Homebirth General Discussion #1

[Schmickers]

More questions apart from the midwives, doulas etc, patrners etc, what other support people at home births have people had. Were there too many, too few people around? Did you find you were able to keep people away (say a friend that doesn't take no for an answer) when its all happening in your own home? What pain relief are midwives able to offer during a home birth? Did mums find that they were more relaxed and didn't require (as much) pain relief compared to hospital births?

At our first birth, we had one of Victoria's friends as a support person. She was lovely, very helpful, and not too intrusive. We couldn't thank her enough. Shortly after the birth, we had also invited one of our midwives' daughters, who was a photographger with whom we'd become friends, to come in and take photographs.

At our second birth, we had Victoria's mother. In hindsight, I think we had her there more for her needs (she had never seen a birth before, and really wanted to be there) than our own, and while she was not unhelpful, she wasn't as intuitve as Victoria's friend had been; I think this is reflected in the fact that Victoria's friend had always intended to be there fully for us, whereas her mother wanted to be there for her own experience as much as ours.

So, in answer, I felt we had the right number of people at our first birth, but perhaps that we could have been just the two of us and our midwife at the second. Having said that, our opinion might have been different of Molly had been awake during the birth as Victoria's mother would have been looking after her!

As far as keeping people away, we just took the phone off the hook and didn't tell anyone it was happening until after the birth. And in the days after the birth, we were quite upfront when we didn;t want visitors. Most people understand, and if you have a helpful midwife, they may be happy to talk to family members and gently remind them that "visiting hours" still apply at a home birth!

Midwives offer non-pharmacological pain relief. That means mild pain relief, such as over the counter paracetamol and similar pain relievers, massage, water, homeopathics, and the like. Some midwives will offer transcutaneous electrical nerve stimulation machines (TENS) or you can hire your own. Sterile Water Injections (SWI) are a fairly new practice that can also be used at home to reduce pain. And rarely, with the assistance of a GP, it is possible to hire an entonox machine (nitrous oxide, or "gas") to be used at home. As many midwives will warn you, though, using artificial forms of pain relief inhibits the body's own pain relief mechanisms, and paradoxically, some women find that they cope better in established labour without pain relief, as their body will produce it's own endorphins.

[Jakana]

I have quite a few questions and I'm not even sure where to begin. I am VERY keen on a home birth, hubby not so but I'm confident with the amount of research I'm doing at the moment that that can be turned around. I was blown away by the safety of HB.
I guess my biggest question involves my sister. Her last birth was in a hospital (4 mins after arrival) and directly after delivering the placenta, she haemoraged badly. We were all told that had she delivered anywhere but where she was she would have died. I am wandering what would happen to me in a similar position at home? Needless to say the reaction of my family when I tell them I am considering a home birth...

[Schmickers]

I guess my biggest question involves my sister. Her last birth was in a hospital (4 mins after arrival) and directly after delivering the placenta, she haemoraged badly. We were all told that had she delivered anywhere but where she was she would have died. I am wandering what would happen to me in a similar position at home?

In order to answer that, I'd have to ask - how long after the birth was your sister's placenta delivered? Was the cord cut, and was the delivery of the placenta assisted by the midwife or obstetrician pulling on the cord? And what was the nature of the birth - was it an induction, did she go into labour naturally, were there any other interventions?

[Ellibam]

hi everyone!
well i am back from sydney where i went to the Homebirth conference! it was awesome! on the saturday it was soo emotional and wonderful! and the sunday was great (but not so emotional which was good i dont think i could have handled crying any more!)
oh makon has woken will come back to finish

[Jakana]

Hi Schmickers,
The placenta was delivered straight after baby, she was just told to push and the placenta came out of its own accord, in tact with a few clots.
She laboured at home, going into transition in the car and delivering the baby 4 minutes after she arrived at the maternity ward. The midwife didn't even have time to put gloves on! There wasn't time for intervention.

This is her 3rd child, the 1st had a lot of intervention, the second not so much and this one none!

