Homebirth Risk Factors

Erin - posted on 05/27/2011 ( 58 moms have responded )

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So these questions really only apply to those of us who have had, will have, or are contemplating a homebirth. My intention is not for this to turn into another Homebirth vs Hospital Birth debate.



Lately I have read several stories of homebirths gone wrong.

One was a GBS+ mother who refused antibiotics... her baby died within 24hrs of birth.

One was a (barely) 36 weeker who, despite good Apgars, silently went into respiratory distress and died later in the day.

Another was a 43yo first time mother who attempted a breech vaginal delivery, resulting in head entrapment. They turned the machines off after a couple of days, and the baby died.

And another was a GD mother who went to 44 weeks, only to deliver a stillborn baby girl.

The midwives attending these last two birth have been charged.



Most of you know I am passionate about natural and homebirth. But I am not an extremist. Responsible midwives risk patients out of homebirth for a reason.



So my questions are these...

Would you continue your plans for a HB with a breech presentation, were over 35,GBS+ status, GD, or prem/post-dates baby (< 37 weeks or 42+ weeks)?

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Mary - posted on 05/28/2011

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Well, I personally would never have a home birth, period. While I fully support this choice for others, it is never one I would consider for myself. My reasons for this all boil down to one simple reason - I have seen almost all of those very rare complications that can occur. You can quote the statistics to me all day long about the improbability of something occurring, and while the logical part of my brain comprehends that the chances of a disastrous outcome are minuscule, it simply cannot overcome some of the things I have seen.

The most vivid of these is a vaginal breech. When I first started working in L&D, these were still done somewhat regularly on women who had had at least one prior vaginal birth. Most of them did just fine, without any problems for mother or baby. However, I did have one patient for whom the worst possible nightmare became reality. It was her third baby. Her first two deliveries had been remarkably smooth - relatively short labors, and pushing less than 30 minutes for babies that each weighed about 9lbs. With her third, she went into spontaneous labor at 39 3/7. She was 7cms when she arrived at the hospital, and was ready to push within an hour. The body pretty much slid out, but the head did not. The baby died. It was truly one of the most horrific things I have ever seen in almost 20 years of nursing. No amount of statistics or stories of successful outcomes will ever erase that one memory for me.

As for the GBS - again, the probability of the baby becoming sick is rather small. However, those babies that do get sick get very sick. I'm not much of gambler anyway, but if a couple of doses of antibiotics during labor can negate the very small possibility of a critically ill infant, than I'm all for it.

I don't understand why IV antibiotics couldn't easily be administered with a home birth. All that it requires is a midwife inserting a saline lock, and hanging the IV every 4 hours until delivery. It takes less than 20 minutes for that little pre-mixed bag to infuse. IV antibiotics are administered on the home for all types of people for a variety of reasons, so this really seems like a silly reason to prevent an otherwise low-risk woman from delivering at home.

As for gestational age...under 37 weeks or over 41 5/7, I'd vote for a hospital birth. The OP's mention of a woman with GD going to 44 weeks is just blatant incompetence and malpractice to me, and utterly indefensible. I don't think that GD in and of itself rules out a home birth, since there is such a broad spectrum of those classified as gestational diabetics. A woman who is completely diet-controlled, with good sugars throughout - eh - I don't think a homebirth is unreasonable for her. On the other hand, one who requires either oral hypoglycemics or insulin - they should have a hospital birth.

I don't know that age, in and of itself, should be a deterrent either. It really depends on the individual. At 38, I was in damned good shape; I was still walking my dogs a couple of miles a day, even the day before I delivered. I also was still working FT. Other than that dreaded AMA label, I had absolutely no risk factors - no GD, no BP issues, nor any other significant health history. I was probably a much better candidate than a lot of women 10 or 15 years younger than me.

TO me, it all comes down to looking at each individual, and not blindly following some checklist of risk factors. Now, I think some things, like a baby under 36 weeks, are simply non-negotiable, but things like age, GBS, and GD have a little more wiggle room.

