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!