Reasons why I couldn't have a homebirth?

[gertrude]

OK ladies, a quick question

what reasons (legitimate) that mean I couldn't have a home birth?

I met with a new midwife today who seemed to be very dismissive of the idea (despite the previous one being very supportive, and the ones at my parent craft classes)

I'm a large lady (UK size 20) but all blood/wee and GTT tests have come back fine, I'm measuring slightly large but I am a size 20

I just want to be forewarned tbh, I think I might have a battle on my hands here

 

[Celesse]

No one can tell you that you are not "allowed" a home birth. But they can "recommend" that you have a hospital birth based on your risk factors. A lot of professionals seem to use the word "allowed" when they really shouldn't. You need to ask what the risks are, do your research and decide if the risks are acceptable to YOU.

The guidelines by NICE recommend that women with a BMI over 35 (I think) give birth in hospital. Having a higher BMI does raise your BMI for certain things, I think the scariest is shoulder dystocia. https://www.homebirth.org.uk/ has loads of info on Home Birth, reasons why your professional may recommend hospital birth and why Home Birth may still be an option.

 

[Bournefree]

In a sentence, there are NO reasons with a high BMI why you can't have a homebirth.
You decide, if anything, what you are comfortable with - there isn't too many risk indicators with high BMI to be frank. Check out the Homebirth website for a full list.

The concern of the health professionals would be patient handling issues - such as, could they lift you if you were unconscious? Which is the usual reason for not recommending a waterbirth - as to be honest it can be difficult at the best of times to get a pregnant women out of the water, without assistance from the women herself.

Also - just because you are measuring big from fundal height measurements, doesn't mean that baby is big. Only a scan can confirm this. and although fetal weight predications by scan are somewhat sketchy - head circumference, abdominal circumference measurements by ultrasound, are quite accurate.. you can then judge if your baby is measuring on the larger side for you to deliver vaginally and asses the risk of shoulder dyscocia or a failure to progress (btw, the ONLY physiological reason there should be a failure to progress is pelvic/cephalic disproportion - not arbitrary time constraints set by policy of you healthcarer)

It is sad to say, but in most cases it appears to be true - don't expect an easy ride if you are outside the norm in wanting a homebirth. however, you CAN have any birth you want.. so become fully informed, ask lots of questions, and do your research and make your OWN decision.
XxX

 

[gertrude]

thanks

what annoys me is this is the first person I've spoken to who has been hesitant - 3 other midwives have been positively enthusiastic about it. She's made me quite cross.

Her whole manner was a bit shit tbh - and the irony is she wasn't that slim herself

 

[Bournefree]

If you really feel harmed and mis-informed by what she has said, don't hesitate to write a letter to your head of midwifery for your area. It might seem extreme, but if you don't do it - who will?

It also has to be remembered that these normal data levels for BMI in pregnancy and childbirth has been used for 30 odd years - and don't reflect our society in the slightest.

I'm not saying there are not associated risks with a high BMI - just that we should all be looking for clinical evidence of those risks.. not just accepting a women is high risk on such a presentation. What actually matters more is the weight you have put on in pregnancy; say if you were 9st and put on 3 to 4 stone in pregnancy this would be a higher indicator of risk, rather than being 16st and putting on 2 stone. however - even this is poor compared to fetal measurements of head and abdominal measurements from scans, which give an indicator for problems, rather than just risk
XxX

 

[gertrude]

I'm going to give her another chance - she started at our practice 2 weeks ago and it's a BIG place, with lots of things to learn. I know what I'm like until I've settled in so I have to see her again in 3 weeks so will see what she's like then If she's still a bit off, I will speak to someone - the last one was fantastic so I know it's not the HB but her.

I have no idea what I've gained weight wise this pregnancy - I might weigh myself but I had a bad relationship with weight/diets etc so have been avoiding it.

This baby was always going to be big - I'm 176cm, I've ALWAYS been big (BMI is around 34 I think) and I have been since I was 12 - this isn't new weight

I don't mind being scanned for size, but I will bear in mind it's not foolproof.

*fight mode engaged*

 

[Celesse]

I'm size 18, BMI 29 and had a massive looking bump from 8 weeks. They scanned me at 40 weeks to make sure I was "safe" to give birth at home and found a teeny tiny 7 pound 6 ounce baby there. My midwife who had insisted on me having the scan was so convinced the baby was large that she thought the scan was wrong. But at 42+1 I gave birth to a 8lb 1oz baby. So BIG bump, normal sized baby.

 

[indigo_fairy]

I'm size 18, BMI 29 and had a massive looking bump from 8 weeks.

See reading all your BMI's is making me wonder how accurate they are anyway! I am a 14-16 and my MW put my BMI at 31 which is over 30 so classed as high risk. So how do they work it out anyway? I know that my fitness instructor (had one before I got pregnant) said BMI should be worked out by age, aswell as a load of other things not just actual weight. My BMI was 28 with her method. Confusing....

 

[chuck]

I think the only real reasons why a HB may not be the best would be no running water and no sanitation perhaps if you living up a tree and the MW couldn't climb LOL.

Otherwise none.

There are lots of recommendations but no one can tell you that you arent allowed.

 

[Bournefree]

^^^^^lol!!!
Living in a tree! I bet I'd still be fighting for my "tree birth" though!
XxX

 

[chuck]

LOL sorry it s bit flippant but the more I read the more I realise it would be easier to write a leaflet saying why shouldn't/couldn't you have a homebirth...it would be very short.

I can think of a few very good reasons why an OB unit would be better but they are good MEDICAL reasons not matters of inconvenience or recommendations from people who want to hit targets and have no real experience of natural birth.

 

[rachiedata]

BMI and size alone are no indicator of your own pregnancy health nor that of your baby. Definitely if all the other midwives you've seen have been supportive, don't let this one annoy you. If her attitude doesn't improve you can always write to the supervisor of midwives and ask not to be seen by her again.

My BMI at booking was based on my weight wearing Doc Martins, and the midwife explained she had to fill out a manual handling and mobility form for me with risk of falls etc. and we had a good giggle because it was so silly, me being a perfectly standard sized girl! OH and my colleagues have also had a laugh at me being medically "obese" (BMI 30). If anyone used this to try and put me off a home birth, I really would just laugh in their faces.