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Planning a Homebirth

Bare with me. The next 4 blog posts are going to be long!

This is the first in a series of 4 blog posts about my journey through my second pregnancy, birth and postnatal period.

Also, these may be triggering, so decide now whether or not you’d like to read on.

Here we go……

Almost as soon as I got those 2 lines on the stick back in January I began planning for a homebirth.

Why a Home Birth?

I took this decision for a couple of reasons. After attending the Positive Birth Conference just a few months earlier I had learnt about the impact of Oxytocin on labour and birth. Oxytocin, otherwise known as the shy hormone, needs dark and quiet and needs you to feel relaxed, safe and loved in order for labour to progress well. I knew that a hospital birth would be none of these things for me given my previous birth and PTSD that followed. I just knew that if I was in a hospital environment the adrenaline would kick in, blocking the oxytocin and stalling any progress with labour.

The other reason was that I’d learnt that having your baby at home makes a VBAC (Vaginal Birth After Caesarean) most likely to be successful. This comes from a small study, as part of the Birth Place Study which found that those who planned a VBAC at home had a significantly increased chance of a vaginal birth compared with those planning VBAC in an OU.

As my Post Traumatic Stress was tied up with having had to have a caesarean in my previous pregnancy, I felt strongly that it was important for me to have a natural birth this time, both to avoid the trauma that was likely to come with another caesarean and also in the hope that a natural birth would have a healing effect on me. If a homebirth was what would give me the best chance at achieving that then that was what I would do!

Meeting Resistance

Planning a HBAC (Home Birth After Cesarean) was never going to be easy, but I didn’t realise quite how much of a struggle it would be, but I was passionate about it and now had a great wealth of resources behind me.

The first obstacle was convincing myself, and my husband, that it was safe. I reached out in the Northern Ireland Homebirthers and Hopefuls page and spoke with the lovely Seána from Birthwise. I did my own research from reliable sources including AIMS, NICE, RCOG, Cochrane Library, Birthrights and Dr Sarah Wickham . The other thing which I did, and to this day I count this as the best decision I made in this whole process, was finding a doula. I knew immediately upon meeting Anne that she would be there to support me no matter what. Even when she told me she would be abroad for a week for a family wedding around my due date, I just knew it would all be ok. I said not to worry as I just knew I would go over my date. (42 weeks and 1 day! Trust your instinct!)

The second obstacle was the midwives. I got the feeling that homebirths are not something they do often, nor feel confident with – much less an HBAC! As soon as I mentioned homebirth, I felt that they were immediately on a mission to convince me that that it was a recipe for disaster and rushed to tell tales of worst case scenarios. Of course the ‘dead baby card’ was played many a time.

I listened, and naturally became frightened, but I had my old friend research to call upon. I made a list of all of the risks they had discussed with me and decided to find out how likely they were so that I could make an informed an balanced decision.

I’ll show what I came up with below, but please if you are reading this, do your own research as everyone is different and what was best for me in my situation may not be what is best for others and their own individual circumstances. Also, I am not a researcher and was relying on good old Google!

As you can see, I was made to discuss A LOT!
None of this was discussed when I was planning a hospital birth.

Discussing risks with someone who wishes to birth at home is a bit of a hot topic at the minute, as many of these risks are also present during hospital births, but are not mentioned in this scenario. It appears to me to be a scaremongering effort by those who are uncomfortable with home births.

Very recently, a new set of guidelines have been published for planning to birth at home in Northern Ireland and an accompanying booklet for pregnant people and their partners. These guidelines recommend that any risks being discussed should be specific to that individual, and not generalised. They should be discussed in absolute terms (for example, the risk of an event increases from 1 in 1000 to 2 in 1000, rather than the risk of the event doubles).

The only risks that should have been discussed with me were the increased risk of uterine rupture (1 in 200) and the risk of baby being harmed by Group B Strep (1 in 500 of baby having GBS disease, less than 1 in 10,000 of baby dying). In both of these cases I looked at the likelihood that this would happen, if there was anything I could do to reduce that risk and then requested what is know as “expectant management”.

Expectant management became the theme of my pregnancy. It basically means that you, and any midwives or doctors are aware of potential risks, but that no action is taken unless it becomes necessary. In both cases the chances of these risks actually happening is very low, but potentially tragic if they did. As the actual risks were so small, and preventative treatment comes with its own risks, I planned to be mindful of warning signs and take appropriate action if these became apparent, but otherwise to allow things to happen naturally.

This was the right choice for me and my baby in our particular circumstances, but I would urge anyone reading this to consider their own decisions on this very carefully. Do your research and make the right choice for you and your baby. I will 100% respect anyone who has made an informed choice, and I hope that others will respect mine.