Kate CP - posted on 05/29/2011

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I think what most of you are not realizing is that a Certified Nurse Midwife who is good and experience at what she does has EVERYTHING the hospital would have except for:
surgical suite
forceps
vacuum suction
epidurals

Just about anything else you can think of the midwife BRINGS WITH THEM. So unless you need an emergency c-section or some other catastrophic event (that is honestly really really rare) happens then home births are very safe about 98% of the time.

Medical interventions are not evil when needed. But most of the time they're NOT needed and then you start the snowball effect of intervention upon intervention. I've had two hospital births. The first one wasn't too bad: I had pitocin and an episiotomy. But I was fighting with nurses and doctors the whole time. The second time around I had been in labor for six damn days (STILL pissed about that) so I had an epidural once I (finally) hit transition. I was fighting with nurses AGAIN because they wanted to take my baby and keep him in the nursery after I delivered because I had GD. When I say they wanted to take him after I delivered I mean they wanted me to push him out and then show him to me and then whisk him away. I was pissed. I was BEYOND pissed. I refused to let them take my son from me. I really pissed off the nurses because I was going against "hospital policy" but I didn't care. He was my son and his blood sugar was FINE and I needed to nurse him.

I have no problem against nurses and doctors attending births. I have a problem with hospital policy having a say in what happens to me and my baby.

Mary - posted on 05/28/2011

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Tara, it's not really a far comparison, though, is it? If all of the high(er) risk patients are ineligible for a home birth, it only follows that you will see more "negative" outcomes in the hospital setting.

And to clarify - the truly horrific things I've seen really have little to do with the presence or absence of any unnecessary interventions. The head entrapment girl had absolutely no interventions (until the head got stuck) - with the lone exception of IV access. The handful of times I've dealt with a prolapsed cord have all occurred after a spontaneous rupture of membrane, not artificial. The two maternal deaths I've witnessed were both amniotic fluid emboluses (and both of those were uncomplicated vaginal deliveries). The ruptured uteri were, coincidentally never on a VBAC patient, although all were with either a 3rd or 4th baby. Of them, I believe only one of them was receiving pitocin.

The complications that you mention, while not to be discounted, are not things that typically result in either death or permanent, irreparable damage.

Erin - posted on 05/29/2011

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I think what some people are missing here is that the OP is asking is, if you were already planning a home birth, what, if any, risk factors would make you deviate from that plan. It really isn't about the home vs hospital debate, but rather, which pre-existing conditions should automatically negate the possibility of a home birth.

Yup, this is exactly what I was asking :)

Mary - posted on 05/29/2011

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I think what some people are missing here is that the OP is asking is, if you were already planning a home birth, what, if any, risk factors would make you deviate from that plan. It really isn't about the home vs hospital debate, but rather, which pre-existing conditions should automatically negate the possibility of a home birth.



As I said, I personally could never consider it, but it really is because of the many things I have seen over my career. It does not mean that I think home births are wrong, or inherently more dangerous. I acknowledge that a lot of those complications are rare, but I've seen that rare case where where a women was planning a home birth, was laboring at home with a (very competent) midwife in attendance, spontaneously ruptured, prolapsed the cord, and 911 was called. We were unable to resuscitate that baby at birth. The mother was one of our own nurses, which made it even more unbearable. No one did anything "wrong"...it just took too damned long for them to get her into the hospital, and get that baby out. The truth is, it could have happened to someone who was planning a hospital birth, and was just waiting to get a little more active before arriving. For me, it just cemented the fact that having all available resources at hand was important for my peace of mind. As I said in my first post, once you have actually been a part of that worst-case scenario (which, working in a high-risk hospital, I have seen a lot of that "rare" stuff), it's hard to be reassured by statistics and probabilities. However, I would not necessarily discourage a friend who was low-risk from pursuing this, if it was something she was really dedicated to.

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Erin - posted on 05/30/2011

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I would not HB twins, though there are plenty of stories out there of it being done.



As for breech presentation, it seems to really depends on the individual doctor/MW's level of experience and familiarity as to whether they see it as a huge problem. And obviously hospital policy has a role to play.

Emma - posted on 05/30/2011

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Im in Kent and the midwifes are good but overworked, understaffed, etc... I had at least 5 different midwifes throughout my pregnancy and none of them were the one to deliver my baby!

Kate CP - posted on 05/30/2011

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Yea, I don't think a breech delivery is doable at home. It really is risky.

