Advice needed when home birth may not be possible

[cantthink]

Hello

I have put this on as I need thougts and advice from other people who are 'naturally minded'. I am aware that people do not want to hear about complications-- so if that is you please don't read on...

I am currently 34 + 5 days pregnant. I am generally having a healthy pregnancy- apart from having a few stressful life changes throughout the duration.

We are planning a home/water birth and have been doing a hypnobirthing course to feel relaxed about it. Have visualised the birth many times- relaxed, calm etc.

I have been having monthly consultations with joint renal and obs clinic as I have a pre existing condition where my kidney leaks protein and blood in my urine. Usually less than a gram of protein. They wanted to monitor me as the strain on kidneys during pregnancy can worsen them.

Usually appts go really well- my blood pressure is always low. No swelling. This time he mentioned that my protein in my urine has increased and my protein in my blood has reduced.

They have a concern that I am at higher risk of getting a clot so have prescribed clexane injections (40mg). I have asked for further clarification on my risk- there are no figures to back it up, but he suggests I am 3/4 times more likely than the average pregnant woman to have a clot. Pregnant women he says have a 1/500-2000 risk of a clot.

The obs was very quick to say that he needed to induce me so that they can leave it a clear 12 hours incase I need an epidural (there needs to be a 12 hour difference). I explained that this is absolutly not what we want. It could not be any further from our minds.

He then went on to say that clots are the leading cause of death in child birth and that I am at risk of it (felt he was scaremongering me). This has obviously made me feel worried.
He also stated that as my blood would be thinner using Clexane- I would not be able to have a home birth. I could however, have a natural (non induced) birth (am very very dissappointed) but if I did need a c-section it would have to be under general anaesthetic.

I am trying to look at the facts and risks. We really wanted a non medicalised birth, natural at home. I am thinkng if I don't take the medication I can carry on as normal.... but is that daft?



I would appreciate your thoughts
Many thanks

 

[Rmar]

I'm not very clued up on certain medication so do note that this is my opinion and may not reflect the opinion of others.

Clexane has a very short half life so it doesn't stay it the blood for very long. If you were thinking of not taking it, you could keep it up until full term. They reason for the 12 hours wait is that clexane will interfer with any epi you get and can result in serious complications regarding the thinner blood. After 12 hours, the reult of cleaxane has diminished enough for an epi so that is some indication of how long it can stay around.

A natural birth is possible with an increased risk of blood clotting. There may be too much of an increased risk for a homebirth but it is an option in the hospital. Was it a hospital appointed ob? Is it possible to change to an ob that is natural birth friendly who may give you a different opinion on it. Don't be afraid to go elsewhere for second, third. ect opinions. He might be making those statements based on one incident that he has seen and now classes everyone who has an increased risk in the same category.

You do not have a clot, right now, do you? An increased risk is a figure but it can't tell you if it is inevitable. A c-section is a thing to be avoided as that may increase the risk even more (I can't comment on your particular case).

An epidural usually has the effect of lowing blood pressure and if you already have low blood pressure, this could be a problem for both you and your baby.

IMHO, a labour where you can freely move might be beneficial for you more that being unable to move from close monitoring.

Some others may be able to add to this much better than I can.

 

[cantthink]

Thanks so much.

I do not have a blood clot now, I have never had one. It is just because my protein levels are changing.

i am quite torn as I do not want to put myself and the baby at risk of a blood clot - but I really wanted a home birth and have been so looking forward to it.

I worry that acting on a perceived risk may result in much more medical intervention and will be more risky in the process. Loss of blood scares me about this.

I suppose people have to deal with these issues when pregnancies become a bit more complicated. Initially I was like 'I won't take it, I will go into labour at home and refuse to come in to hospital and they will have to come to me'. Now I feel a bit different .... and worried about the blood clot.

I think I will go for a second opinion. I see a renal consultant and a Obs. I'm not too sure which one I need a second opinion.

BTW- my blood pressure is not low- I meant relatively. It is not high that is all.

Many many thanks

 

[Rmar]

Ah, Ok. I see what you mean about the blood pressure.

Search around the internet for natural birth friendly obs in your area. Get an opinion from your renal consultant and another ob than what you have seen before. They will probably give you a different outlook on it so that you can see the situation from all angles.

