!

3rd birth - home - 10mins - easy, no trauma, no fear, FANTASTIC experience......

Looking back, didnt even think of homebirth, they were for tree hugging hippys that lived in byron bay LOL.....followed the system because thats just what you did. Now feel totally lucky, like i had a very close escape from certain disaster having my babys in hospital (ok so a bit extreme but you get the idea). 3rd baby i just had the thought from the moment i fell pregnant. I will have this baby at home as WHY would i have it anywhere else! There was just NO need either time before to use up a hospital bed. I was perfectly ok and so were my babies! Home was right for our family. and if/when we have number 4 it will be at home

[Julie Doula]

Wow, Tegam - did you say 10 MINUTES with bub #3? Woah, you are the woman! I'll have to read that birth story! Sounds like home is the perfect place for you to be with super-fast births ...

Did your midwife make it or was it a freebirth??

[Laranna]

That's ideal timing for a VBAC - rock up to hospital fully dilated and feeling ready to push. One way you can help figure out the timing is feel your own cervix when you're at home (as long as your waters have not broken prior to active labour starting.) You're just observing for changes. You'll find you can tell when your cervix is starting to open, when it's about half open and when it's hard to feel any cervix left at all ... but hey what's that furry walnut feel?? Izzat my baby's head??? Or you might feel something like a balloon in front of the hardness of your baby's head, which would be the forewaters. OK so NOW you're ready to go to hospital!

There's a good link here on doing your own vaginal checks called "It's Not Rocket Science"

Thanks Julie!!! I would never have considered checking my cervix whilst in labour. All this new info has got me excited! And more confident that I'll get my VBAC

[Talia*L]

Yes I am planning a home birth for my first That article / statistics are great - not for me (I have done my research and know that HB is the only way for me!) but for people who ask me about it. I am putting together a document with common Q&As for family and friends, I will include some of that information.

Personally, I do NOT understand the 'fear of the unknown' for HB at all!? MAN i know my own home and body so well, so there is nothing unknown about that! The thing I do NOT know well? A hospital, and a staff of midwives / doctors / nurses with whom I have no relationship!! The hospital is the 'unknown' to me!

And I have done probably over 200 hours of reading and research, watched youtube home births, educated myself as much as possible. I will also be engaging the services of a highly experienced HB midwife, and a doula with experience in HB too! So I know that I have nothing at all to fear. I look forward to the birth wholeheartedly.

[Julie Doula]

Hi Talia! *waves*

[Talia*L]

*Grin* Hi Julie!

Btw Julie - my 7 week scan showed a 5 week sac, however they think I'm not as far along as suspected! So I am going back in a couple of weeks, fingers crossed... So hopefully I will call you after that!

[Tegam]

*Grin* Hi Julie!

Btw Julie - my 7 week scan showed a 5 week sac, however they think I'm not as far along as suspected! So I am going back in a couple of weeks, fingers crossed... So hopefully I will call you after that!

Hope all goes well with your scan and enjoy your HB! Clever woman!

[paradise lost]

How about you? Did you have your first at home? How did it go? How did you handle the pain, effort or intensity with no pharmaceutical pain relief available? If there were any complications, how did you and/or your midwife handle it?

I had my first at home. It went fine i guess, though i had midwives i didn't know (had only met one of them once before) so it could have been better, next time around we're hiring an IM to eliminate that problem. My labour was 15 hours from waters breaking to birth, but under 4 "active" stage. I used entonox (gas and air) for the last hour as i'd been told not to push (they thought my pushing urge was premature as i'd not been close to being in labour when they did my first VE - DD 's head was half out at my second VE) and it was very difficult to resist the urge. I had a second degree tear (probably because my first and last push of the entire labour delivered her ears to toes VERY fast) but i chose not to have it stitched (not an option in hospital i was told) and it healed fine without intervention.

If i'd been in hospital having that labour i know i would have potentially faced:

Having her at home anyway (i would have been sent home after the intial VE as i was 2-3 and 50% effaced, and i hit transition about an hour after that and literally couldn't move position without about 8minutes warning, no WAY could i have gotten back in a car after that stage).

Getting an epidural (the words "don't push" do NOT tell you how to resist the ejection reflex or the urges it brings, and was totally panicking for much of the last hour's contractions because the urge was so big i felt hopeless trying to resist it - i was told off for using the entonox wrong as i had to roar during the contractions to stop myself pushing so i was using it in between contractions to knock myself out so i couldn't think about the next one as it scared me so much - pretty sad! i know in hospital i'd have said "this is hopeless, numb me up so i won't push" - probably about an hour before DD was born so goodness knows the problems that'd have caused).

Been forced to be stitched (the MW told me that the obs don't leave 2nd degree tears, no matter their location or severity or the feelings of mum).

Had DD taken to NICU for the first night (after being born her apgars were 9, 7 and 10. When she hit 7 they suctioned her and gave her some oxygen - the wait on my perineum while i was not pushing followed by the sudden flight into the world had shocked her and she'd swallowed some mec, in hospital all mec/suctioned babies go to nursery for the first night, no ifs, no buts).

That's not to mention all the standard stuff one faces in hospital. I'm really glad i stayed at home, but i'm still hoping for a better birth experience next time around. I think you can still suffer for your relative naivety from it being your first time even if you're at home, it's just the severity of the things you can suffer is much lower.