Emma - posted on 05/30/2011

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Really wow. My midwife said to me not to worry about breech births. She said its not a big problem because it was my second and if baby was breech they would still happily deliver at home. Im glad I had her at hospital now!

Merry - posted on 05/30/2011

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My midwife wouldn't deliver multiples at home, I wouldn't want to either. I'd want a vaginal birth in hospital just in case. Not an elective c section though.

Emma - posted on 05/30/2011

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It is interesting for me that so many of you would not consider hb if baby was breech. In ENG breech is not a big deal. If it's your first baby it is recommended to go to hospital for breech baby because labour tends to be longer and require more possible intervention, but if its your second baby or more then midwifes do not put any emphasis on breech babies. They are more than happy to deliver a breech baby at home and do not consider it to be a risk factor!

Another point I thought I would mention is that multiple births are not allowed at home, however it has been known for a woman to hire a private midwife to deliver her twins at home. Both were fine but would you consider hb for multiples??

Merry - posted on 05/30/2011

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GBS- I'd do the probiotics, the wash, and continue at home.
GDIabeties, if it's well controlled I'd continue at home
Over 35, depends on the pregnancy not the age.
Breech, my midwife wouldn't do it. I wouldn't either. Vaginal in hospital maybe if it's frank.
Before 37 weeks my midwife wouldn't do it, 41.5 weeks she started mentioning a hospital induction, I delivered 9 days over at home no problem, but one or two more days I would have had a non stress test and if she was needing it, induced ASAP.

I want the best safest birth for my baby, be it athime or hospital I choose based on what is best for the baby first, then what's best for me and my family as well.
Baby's health comes first always.

Tara - posted on 05/30/2011

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Yes Erin I would have continued with my plans for a HB if I had GBS, if I were over 35. I almost pushed the rules with Riley who is baby #6. My water broke at 36 weeks 6 days, technically I should have gone into the hospital if I were pre-37 weeks. But my actual labour didn't start until the next day and he was born at home. However if it had started that day, I would have stayed home anyways, the midwives knew it. But it was my 6th baby and I knew what to expect. But I would not have a HB if I were 36 weeks, if I were over 41 weeks or if I had any pre-existing condition that was beyond the scope of "normal healthy low risk pregnancy".
In Ontario your care is transferred to an OB if you have anything beyond a normal healthy low risk pregnancy, midwives will still be your support but care is taken over.
Midwives here risk losing their license to practise if they go outside of the boundaries of normal healthy pregnancies. They risk losing it all if they deliver a mom who is pre- 37 weeks at home, if they ignore a GBS test and not offer treatment options to mom, if they choose to try for a breech birth at home, if they do not consult with an OB for GD issues etc. etc. etc.
They are very strictly regulated where I live so that makes me feel a lot better when it comes to the quality of care I receive.

Elfrieda - posted on 05/30/2011

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I had a homebirth with my baby in Dec 2009, and he just was not coming, even when my due date was adjusted to match with when I thought I conceived. He ended up being a very long 5 days late, which was fine, and I was able to have a homebirth and everything went great, mostly.

My midwives wouldn't have attended me at home if he'd been a week later. I'd have had to go to the hospital and be induced, which I was so scared of. So it's not really a choice here in Canada.



Of all those risk factors, I think I'd only continue with a homebirth if I was over 35 or had GBS. With all the rest, it's just too risky, in my opinion. I'd want a room with a lock on the door and just the midwives and my husband in there, but just in case, the drs would be right around the corner.

~♥Little Miss - posted on 05/29/2011

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Cathy, I agree fully, these threads tend to deviate, and if someone is considering home births, I think they have received some excellent insight to the pro's and con's.

~♥Little Miss - posted on 05/29/2011

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Kate, CNM'S not having emergency access to a surgical room and equipment in case problems arise was the point I was making. It is unfortunate your experience, but you could also have had a CNM that had hospital priveledges, and who is affiliated with Doctors...they are bound differently by hospital policy. At least where I am at. (but maybe that was not available to you) The Doctor is updated on progress, especially in high risk cases, like you with GD, and a compromised immune system, and like with me as a VBAC. I really enjoyed my CNM over my ob experience so much more, and I was actually more confident in the CNM than my previous ob.