Thinking about what you will do in high risk situations is so hard especially when it involves things that mean you have a higher risk and it may not even happen. I understand what you mean about recieving uneccesarry intervention just in case to make it more of a risk. It is a common worry and so is what will happen if you really do need the intervention and you aren't in a place to get it. It is one of the most common worries of giving birth and it must be so hard in the case of an increased risk of it happening.

Do remember, even if you don't get your homebirth that you have been looking forward to, in the end, you can have a positive birth experience. It is a rite of passage, no matter how it happens and it is yours and your babies rite of passage. For some births, that's just how it needs to happen but it doesn't make it any less special.

I hope you get the kind of birth you would want. It wont be long (although, it may feel like forever) until you are holding your precious newborn.

 

[Anna_due Dec]

Have a think about this...is it worth it? Are you weighing up the risks? If things go bad, is having a crappy, monitored labor worse than the consequences of your worst case? I too am having a difficult pregnancy. I have zero chance of having a homebirth as my babies are born really prem and spend several weeks on ventilators in intensive care from the moment they are born. I hate my situation. I am a woman. i have periods, moodswings, boobs etc etc why cant i just get pregnant and have a baby, it's not fair but having said that...i do everything the docs tell me to reduce the risk for my babies because there is something i want more than natural birth and a pregnancy with no medicine and that something is a live healthy baby at the end of it and i want to be there to be it's mummy. My advice is don't find ways to reduce risks and get around doctors orders...suck it up, do as they say, avoid the risk and take home your healthy baby from the hospital and love it forever. Again...is this really worth it?

 

[MrsRH]

double post

 

[MrsRH]

Have a think about this...is it worth it? Are you weighing up the risks? If things go bad, is having a crappy, monitored labor worse than the consequences of your worst case? I too am having a difficult pregnancy. I have zero chance of having a homebirth as my babies are born really prem and spend several weeks on ventilators in intensive care from the moment they are born. I hate my situation. I am a woman. i have periods, moodswings, boobs etc etc why cant i just get pregnant and have a baby, it's not fair but having said that...i do everything the docs tell me to reduce the risk for my babies because there is something i want more than natural birth and a pregnancy with no medicine and that something is a live healthy baby at the end of it and i want to be there to be it's mummy. My advice is don't find ways to reduce risks and get around doctors orders...suck it up, do as they say, avoid the risk and take home your healthy baby from the hospital and love it forever. Again...is this really worth it?

I do agree with this, hun

labour is a risky time for mum and baby anyway. even a perfectly healthy women with a healthy pregnancy can run into unforeseen problems in labour. (like me! 3 1/2 days of labour, epidural, episiotomy and forceps)

if you take your clexane, you are at risk of bleeding/haemorage, despite the 12 hour half life, it could still affect your clotting.

if you don't you are at risk of clots, the docs are right that these are the 2 biggest killers of new mums. FACT unfortunately.

Yes a home birth would be great, if that's what you really want. But as the lady above said, it is worth the risk because the risk is not only to you, but your baby.

My birth plan went out of the window as my Blood pressure was so high.( I wanted a natural water birth got the exact opposite)
All I wanted at the end of the day was my baby delivered safely and me to be safe.

xxx

 

[MrsRH]

Thanks so much.

I do not have a blood clot now, I have never had one. It is just because my protein levels are changing.

i am quite torn as I do not want to put myself and the baby at risk of a blood clot - but I really wanted a home birth and have been so looking forward to it.

I worry that acting on a perceived risk may result in much more medical intervention and will be more risky in the process. Loss of blood scares me about this.

I suppose people have to deal with these issues when pregnancies become a bit more complicated. Initially I was like 'I won't take it, I will go into labour at home and refuse to come in to hospital and they will have to come to me'. Now I feel a bit different .... and worried about the blood clot.

I think I will go for a second opinion. I see a renal consultant and a Obs. I'm not too sure which one I need a second opinion.

BTW- my blood pressure is not low- I meant relatively. It is not high that is all.

Many many thanks

a large hospital should have a joint renal /obstetric clinic, could you be referred there??

I think an obsterician won't know much about renal disease and vice verse. but I'd say as the ob will be overseeing your care, it's them you need a second opinion on
xxx

 

[Blah11]

I think you should do the best for your baby and for yourself. Not having a homebirth isn't the end of the world hun.. is it worth the risk for you? You can have lovely hospital births, mine was great I was pretty much left alone from the MWs and I did my own thing in regards to pushing and I brought my baby onto my chest myself when she was born. The birth will be special no matter how it goes because you're bringing a special new life into the world.

