Getting a booking to have your baby at home can be hard enough for a woman of average height, expecting her second child after a perfectly straightforward first labor. If, as is likely, you fall outside this very specific category, then you can expect even greater objections based on your allegedly ‘high-risk’ status.
Many doctors will consider you to be at high risk of experiencing complications in pregnancy or labor if you are:
— Expecting your first baby.
— Expecting a fourth, fifth or subsequent baby.
— Are 30 or older if it’s your first baby, or older than 35 if you already have a child.
— You have had an operation on your uterus, including Caesarean section.
— You had a ventouse or forceps delivery last time.
— You are under 5 feet 1 inch tall.
— You have previously had a postpartum haemorrhage.
In many cases these objections will be related to statistical risk rather than directly to you. Independent midwives have a strong belief in the benefits of home births and consider that very few conditions render a woman unsuitable to have her baby at home. They find that a healthy lifestyle and an informed, positive attitude is likely to result in a successful home birth, regardless of the mother’s age or her previous history. Their attitude of encouragement and belief in a woman’s ability to give birth unaided means that women under their care do just that, even though they may be deemed to be at very high risk of encountering problems.
In some instances it is quite clear that refusal by a doctor to accept you for home delivery because you fit into one of these categories is due merely to a reluctance to do any home deliveries; for example, the woman who was turned down because she was ‘too short’ at 5 feet 1 3/4 inches.
If you are fit, healthy and taking positive steps to ensure the health of yourself and your baby, these factors can become irrelevant. The most pertinent objections are those related to your particular obstetric history. You will have to decide whether previous problems arose because of circumstances which remain the same in this pregnancy, e.g. contracted pelvis (where the pelvis is deformed due to injury or illness); or whether they could have been due to the way your labor was handled or were specific to that individual baby. For example, the previous problems might have arisen because your labor was actively managed, because you felt tense or inhibited in hospital surroundings or with unhelpful staff, or because the baby became distressed. If you are uncertain as to whether circumstances will repeat themselves, you have to choose between having the baby in hospital or booking for a home delivery bearing in mind the possibility of transfer. If you opt for home but have to go in, you will at least know that the need for hospitalisation has been demonstrated and that you are less likely to be subject to ‘just-in-case’ obstetrics. On the other hand, you do have to be able to feel that you can trust your attendants, as it is in precisely this sort of situation that a midwife or doctor who has doubts about home birth will err on the side of conservatism and get you transferred. There is also the very relevant point that negative emotions and lack of enthusiasm will have a detrimental effect on your labor and justify their fears.
Some conditions will be unique to you so that only you will be able to weigh them up and come to a decision. However the following guidelines can be offered, together with some suggestions as to their validity.
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