Also, when I was originally interviewing mid wives, I had one trying to push a HB on me EVEN on knowing full well I was a VBAC. Sometimes people have agendas, but doing your research, going with what you feel comfortable with is the key.

~♥Little Miss - posted on 05/29/2011

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Also Christina, doctirs are available incase the worst case scenerios happen, uterine rupture, bleeding out, collapsed cords, I mean the list goes on. Medical intervention is not evil.

Christina - posted on 05/29/2011

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In some states, there is NO MEDICAL DEGREE AT ALL for midwives. None. They don't go to school, nothing. So you are having a "specialist" come into your home who has no flipping clue what to do if something turns disastrous medically because they are not a medical professional! A CNA has more medical training than a midwife sometimes!
If your midwife can practice in a hospital, she has a degree. If she can not practice in a hospital, she most likely doesn't.
I refuse home births. I do not agree with them for myself. I did use midwives for two of my births. They delivered me in the hospital where they had their hands on all kinds of medical stuff to help me when things went bad.

~♥Little Miss - posted on 05/29/2011

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Mary, I had 5 different CNM'S that I rotatated through, and one Dr in charge of the practice. I was a VBAC, and was told be Drs and other facilities to find great CMNS for the delivery. I delivered completely drug free, practically unasssisted, and in the hospital. It was awesome.

Mary - posted on 05/29/2011

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Erin, I have to be honest about my prejudice towards the way a midwife is educated; I'm really only in favor of CNM's. The reasoning behind it is this - they are simply more educated, and possess a broader knowledge level. Having already obtained a bachelor's in nursing, they will have a stronger foundation, since they will have studied the human body in all facets of health and illness, and not just as it pertains to pregnancy. Are they experts in pulmonology, cardiology, immunology, or infectious diseases? No, but they at least have a background knowledge of them. The pregnant woman is not just a pregnancy and delivery; she is a human that is susceptible to a host of issues that can arise that are not obstetrically related, and a key part of caring for her is the ability to recognize what is going on with her.



I also think CNM's, while very pro-woman, pro-choice, and non-interventionists, are not as anti-establishment. This means that they are more likely to not only realize when a woman has issues that are beyond their scope of practice, but are more willing to transfer their care when it is in the best interest of the woman and/or the baby.

Erin - posted on 05/29/2011

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There's no doubt that breech vaginal births require a certain amount of experience and skill from the care provider. The large hospital in my city still do them, but not the smaller ones. And even then it depends on the doctor, because some simply don't have the number of breeches behind them to be confident attending. The old-school OBs? Sure.But not the newbies.



I think that's something that needs looking at, both here (Aus), Canada and the US. If OBs are familiar and confident with breech vaginal births, those women who are determined to avoid a c/s for breech will be far more likely to go to hospital.



Hospital policy has a lot to answer for in cases like this (VBAC too). There are plenty of OBs who would be happy to attend a woman with a breech or VBAC, but the hospitals simply won't allow it. That is the biggest part of the problem. Intellectually I know that liability, staffing and other issues come into play, but it still sucks. And it is why these women are turning their backs on mainstream maternity care at any cost.

Jenny - posted on 05/29/2011

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"It was only in the last 3 years they will even allow you to try to have a vaginal breech birth"



Damn, too bad it wasn't a few years ago. My daughter was breech and we found out a week before our due date. I had been preparing myself for months for a drug free natural delivery. I asked if I could do it anyway but my doctor said No and I respected her opinion. I was a breech baby too and my mom always told me it was an easier delivery than my brother who was the regular way.

Becky - posted on 05/28/2011

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With my next, I want to have a midwife-assisted hospital birth. To me, that's the best of both worlds. I get to have the more personal, "mom and baby centered" care of a midwife, my husband gets the feeling of security of knowing that we're in the hospital and can get emergency medical treatment if an issue comes up.

Erin - posted on 05/28/2011

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I think there is too much of a "movement" behind the practise, often being extremist and therefore allowing higher risk home births that result in death or severe complications, all in the name of a women's right to choose where she births.