Despite me making it clear that I was very well informed about these issues and had made my decision on balance, these risks continued to be discussed at almost every appointment and with every new person I met. I felt judged every time. Their opinion, and it is just their opinion, was opposed to my decision. The NHS is amazing, but it is based on a fear culture and is risk averse, however in reality tragedies are rare and normality is the norm.

It became very wearisome and began to impact my mental health. In the end I had to write a letter to avoid this discussion and having to persuade everyone I met that my decisions were informed.

The one thing I would love to come out of my experience is that women and birthing people will have their decisions respected. If someone has read the research and has come to an informed decision, then this needs no further discussion.

Please know that during pregnancy and birth all of the decisions are yours to make, not anyone else’s. You dictate what happens to your body and your baby.

Birth Plan

The one thing I knew I must do was to make a birth plan, or a list of birth preferences for all eventualities as it was the loss of control which impacted me most in my last pregnancy and birth. This time I wanted to make sure that I was prepared for anything, and also that my preferences would be respected and upheld no matter what situation I found myself in.

I used the Visual Birth Plan from Milli Hill. I’ll show it below in case it is helpful to anyone else, but again this is very personal to me and what might be right for someone else could be completely different.

Hypnobirthing

We prepared for the birth by having hypnobirthing sessions. We did this at home with our doula. It was a really lovely time for us. Anne would come in the evening once we had our toddler in bed and my husband and I would spend a lovely relaxing evening getting ourselves into the right frame of mind and filling up our hypnobirthing tool kit with all of the techniques that would benefit us and the baby throughout pregnancy, labour and birth.

We used the Marie Mongan Method. I’d highly recommend it. It’s part birth education, part hypnobirthing and I loved it all. One of the best parts was the tracks that came with the course. We listened to these as we were going to sleep every night. I don’t think I ever heard them all the way through as they just sent me off to sleep! So relaxing.

Hypnobirthing, and particularly using our own doula as our hypnobirthing practitioner was amazing. Anne was always on hand or at the other end of the phone to remind me of the techniques I could use to relax or deal with difficulties I was coming up against. She even came round to read me hypnobirthing scripts for fear release closer to the end of my pregnancy to make sure that I was as ready as possible, full of confidence in my decisions and my body’s ability to birth my baby.

Preparing at Home

For homebirths the midwives are on call from 37 weeks until the date your baby arrives. I knew to expect a delivery of all the homebirth equipment just before I reached the 37 week mark. With a toddler around I decided to make space under the stairs so that the equipment could be kept safely away from little inquisitive hands.

The Midwives’ homebirth kit

Now things were beginning to feel real!

All that was left to do was to set the scene, make my home ready for my baby’s birthing day.

Since my previous baby had been breech, and this was the reason for caesarean, I printed off some optimal positioning images and used positive visualisation techniques from my hypnobirthing to get my baby into a good position for birth. I actually had these displayed from around 28 weeks, just to be sure! I had also been using the Spinning Babies Daily Essentials exercises every morning since 20 weeks to make sure everything was properly aligned and that baby had the maximum space.

Optimal Positioning Images

I had been practicing lots of positive affirmations by listening to my hypnobirthing tracks every night before bed, so I printed some of these off so that I could read them while I was in the pool or labouring in the living or dining room. Of course there were plenty of fairy lights involved!

Positive affirmations for birth

I also displayed some positive birth images for the crowning stage, just in case I got the fear at the ring of fire! I love these images as they just make birthing look like the most natural and powerful thing. I wanted to see myself as strong and capable of birthing my baby in the most natural way. I displayed them around a piece of wood we used as a guest book at our wedding, so it had lots of lovely messages from our families which made it even more meaningful. A friend also pointed out that the markings on the wood resemble pregnancy! I can see it now, with the heart being the baby, but I hadn’t noticed it before.

Birthing and opening blossom images

The last, and most exciting thing to do was to have a practice run of filling the pool and making sure that it didn’t leak. It’s a really good idea to do this so that you have an idea of how long it will take. It took us 1 hour to fill.

I took this opportunity to get some bump photos, just in case we didn’t get a chance to during labour, and as it turns out I’m so glad that we did.

I got a box ready with some old towels and sheets, a few shower curtains and a tarpaulin for under the pool. We filled the fridge with my favourite snacks (several times over actually as somehow they kept disappearing!) so I’d be well fed during labour. The midwives thought it was hilarious that I thought I’d be wanting olives, chorizo and hummus during labour, but a mama knows what she needs!

Everything was ready, all that was left to do was wait!

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