Follow up to my anti HBAC post Part 1 of 4 – Pros and Cons of Home Birth in general

I can’t believe the amount of views my last post has gained. I have had a few responses in regards to HBAC from people still advocating that it is safe and low risk.

I still stand by my opinion that HBAC is extremely dangerous, I’m a firm advocate for VBAC as the benefits of a vaginal birth are far greater for both mum and baby and despite my experience with a failed VBAC, Uterine Rupture and Placental Abruption I do not regret trying for a VBAC. 

The risk of Uterine Rupture in a VBAC is 0.5% or 1 in 200. There are sites that state the risk can be as high as 2% but I can not vouch for their accuracy. Whether it is 1 in 200 or 2 in 100 the risks are still high and not as low as the HBAC advocates would have you believe.

I do agree that with a home birth you are likely to suffer less complications as there isn’t as much intervention. Your body is able to do what comes naturally without drugs and assistance and this can be extremely beneficial.

Over the next few posts I want to evaluate the risks and Benefits of Homebirth, VBAC, HBAC and Caesarean Section. You can then make your own mind up as to what you feel is safe for you and your baby, but as always my main purpose is to discourage as many women as possible from HBAC. I am not trying to brainwash you or strip away your rights as a mother. All I wish to do is inform you based on my own personal experience and research. If I manage to save just one baby from someone having read my blog then my work is complete.

This post will focus on Home Birth in general, links to all of the resources used will be at the bottom of the post.

Benefits of Home Birth (In general not HBAC) according to the Birthplace Study

(Thanks to The NCT for the following information)

  • a lower risk of having a caesarean section,
  • a lower risk of an assisted delivery, i.e. forceps or ventouse and
  • less risk of haemorrhage.
“The study found that women planning a home birth were more likely than women planning for birth in other settings to have a ‘normal’ birth. In this context, normal birth is defined as labour that starts spontaneously without induction, progresses without the use of an epidural, and the baby is born without assistance from forceps or ventouse nor the need for an unplanned caesarean.
Birthplace results show 88% of planned home births were ‘normal births’ compared to fewer than 60% of planned obstetric unit births.
Other studies have shown that labour tends to progress well at home, where women feel relaxed and free to move as they wish. It is usual to have continuous care and support from a midwife that you have met, or come to know quite well, during pregnancy. You are also under less pressure to labour within strict time limits. This means there is less need for intervention, such as drugs to speed up labour, or delivery with forceps or ventouse.
As well as potential benefits, these interventions carry risks, and are more likely to be suggested if you have your baby in a hospital. Finally, there is less risk of infection at home, for both mother and baby.
Your midwife will monitor your baby’s heart and your condition regularly through labour, and will advise that you transfer to hospital if she has any concerns about the health of either of you. The aim is to transfer well before a situation becomes an emergency.”

Why do women choose planned home births? 

(Thanks to the Mayo Clinic for the following information)
” You might choose a planned home birth for many reasons, including:
  • A desire to give birth in a familiar, relaxing environment surrounded by people of your choice
  • A desire to wear your own clothes, take a shower or bath, eat, drink and move around freely during labor
  • A desire to control your labor position or other aspects of the birthing process
  • A desire to give birth without medical intervention, such as pain medication
  • Cultural or religious norms or concerns
  • A history of fast labor
  • Lower cost “

Are there situations when a planned home birth isn’t recommended?

(Thanks to the Mayo Clinic for the following information)

” A planned home birth isn’t right for everyone. Your health care provider might caution against a planned home birth if you:
  • Have diabetes, chronic hypertension, a seizure disorder or any chronic medical condition
  • Previously had a C-section
  • Develop a pregnancy complication, such as preeclampsia
  • Are pregnant with multiples or your baby doesn’t settle into a position that allows for a headfirst delivery
  • Are less than 37 weeks or more than 41 weeks pregnant “

As you can see with a home birth you have a higher chance of a successful natural birth with no intervention 88% rather than the 60% who labour in hospital. I do struggle to make sense of the figures though. Considering the fact that more people choose to labour in hospital than choose a home birth I’m not convinced the percentages are wholly accurate and can’t vouch for how they have been attained. I will agree that in my opinion the risk factor for complications does go down with a home birth.

However there are still risks that do need to be considered. According to the Mayo clinic (and again I can’t vouch for the accuracy) Despite the fact that due to careful screening ‘planned’ home births have a lower risk of complications, they are also associated with a much higher risk of infant death than a hospital birth. I can only assume that this is down to the time taken to transfer a labouring woman to hospital once complications start. The risk of infant death with a home birth is double to triple that of a planned hospital birth. Whilst this sounds very dramatic the risk is still very low. 

There are studies that show the risk of infant death to be quadruple that of a hospital birth. In a study led by Dr Amos Grunebaum a professor of clinical obstetrics and gynecology at Cornell University’s Weill Cornell Medical College. The researchers found that the absolute risk of a baby dying at birth or in the 28 days following delivery was 3.2 per 10,000 births when a midwife delivered the baby in a hospital, compared with 12.6 per 10,000 births when a midwife delivered the baby at home.

The risk is increased (in my opinion) in homebirth as there is no immediate access to critical care for mother and child. I needed immediate medical attention for both of my births. With DS1 my pregnancy was textbook and I even considered a homebirth myself. However I opted for a planned hospital birth with minimal intervention just to ensure that if anything should go wrong that I was in the right place at the right time. I lived a 20 minute drive from the hospital and this heavily influenced my decision, had I lived closer I may have chosen to birth naturally at home. I wrote about my birth experience with DS1 in a previous post so won’t go into detail in this one.

With DS2 the concept of a homebirth didn’t even cross my mind, I knew I wanted to try for a VBAC, but I wanted to be in a safe environment with access to immediate critical care if need be. Home birth (HBAC in my case) was not an option or something that I wanted to risk, and I’m pleased I chose to birth in hospital as without critical care within minutes I would have lost my son.

The choice to homebirth or not is ultimately one of the mother, and not one I would choose for myself in hindsight. Whilst there are risks, compared to a HBAC these risks are relatively low, and there will always be risks with any pregnancy or labour.

Opinions are all my own as is your choice to homebirth or not.

Bella xxx

Resources:

http://www.nct.org.uk/birth/home-birth-safe – Benefits of Home Birth
http://www.nct.org.uk/professional/research/pregnancy-birth-and-postnatal-care/birth/birthplace-study – Birthplace Study
http://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/home-birth/art-20046878 – Pros and Cons of home birth
http://www.webmd.com/baby/news/20140203/study-ties-home-births-to-higher-infant-death-rates – Home Birth leads to higher death rates

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