I see this as a problem too. The ideological component of the choice to birth at home seems to sometimes override the practical. And with the inconsistencies in midwifery regulation and protocol, this can pose a serious issue.



I read a few birthy FB pages, and have seen women WISH for a breech, just so they can show how it's done and prove a point that it is possible at home. That just honestly makes me cringe, and does nothing for the homebirth movement. Attitudes like that are the reason homebirthers get stereotyped as selfish and irrational.

~♥Little Miss - posted on 05/28/2011

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Ok Tara, I would think your friend attended many more hospital births than home births. In turn, of course with the vast amounts of hospital births she participates in, she will see a rise in complications. Home births are just not as common.

Tara - posted on 05/28/2011

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Mary I understand there are scenarios that won't present until active labour or after delivery. That is why I am strong advocate of normal low risk home births when attended to by a qualified, professionally trained midwife who also has all the gear and emergency supplies needed, who also has hospital privileges and emergency back up medical care on stand by.
These are all things I love about Ontario midwives. My midwives are better trained than GPs that deliver babies in Ontario. They have a more extensive and lengthy education, they have more requirements for births attended before delivering, they have all the up to date medical information and training, they have all the stuff a GP has and then more.
I don't agree with a lot of the midwifery practises in the US, I think there is too much of a "movement" behind the practise, often being extremist and therefore allowing higher risk home births that result in death or severe complications, all in the name of a women's right to choose where she births.
While I support homebirth, I don't support irresponsible homebirthing.
Trained knowledgeable staff are important to me whether I'm at a hospital or at home.

~♥Little Miss - posted on 05/28/2011

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These stories make me sick, and heartbroken all at the same time.

I will never, and have never had a home birth. I think there are just to many unknowns to risk it.

I had strep b, and delivered so quickly they did not have time to administer the antibiotic. My daughter was watched closely, and she ended up being fine. But things could have been different, it could have ended badly. That is a scary thought.

Erin - posted on 05/28/2011

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Mary, the midwife responsible for the 44wk stillborn was actually practising as a DEM after she was stripped of her CPM licence in 2004 :-s



There appears to be a glaring problems with training and regulation of CPMs and DEMs in the US. There are simply too many stories of them operating outside the scope of 'good practice', and that is VERY hard for me - a homebirth advocate - to admit.

Kate CP - posted on 05/28/2011

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If there are risk factors like that it makes no sense to risk your life and your baby's for the sake of birth experience. I wanted to birth at home SO BADLY but I couldn't because of my immune deficiency and either my hyperemesis (with the first one) or my GD (with the second one). It just didn't make sense to risk everything. Granted, the labor and delivery for both seemed to go (relatively) fine, but it wasn't worth it to me.

I *love* the idea of home births or birth center births over a hospital...for those who don't have serious risk factors.

Rosie - posted on 05/28/2011

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can i ask why on earth anybody would refuse a GBS test? all they do is swab your butt and vagina? why take the risk? i dont' get it.and to also refuse antibiotics when you have a positive one? IMO she knowingly killed her kid.

Tara - posted on 05/28/2011

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I understand your position Mary, my best friend has been an L&D nurse for over 10 years, she has seen it all, she has had babies die moments after birth, she has had still births, she has seen all the possible complication that can arise.
She is also the on-call for the Midwives of Lindsay Ontario as their primary infant care nurse. So if only one midwife is available for your birth she is the nurse that comes to your homebirth to provide medical intervention or assistance to your baby.
She has seen far fewer complications as a homebirth attendant than she has in the hospital. Most complications she has seen at home were easily dealt with such as a cord wrapped around a neck, should dystocia which can be corrected with the Gaskin maneuver, and minor respiratory problems for babies that had a longer than normal delivery or a faster than normal delivery. A lot of the complications she has seen in the hospital were due to interventions. The most common one being inductions that lead to epidurals that lead to emergency c-sections. And second to that is premature rupture of membranes that leads to such an increase in pain and intensity that epidurals are used far more frequently on patients who had their membrane ruptured early in labour, this then leads to further complications such a a drop in fetal heart rate etc.
There are many many cases of death in hospital settings and all research about home birth whether for or against agrees that there is a decrease in post partum infections in both mother and baby when born at home.
Also a decrease in interventions leading to c-sections.
Informed, educated and regulated midwifery care is just as if not safer for a low risk pregnancy than a family doctor, and a homebirth with such a midwife is as safe if not safer for a low risk pregnancy than a hospital birth.

