And good luck Chuck and Jen!!! Remember is it all about getting the home birth you want and them helping you achieve it!! They are duty bound to tell you about any associated risks with your pregnancy (and I do mean YOURS, so make sure there is any evidence provided if you might be indicated for certain risks)
Also, make them be specific if any of the risks they mention, might be treated or managed differently in a hospital environment.
For example - the big ones are, that can apply to any birth is:
*Post-partum haemorrhage. (after your baby is born) The midwives at home (just as in hospital) will bring clotting drugs (Syntometrine or Ergometrine - this one can contract you uterus down in less that 45 seconds following IV administration) and IV fluids, but they won't be able to do a blood transfusion - you will have to transfer for that. (as you would have to be moved in hospital actually!) However, you are more likely to have a physiological 3rd stage at home (which reduces the incidence of a retained placenta), and not use these drugs to deliver the placenta, but they can be used if you have a large bleed.
*Shoulder Dystocia. But 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 NICEs 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 doesnt hold any advantage on this one.
*Failure to Progress. You are far less likely to have this problem at home - you will be more relaxed, less inhibited, and not on a time schedule, unlike in hospital, where arbitrary time limits seem to be set, and discourage and worry mothers - further compounding problems. This is the most common reason given for a necessity of a c-section. Where as the ONLY physiological reason for a failure of the cervix to dilate beyond a certain point should be cephalo-pelvic disproportion (I.e babies head is too large for your pelvis)
*Fetal distress. The only way that fetal distress is measured is with monitoring of the babies heart beat - it is worth noting that fetal monitoring is a fairly recent routine medical technology. So it is unclear whether some of the changes in fetal heart rate, are not just the normal consequences of labour for the baby, as there is little data available. (infact what has been shown is that fetal heart rate will dip in a contraction, and that is very normal) However, below 100 bpm or even over 160bmp could indicate the cord has become restricted. You will not be overly monitored at home - the mw dont carry CGT for constant monitoring.. So it is every 5 to 15 min with a Doppler and much less restrictive! Another sign of fetal distress is meconium staining. - midwives are under instruction to take women to hospital with meconium staining - though, light or old, rather than fresh, wouldnt be an indicator to transfer.
Sorry that all sounds really scary - but the point is.. some of the management is just the same! and there isn't a benefit to going in.. and will increase the likelihood of a c-section.
As for cord getting stuck round babies neck - that becomes more common when babies head is already descended into the birth canal, that it can come under considerable pressure, restricting blood flow to the baby. All midwives run their fingers round babies neck, once presenting, to check the cord isn't restricted. Because although, we could choke of we had something round our necks, the baby until born and the cord has stopped pulsating, is receiving all it's oxygen supply from the cord.. so it is the cord that is important to maintain continuity - not the babies neck.
At your homebirth assessment Jen, if your OH is about, they will want to hear from him that he is onboard with your homebirth plans.
Also, an almost certain and an unfortunate practice is, you will receive a letter from the senior/supervisor of midwives stating all the problems you might encounter above (and perhaps some more), and also stating that the Trust/providers might not be able to provide cover for homebirth. Don't get disheartened, it is usually a standard letter, and if you stand your ground, they will come to you. (this is from personal experience - I said to my midwife, I simply wasn't going to go in if asked on the phone without any medical reason - she kindly assured me, they would get to me hook or by crook - as I was saying I'd rather have a paramedic assist me, if they were unable, but there wasn't an ice cube in hells chance I would be moved!! hahaha)
It's a balancing act between listening to their concerns, and knowing your own mind and getting your views across. It can help to write down some reasons why home birth is for you - so it doesn't feel all doom and gloom!
Also, prepare a list of questions you would like to ask - how many midwives are on call at any one time (excluding holidays) for example? What equipment do they carry? how soon would they be able to get any equipment they don't carry as standard (extra g&a, or extra sutures etc)
Let us know how you both get on?
P.S Chuck - remember to ask your Obt if they have seen a natural birth, and when was it?
xxxx
*** Sorry Chuck just seen your update - well done you!!! xxxxx!!****