One more question, how far is to far from home to hospital? As in how far away can you be and still be attended by a midwife?

[Jakana]

Oh, sorry I forgot to say she went into labour naturally!

[paradise lost]

Jakana sometimes women hamorhage after birth. It is FAR more common when there has been intervention, but it happens where there has been none too. Previous complications and later pregnancies (3rd and more) can raise the risk, but don't necessarily. In cases like your sister it is difficult to predict and rare. I'm sorry it happened to her To minimise your risk of the same thing happening one can decline the use of induction drugs and stay upright and active to minimise the risk of forceps or ventouse being needed, ask for the cord to be left to stop pulsing after the birth and not cut until the placnta is delivered, allow no-one to touch or tug on the cord or push your belly and generally let nature do it her way.

When i gave birth i was about 10 minutes by car from hospital (40 in heavy traffic, 4 in helicopter which was a possibility as there is an air ambulance from there). I'm in the UK so you get a midwife no matter how far from hossie you are. My midwives had pitocin (to make my uterus contract hard, enough for 3 times the dose they use for the 3rd stage), adrenalin and oxygen with them as well as an IV shunt and 1l of fluids (saline). So if i had had a bleed after birth, they had equipment to keep me alive and my blood pressure above a dangerous level long enough to get me to hospital. You can ask what provision miwives have for this circumstance when you're looking to book one.

Another thing i would say is that LOTS of women are told "If you'd been anywhere else you'd have died" - i even know women who had botched inductions ending in c-sections told that - if they'd been elsewher they'd have died! What like, on the sofa waiting for bubs rather than hooked up to a drip at risk of infection after an AROM! Bleeds can happen VERY fast but midwives don't just sit there and watch, they IMMEDIATELY begin to stabilise you and stop the bleeding while simultaneously getting you to hospital as fast as possible. Because of the intervention statistically you're more LIKELY to suffer a PP bleed in hospital (which i know isn't much help when your sister had one with no intervention).

Bx

[Schmickers]

One more question, how far is to far from home to hospital? As in how far away can you be and still be attended by a midwife?

It's up to the midwife. As an absolute maximum, I would say that most midwives would not recommend a homebirth if you are located more than 60 minutes from the nearest hospital. The research indicates that there is a 75 minute window of action from when complications are detected that results in good outcomes for woman and baby.

As far as what happened to your sister, it must have been very distressing to her and all of you. But the statistics suggest that something like that happening as a result of a well-managed natural birth are quite rare. I would go so far as to say that your sister was quite unlucky.

As far as her having died if she wasn't in hospital, I do not believe that is necessarily the case. Initial treatment in the event of a haemorrhage is the same at home or in hospital; insertion of an IV cannula, commencing fluids to expand blood volume, and administering oxytocics to induce strong contraction of the uterus to stop the bleeding. A good homebirth midwife will be able to manage all of this at the same time as arranging for your urgent transfer to hospital.

[r8chele]

We were all told that had she delivered anywhere but where she was she would have died. I am wandering what would happen to me in a similar position at home? Needless to say the reaction of my family when I tell them I am considering a home birth...

I had a post partum haemmorhage at my last homebirth. I did not die!

HB midwives carry syntocinin, the drug that is used in case of excessive bleeding. Many mws also carry IV fluids. if a woman were to haemorrhage at home the first line of action would be an injection of syntocinin. If additional assistance were needed she could put fluids up and transfer to hospital.

The "if you had been anywhere else you would have died" line is popular but not always accurate. Or as another poster said (altho not relevent in your sister's situation) the "drama" was caused by intervention to begin with. I have had many women tell me their birth horror story that starts with induction, continues with epidural, failed ventouse, then cs. They are told they would have died had they not been in hospital... but they woudn't have had a "failed induction" at home!

Good luck making your decisions.