Frances - posted on 05/28/2011

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Unfortunately, you can find cases of unnecessary death among hospital births. My brother was born in the hospital with no one present, except my mom. She would have received better care at home. Sometimes it is pitocin or other things that cause complications which would not have happened in a home birth.

Mel - posted on 05/28/2011

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I wont comment because Im completely against home birth, but I just thought some of the stories you put up were so sad...those poor babies dying unnecessarily

Tara - posted on 05/28/2011

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No I wouldn't. And in Ontario where I live NO midwife would allow for a homebirth with issues like GD or pre-37 weeks, or any kind of breech birth. As for GBS, our midwives allow for us to choose whether to have the test or not. They will wait if you ask and treat the baby if they present with illness or treat your puritanically if you choose not to have the test done, or have the test done and if you're positive you have an anti-biotic drip while at home.
I had 3 homebirths after having 3 hospital births. I loved being at home BUT I wouldn't risk my life or my baby's life if I had presented with any of the above mentioned scenarios (with the exception of GBS). And no responsible or respected midwife would deliver anyone presenting with the above mentioned complications at home (with the GBS exception). It was only in the last 3 years they will even allow you to try to have a vaginal breech birth, and it depends entirely on the OB/GYN who you are referred to. Most of our midwives will do shared care if you fall out of the scope of "normal and healthy low risk pregnancy and birth" so that they can still advocate for you, still support you, but the medical care of the baby and birth is left to the specialist.

It is unfortunate that there are irresponsible midwives who will risk their patients lives this way. They give a bad name to all those who are properly trained, follow the rules laid out by the college of midwives and take their profession seriously.
I would not continue with a planned homebirth if I had GD, if I were not at least 37 weeks or if I were breech, with GBS I would continue, but only because I know I can be medicated during labour and delivery at home if I choose.
I was over 35 years when I had my last at home, he was 37 weeks on the dot, my water actually broke at 36 weeks 6 days and was I determined to stay home, I made it to the next day and delivered him into Steve's hands while the midwives sat next to him, ready to help if needed, but they weren't.
:) Ah... memories...seems like so long ago, they grow too fast!!

Emma - posted on 05/28/2011

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Ok....I really wanted a home birth with my second baby. It was all planned and I had everything ready and the midwife was on call and everything. However, my baby decided she did not want to come and at 41 wks + 5 days I had to go to hospital and be induced. In the UK this is standard practice. However, I have heard that women can choose not to be induced and still have a home birth...although they may have to hire a private midwife as most hospitals now have clauses saying they will not perform home births after 41 weeks...due to extra risks and them not wanting to held accountable.
As for my personal choices, I would only consider a hb if baby was breech and midwifes said this would not be a problem. If I was before of after the 'safe' dates then I wouldn't and if I had any infections, etc then I wouldn't. I would have faith in my midwife and would look to her for advice on my individual circumstances and would take her opinion into great consideration. I love both my babies more than life itself and could not imagine ever putting their lifes...or any other babies to come.....in danger just because I did not fancy going to hospital to have them.

Erin - posted on 05/28/2011

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I only recently found out the UK doesn't do routine screens for GBS. Here, we do a swab at 36 weeks.

Erin - posted on 05/28/2011

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See my concern with GD is not baby's size, but the BSL and jaundice problems associated with GD. Not to mention the risk of high BP for mum.

Amie - posted on 05/27/2011

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Under the assumption that I would do a home birth (I wouldn't) if we ever decided to have another child (which we won't, haha):

Breech? No.
Over 35? It would depend on how the pregnancy was.
GBS+? Since I am, so long as I had the antibiotics. (Unless I misunderstood my doctor, once you test positive you always have it)
GD? Hell no. My sister was a GD baby. I had a "largish" baby without GD. Size does matter and it does hurt more. Not happening without good, strong drugs. =) I birthed our "largish" baby au natural and I thought I was going to die.
prem/post? No, never.