 

[Adela Quested]

I am very much pro-homebirth and non-intervention (when the mother wants it, that is!) but I think that the absolute most important thing is to have a health care provider that you are comfortable with and that you trust. I think that's the problem here - that you don't feel 100% comfortable with your OB. Is it at all possible to get a second opinion?

If you have a blood clotting problem, then I suspect that your OB is correct anyway (even if his or her motives are a bit off). These things are no joke - women die of clots, and excessive blood loss and a hospital dash are no fun either (happened to a friend of mine a few months ago as a very rare side effect of early miscarriage - scary for her and terrifying for her OH, who thought she was going to die). You don't want either of those things.

I have never given birth (any minute now, I hope!) but from what I've heard from my midwives, here in this very pro-home-birth country, one of the most important things is to go with the flow and if things don't go how you would have wanted, to NOT blame yourself and to try not to be too disappointed. From their website:

"A birth’s success doesn’t depend on how it progresses or whether it was easy or difficult. The success is chiefly determined by the feeling that you have done everything possible to bring your baby into the world safely and you have been helped to do so lovingly. It then doesn’t matter how you eventually give birth: at home, in hospital, with forceps or with an epidural. Even a caesarean can be a triumph. With this attitude, your birth can never go wrong."

I hope that helps a little. Like I said, I am not in favour of intervention where it's not necessary - but there are most certainly times when modern medicine can save our lives and/or our babies' lives, so it's key to have a trusted medical advisor who can help you weigh up the risks. Sometimes you have to go with the flow a bit and accept that it's out of your hands.

 

[SactoSweetie]

You've made it so far with, what to me, sounds like a fairly scary condition. I totally agree that it sounds like you might not 100% trust the doctor giving you advice, which is why you feel conflicted. There is some great advice about finding a second opinion and whatnot especially since you still have some time. It sounds like the best case scenario might be going to the hospital when you start labor and attempting a natural birth, while keeping in mind that your plan may change.

I know that this is a possibility for me as well. I had pre-eclampsia with my first and almost died in the hospital. I thought I couldn't do a home birth because of that, but I have a great team of midwives and I know that if they tell me its time to go to the hospital, that we truly did everything possible to avoid it. That is what I mean by 100% trust in your care provider. Safety is always the first thing and no competent midwife is going to recommend you stay home when you clearly need medical attention. If you can find someone you trust, that may help you deal with the decisions and feel good about your birth expererience regardless of where it takes place.

Good luck to you and be proud that you've made it this far

 

[cantthink]

Thanks so much for your advise (I just wrote a long reply and accidently deleted it!)

I am taking the clexane and am going for a hospital birth. Think I needed time for it to sink in.

A healthy baby and me is what is most impt.

Also the renal and obs do not want me to go above 40 weeks so will induce me in 3 weeks! EEEeekkkk


Thanks so so much
xxxxxxxxx

 

[MrsRH]

Thanks so much for your advise (I just wrote a long reply and accidently deleted it!)

I am taking the clexane and am going for a hospital birth. Think I needed time for it to sink in.

A healthy baby and me is what is most impt.

Also the renal and obs do not want me to go above 40 weeks so will induce me in 3 weeks! EEEeekkkk


Thanks so so much
xxxxxxxxx

glad you got things sorted, hun and I hope you are happy with your decision.

You can make a hospital birth special taking home comforts.....music, blankets, nice smellies etc
all the very best
xxx

 

[Anna_due Dec]

I am taking the clexane and am going for a hospital birth. Think I needed time for it to sink in.

A healthy baby and me is what is most impt.

I think you have made a great decision. These days hospitals are often set up to be quite homey and the midwife generally lets you do whatever you want. It's so great to see someone put there child's needs in front of their own desires. Not saying i'm anti-birth but mum's have to take their situation into account. I'm sure you'll be an awesome mum

 

[KandyKinz]

oh hun I'm sorry this new birth plan was not the one you originally had in your heart It's completely normal and healthy to grieve it.

And remember just because you are in a hospital does not mean you cannot take control over the birth experience. You come up with a birth plan and you make sure your support people are on the same page! A hospital birth can be a very rewarding meaningful experience if you have it in you to fight for the things you want and I believe by your posts you certainly have that in you.