Am so confused- home birth or elective C section?

[aliss]

I know, bizarre choice to make eh?

Long story short, Alex was born with shoulder dystocia after a number of hospital interventions (failed induction x2,GBS,4 day labour, morphine,epidural,broken clavicle). I believe 100% that these interventions were the cause (as he was 9lb 3oz but every woman in my family has given birth to such large babies or larger with no problems).

I am supposed to have an elective C-section next time (1/5 chance of the dystocia happening again) but I question whether or not to have a natural home birth. My big fear is that shoulder dystocia can kill the baby but I think it happened *because* of the hospital iykwim??? This is not something that can be transferred to a hospital when it happens.

I don't know what to do. I'm not doing a hospital vaginal birth, that's for sure. Does anyone have experience with what to do after a horrible 1st hospital labour? We're thinking of TTC #2 soon and I really need to figure this out. I got pregnant the 1st month with him so it would be a quick decision!

 

[Incubator]

Hi.

What about going for a middle ground of finding a hospital with a good natural birthing centre attached? You'd be close enough to the hospital if anything did go wrong but you'd be in a much more relaxed and 'natural' environment. Would you consider a change of hospital? I had a truly awful vaginal delivery the first time around and was at a different hospital with my 2nd and was amazed by the difference in care.

How far from the hospital are you? I know this would help inform my decision. I'm only a 5 min walk from the hospital now, and about a 2 min drive so I feel very comfortable that if anything happened that it would be just a quick for me to get there than it would be be transferred from one part of the hospital to another!

I think if the docs are giving you a 1 in 5 chance of the same thing happening again, it seems quite high odds. Do you know how well equipped home birth midwives are to deal with shoulder dystocia? I think there's a lot of questions you need to ask the professionals when you do get pregnant again so you can make an informed choice - I'd also seek second and maybe third opinions if you feel that the care you received resulted in the problems with the birth. I totally understand your desire to not have another hospital vaginal delivery owing to your previous experience but I guess it's good to remember that every pregnancy and birth is different.

As an aside, I had placenta previa with my 2nd (we had planned a home water birth) so had to have a section and despite some of the c-section horror stories you're likely to come across, I had a really positive experience. It wasn't the home birth in water with candles and music that I'd planned and dreamed of, but it wasn't dreadful either. And at the end of day my LO was born and is a happy and healthy little monster child. I'm in the process of having to decide what to do this time (with only 3 weeks to go I'm cutting it a bit fine) but I veer from HBAC to VBAC to elective section. My consultant has told me I must decide by tomorrow but I'm still unsure!

Sorry for such a long reply. Best of luck with everything and I really hope whatever method you go for next time, that you have a good birthing experience.

x

 

[Celesse]

You could opt for an all or nothing approach. Which would be something along the lines that if everything during the pregnancy and labour is ok then you will birth at home, but if something deviates away from the norm then it will be hospital and section.

 

[Bournefree]

It won't really matter about when you conceive, as your obstetric history is always going to be the wall that you will need to over-come.
Lots of ladies feel the same way as you, and turn to natural or Homebirth as a way or not repeating their first labour and birth experiences.
There are some risks (however tiny) that are associated with any birth... and your MWs and or consultant will be duty bound to tell you these risks. So they are not pushing you (or at least they shouldn't be - though, experience tells me differently), into one particular course of action. You don't HAVE to HAVE a c-section, as I'm sure you know, and it is your choice.
One of the risks applicable to all births is Shoulder Dystocia... and is hard to predict although - there are some tests that can be done BEFORE you're pregnant again.
You can have an x-ray of your pelvis to measure the pelvic opening - this will help you judge in your later scans if babies shoulders are likely to get through. However, the head is the biggest bit - so if that goes through.. it really is about baby being in the best position as they make the turn after the head is born, to let the shoulders come through.

It is worth noting that with Shoulder Dystocia at home, the treatment and management of this is exactly the same as in hospital - they will ask you to try and adopt an optimum position (which you are more likely to be in at home anyways - rather than on your back! This is confirmed by NICE‘s Interpartum Guidelines - where data has indicated a lower incidence of shoulder dyscocia in home births), then when all else fails (i.e reaching in a pulling baby out, next step involved is breaking the babies clavicle - just the same as in hospital, so the hospital doesn’t hold any advantage on this one.