Becky - posted on 05/27/2011

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Ugh, I had a post typed up and then hit the wrong button! Anyway... I would love to have a homebirth with my next - and I will be at least 35, if not older, since I'll be 35 in 2 months - but it'll be a miracle if I manage to talk my husband into it. He's so nervous when it comes to me giving birth! So, I know that if I did manage to talk him into it, things would have to be pretty much perfect. First sign of any complications and he'd be dragging me into the car and taking me to the hospital!
That aside, I definitely wouldn't have a home birth earlier than 37 weeks. Even at 37 weeks, my oldest was small for gestational age and ended up with severe jaundice, so even if we'd had a home birth - which we couldn't because of my BP - we'd have ended up in the hospital. Post dates, maybe, if I was being closely monitored through ultrasounds. Probably not later than 42 weeks though.
GD and GBS - I'd have to research the possible complications. GBS, maybe, with antibiotics and a follow-up with the doctor within 24 hours.
Breech, no. Even though I might still want to try to deliver vaginally, I'd want it to be in the hospital in case a c-section became necessary. I wouldn't want to waste precious minutes getting to the hospital if my baby was in distress.

Erin - posted on 05/27/2011

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Oh I will also add, I would do a HBAC (providing I had a classic scar) without hesitation. The risk of rupture is miniscule.

Erin - posted on 05/27/2011

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DAMMIT! COM just ate my answer.



Anyway, I would transfer care in a heartbeat if I was under 37 or past 42 weeks. I would not continue with my homebirth plans if diagnosed with GD.



I would do a homebirth if over 35, but not over 40, (and likely not over 35 if it was my first).



If my midwife was able to administer the IV antibiotics, I would continue with a homebirth with a positive GBS swab. If it showed in my urine (meaning heavy colonisation) I would have to reconsider. No antibiotics? No way... I would transfer. No garlic or Hibiclens for me.



I have the hardest time with imagining what I would do in the case of a breech. I don't *think* I would do a HB, but I would certainly seek out a breech-friendly doctor (there was a local OB here who was reknowned for his breech skills) for a hospital birth. If that was impossible, I would absolutely NOT schedule a c/s. I would wait for labour to start, to be sure baby didn't turn vertex at the last minute.

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GBS? Please forgive my ignorance but I've sat here for 10 mins trying to figure out what it stands for...

I guess I COULD just google it....

Sal - posted on 05/27/2011

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i am not a big fan of home births for ME mostly the mess uts me off, but i am happy for mums to do it when the likely hood of a normal natural birth are likely, but i think the first and most important part of being a parent is to put the safety of your child first, i can only assume that mothers who want a home birth want it for the benifit of themselves and the baby, when the benifits are being outweighed by risks i think a hospital visit, or other appropriate action, (calling in a more qualified person or having an ambulance on stand by or something else that i don;t know about) is in order and not to do so should be seen as negilgent on part of the midwife attending or the mother herself if she is going against advice, premi and post date babies should go to hospital i feel for the baby and the baby to me is the central issue, and breech births i would really consider it as well, at the least have the hospital on standby if needed, and i also think that at the first signs of distress to the mum or bub, rasied bp or the like action should be taken as well

Lady Heather - posted on 05/27/2011

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I would not because a) I wouldn't want to and b) there is no way in hell my midwife would allow it. Well, maybe over 35, but everything else would have to be perfect. None of the scenarios listed would happen around here, at least not with a registered midwife.

I can't have a home birth ever. My midwife vetoed that pretty fast. It doesn't do home birthing advocates and midwives in general any favours when people act recklessly like that.

Jocelyn - posted on 05/27/2011

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I had my daughter at home while I was GBS+ (I went into labor 12:30 am on the day the midwives were going to be picking up the antibiotics LOL)
I would also attempt a breech birth (tho I probably wouldn't have if it was my first child).
I would NOT attempt a home birth if my child was less than 37 weeks or over 42 weeks.
As for GD, in our area you would be considered high risk and you wouldn't be able to get a midwife anyway. But if it was just the large size of the baby, pfft...my daughter was 10lbs :P Easy peasy.