[SamanthaP]

I was at a birth a few months ago which ended in a PPH with about 1.6l lost, so not a small amount. It was an induction with synto and epidural given at 40+4. Once the emergency was over, the midwife said to me 'lucky this didn't happen at home!'. Oh, the irony! I would have laughed in her face if it was not for the poor woman trussed up with a blood transfusion in the background.
Jakana, HB midwives are quite capable of dealing with those sort of situations in the home, with transfer to a hosp, if necessary. It's up to you to decide how far you are happy to travel in an emergency situation. I think that is the beauty of homebirth. It's up to the individual to own and be accountable for what happens during the pregnancy and birth, and I think that's what makes homebirth a much more satisfying and empowering experience.

[Roryrory]

Question which is off the track of the thread (which I apologise for) but how do you deal with cleaning up the mess after a home birth? Does the midwife "take care of things" (LOL!) or do most people buy a heap of cheap towels and sheets which they just accept will be thrown out afterwards? I mean, you are essentially talking about medical waste so what do you do with the "blood and guts" side of things?

[Trish]

Rory, you do it at your mum's house and she cleans up after you

That's what I did with Tehya. LOL. She was born at 6.35am and I swear by 9.30am all the washing was down, the pool was drained and washed out and all the furniture was back to normal. There is no way you could tell that a baby had just been born there.

I bought some cheap brown towels from best and less for myself and soem pink ones for Tehya. I still have them to this day, everything washed up just fine (thanks mum) I will be reusing them for this birth too.

Generally though, unless you have a mum like mine, your midwife will do some of the cleaning up along with your partner.

[Claire]

Rory,

My midwife actually supplied all the linen and sent it away to be cleaned professionally - great idea!! DH cleaned out the pool and cooked everyone breakfast - no trouble at all. Sometimes your doula may assist with that side of things too.

[paradise lost]

There was no mess for me. I lay down on 4 incontinence mats for a VE (my waters had gone a good bit before) on my bed (which had a showercurtain under the sheet to protect the mattress) and she was crowning. She was born onto those 4 mats, then the MW put another 2 on top of those for the 3rd stage, put DD on my belly, wrapped a towel over us both and a blanket over that, then gathered all the pads and placenta (after it was examined and deemed whole) up and yllow-bagged them with her gloves. That was it. There was no other mess. We had all the towels in th house clean and dry JIC but we only used 2 - one around DD and me and one when i had a shower an hour later....

Bx

[Schmickers]

There's invariably not as much blood as you think. Most of the cleaning after our homebirths has just been putting the house back in order - a general tidy up as when everyone is preparing for a baby to be born, no one really pays much attention to where they are putting things or moving furniture, etc. So lots of straightening up sheets, putting towels on to wash, tidying away equipment. Shower curtains are fantastic as mattress and floor protectors, as are painters drop sheets, about $4 each from a hardware shop.

[Trish]

Michael, have you done this before

[Schmickers]

Just a few times, yes... Maybe I should do the Doula course, although I don't know if the sight of a big hairy man as a doula might scare a few poor pregnant women...LOL

[suse]

Oh Michael, after reading all of your wonderful posts I think you'd make a fantastic doula!!! (although isn't a male doula a contradication in terms?) ;-)

Sorry if this is a little off topic - but I couldn't find a waterbirth general discussion thread. I'm v. v. excited after having my appointment at the hospital to prepare for a waterbirth!! The public hospital I am attending supports and encourages both active and water birth - isn't that a bit of an anomaly within the public system? In any case I am cautiously optimistic about my chances of having the type of birth that I would like!

I would have loved to have a home birth but we just moved to an area with limited home birth resources, and not much time to seek them out. But I have been very happy with the hospital support I've received so far, and if not for the strong BHs I've been getting would have literally skipped out of the hospital after meeting with the waterbirth consultant midwife! The little guy is still determinedly posterior so it's been great reading other BB members' positive experiences with posterior home and waterbirths.

I don't think that I would be going into this experience in such a confident state of mind without all of the wonderful support from BB! Thank you to everyone!