You need to weigh this up - but don't let it stop you from deciding to have a baby, or thinking you have to go for an elective c-section, or from having one at home.
Happy humping!
XxX

 

[chuck]

Arent rates of shoulder dystocia lower for homebirths anyway as there are fewer interventions and women tend to birth more upright/actively?

 

[aliss]

Hi thanks everyone

Yes SD rates are lower in home births, while baby/pelvic size is a factor, multiple interventions is also another major factor. I'm not sure which one or if both caused ours.

Part of what scares me is that after breaking the clavicle (which worked for us), the next & final step is a zavanelli maneuver (which I was prepped for but avoided). Basically they shove the baby back up the birth canal (because the head is already out with SD) and do a C-section. It's extremely dangerous and a last ditch attempt to save baby's life, it's more dangerous to baby than a 'standard' crash C section.

I'm not sure if it's worth the risk IMO??? I don't know what to think. It's all full of "what ifs" and when it happens, there's no room for error?? So I dunno.

I like the idea of a birthing centre in a hospital, we are moving soon so I'm not sure if they exist in Montreal Quebec, anyone know?

 

[smam]

Does the GBS stand for Group Step B? I thought if you had it then you had to be in hospital on antibiotics as soon as labour starts? Thats what happened to a friend and they said if she had another she'd have to go in again rather than the homebirth she wanted or do you not always carry it?

I haven't got any advice for you as ultimately it is your decision but that last ditch attempt to save bubs would scare the life out of me, I think I'd prefer being in a birthing center adjoined to the hospital just incase. x

 

[Bournefree]

To be clear:
GBS - DOESN'T mean you have to be in a hopstial.
You can have iv antibiotics at home. MWs at home can put in canellas.. just the same as a birthing centre.
Lots of people have GBS, and just don't know it. The NHS for example has a 50% false negative rate.
There is a GBS support thread in this section for further information.
https://www.babyandbump.com/home-natural-birthing/504819-group-b-strep-support-thread.html
XxX

 

[Jenniflower]

It is worth noting that with Shoulder Dystocia at home, the treatment and management of this is exactly the same as in hospital - they will ask you to try and adopt an optimum position (which you are more likely to be in at home anyways - rather than on your back! This is confirmed by NICE‘s Interpartum Guidelines - where data has indicated a lower incidence of shoulder dyscocia in home births), then when all else fails (i.e reaching in a pulling baby out, next step involved is breaking the babies clavicle - just the same as in hospital, so the hospital doesn’t hold any advantage on this one.

WSS ^

This was exactly what I was going to write when I first read your post but Bourne got there first. My midwife who is little miss negative nelly in my eyes even said that in regards to a SD there isn't much of a difference from being at home to being in the hospital. She mentioned that if it was something they were going to do then a call would be made immediately into the ambulance to take us into hospital directly after to ensure everything is ok. But that what is done during and on the way would be the same care as in a birthing centre or hospital. And this coming from the midwife who thinks I'll need to go into hospital because I'm too fat to get LO's heart beat. hahaha.

Don't think of anything as all or nothing though hun, there are so many options out there for you and when you do become pregnant just be sure to come back here to all of us for any support you need.

 

[smam]

To be clear:
GBS - DOESN'T mean you have to be in a hopstial.
You can have iv antibiotics at home. MWs at home can put in canellas.. just the same as a birthing centre.
Lots of people have GBS, and just don't know it. The NHS for example has a 50% false negative rate.
There is a GBS support thread in this section for further information.
https://www.babyandbump.com/home-natural-birthing/504819-group-b-strep-support-thread.html
XxX

Ahh right, I didn't know that, will tell my friend when I see her next as she really wants another bubs and have a HB too

 

[NaturalMomma]

If I was in the same position as you (first baby with SD) then this is what my line of thought would be.

There are risks with a elective c-section, there are risks with a vaginal hospital birth and there are risks of a homebirth. Which risks are higher? And which risks are I'm willing to take to get the safest outcome? For me the elective and vaginal birth might be higher, so I'd take the homebirth or birth center route. Staying active and being in a stand,squat or all four position will greatly decrease your SD chance.