Minnie - posted on 05/27/2011

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Would you continue your plans for a HB with a breech



Depends on the breech presenation. Frank, yes. Footling....ehhhhh, a possibility. Doing the splits enutero? Nope.



However this is providing that I was in labor. I would not just automatically assume that a baby doing the splits (or any breech presentation) wouldn't turn and pre-schedule a ceserean, you know?



were over 35



Of course.



GBS+ status



I don't even test for this.

GD



I would consider it if I could control it with diet alone. If I had to have insulin, no.



prem/post-dates baby (< 37 weeks or 42+ weeks)?



My midwife was comfortable attending my birth at home if I went into labor at 36 weeks at a minimum and up to 43 weeks.

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Yes to almost all, but with serious consideration of all circumstances, very careful management and only in complete agreement and collaboration with a very skilled and trusted midwife. Both myself, my partner and the midwife would have to be completely comfortable with the situation and I would also want a formal back up plan in place.



Post dates of 44 weeks with GD would definitely give me serious cause for concern and I doubt that a responsible midwife would continue to work with me anyway. I would at least expect regular monitoring and ultrasounds and collaboration with other medical professionals. Post dates with GD really is a risk factor that most midwifes would consider transfer of care. Post dates in itself (42-44wks)

for me would not indicate need for hospital birth so long as baby and I remained healthy but I would expect and consent to an increase in monitoring with the expectation of increased likelihood of transfer of care.



Pre-term labour < 37 weeks would also make me pause and consider, I would be more comfortable with access to NICU and/or immediate neonatal assessment and care should baby need it.



GBS+ status, I would still go for a homebirth so long as I avoided all the other risk factors (pre-term labour < 37 wks, UTI with +GBS, breaking or leaking of amniotic sac at < 37 wks or 18 hours before commencement of labour, fever during labour or previous baby born with +GBS infection). I would consult with my midwife about options with antibiotics or chlorhexidine rinses during labour, 24hour midwife post partum attendance and would get baby checked by a doctor asap following birth.



Breech baby home birth only if my midwife was very experienced with breech vaginal delivery. I would still attempt it if it was my first, but not if it was my first and I was over 40. Over 40, if I was healthy and had a normal, healthy, risk-free pregnancy; yes I still would consider it.

Sneaky - posted on 05/27/2011

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Home birth was never really an option for me because my husband was so opposed, but it was something I liked the idea of and would have tried if I had the opportunity. So to answer your questions:
Would you continue your plans for a HB with a breech presentation; no.
were over 35; yes :o)
GBS+ status; not an issue for me, but if it was I don't see a problem with it as long as you TAKE THE ANTIBIOTICS!!!
GD; would depend on how big the baby was guesstimated to be on ultrasound. Even then, a pelvis is designed to let 10-11 pound babies out, so as long as the GD was controlled well, I'd probably go for it.
prem/post-dates baby (< 37 weeks or 42+ weeks); NO!!! I would want that baby to have access to NICU ASAP if needed.

I guess it would be up to the midwife to truthfully tell you that she was confident with these issues and your ability to trust her to tell you if you needed to pull the plug and call an ambulance.

The last two scenarios (were the midwifes have been charged) were actually a combination of factors not just one. I would have to say that if I was 43, a first timer and having a breech baby, I'd be in hospital having a c-section, no two thoughts about it :o(

I have no problem with the idea of going beyond 42 weeks - with careful monitoring, but in combination with GD?? Recipe for disaster :o(

Frances - posted on 05/27/2011

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I would consider breech if it was not my first birth. I would also do home birth if I was under 40. I would not consider home birth for the other factors.

Cassie - posted on 05/27/2011

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No. In my opinion, it's reckless and dangerous when there are risk factors present. I would have loved to have had a home birth but both of my pregnancies were high risk (for two very different reasons). I was induced early with both girls (Kiera at 38 weeks and Emma at 37). If I were to have another child ever, I would love a home birth but only after a monitored pregnancy that showed no implications of any complications for delivery.

The mothers of these children that died as well as the midwives who assisted in the deliveries should be held accountable for their actions in the deaths of these babies..BUT these deliveries should not push people away from homebirth. It should simply show them that families who choose a homebirth delivery need to be aware of all complications and have a responsible way to get the help they need when it is needed.

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