I have a client who is 36 4/7 and is under extreme stress due to several family matters. She really wants a homebirth in water and her 3 sons also want to attend. Her first birth was a c-section due to distress and she has since had 2 VBAC's.

This baby seems very small for dates and her appetite is low due to dates. The last sonography abut 10 days ago says the baby is less than 2 kilos.

I have asked her to be on bedrest and a high protein diet for the last 10+ days as she was having mild signs of premature labour. Now she is enduring bed rest by thinking positively about growing her baby for a home birth.

She will be 37 weeks on sunday. The back-up doctor doesn't want to be a back up so we are meeting a new one on friday. By hands and measurements I estimate the baby to be around 2.5 kilos.

What in your opinion is a safe size /weight and dates to go ahead with a home water birth?

We have just imported a pool from the UK!

Thanks

Lina

This is waaay out of my league. I am neither a midwife or a doctor, and my specialty is what the research supports as safe and healthy birth in essentially healthy women. If you are her midwife, the judgment call is yours, but from where I sit, several factors that take her out of the low-risk category: stressful home environment/personal issues, possible small-for-dates baby, and prior c/sec, although having two prior VBACs is good news. Your client's story exemplifies the enormous advantages of having an integrated system such as is found in British Columbia in Canada. There, the same midwives care for women in home births and in the hospital, which makes the initial decision of planned home vs. planned hospital birth easier, and midwives can readily consult, collaborate, or transfer care to an ob according to the woman's circumstances and how those circumstances evolve. I'm sorry I can't be more helpful.  

-- Henci

Thanks Henci,

Yes , re-reading the situation myself made me feel a little out of my own league! However since then I have found a doctor who is willing to be her back-up and he may even come for the home birth as we have now established that the baby is big enough and that the family situation is not as stressful.

She is off bed rest and very excited for a home birth. We shall see ...... If not, there is a hospital near-by.

The Canadian set up sounds like a dream.

In this country the doctors do not look favourably to home birth anymore as it has a bad reputation of un-skilled atendants and bad outcomes. I have helped a few fulfill their choice of a homebirth. Some of the  "street-dwelling/slum"  ladies I know don't want to go to hospital because it is a brutal and terrifying experience. The "richer" ladies don't want to go because there are no options of even a hot shower in most places and the interventions these days are too much.

I tread the fine line of going between the two and accompanying women in all circumstances to give birth and welcome their babies into the world. I admit to preferring homebirth these days..... Sometimes the hospital is a battle from start to finish!

This is excellent news! Please let me know how everything goes for her. I'm curious as to what country you are in and would add that in all too many hospitals in the United States, it is also "a battle from start to finish" and one the woman will almost always lose. 

-- Henci

She had a stunningly beautiful waterbirth at home in an indian monsoon! I have sent the wonderful story in to Midwifery Today for the up=coming issue on waterbirth!

Al her 3 sons were at the birth (14, 11 and 6) and my second midwife experienced her first waterbirth. Her first born was an emercency c-section birth, 2nd was a hospital VBAC, 3rd was a midwife's house birth in the bath and 4th was her dream home waterbirth :)

I am delighted to hear this!

-- Henci