An unexpected HB consideration...

[MilkOnTap]

I have had a few things pop up this pregnancy that I haven't experienced before, nor have I ever pondered the possibility of how I would react to them. Firstly I began having infrequent premature labour symptoms around 25wks. My IM diagnosed it as being Irritable Uterus (IU). So I began on magnesium to ease up the symptoms, and its worked a treat!

Then a few weeks ago I had absolutely unbearable itching and have had a couple of blood tests. I believe that I may have a very mild case of Obstetric Cholestasis (OC) which has increased risks of stillbirth after 38wks (10-15% risk of stillbirth). My midwife doesn't think I have OC, but being the fabulous midwife that she is, she's willing to allow me to be intuitive and trust my instincts which I feel are telling me to get baby out by 38wks. Of course, for me to still have a homebirth BEFORE 38wks, I only have 1 week to self-induce. My midwife has agreed to do a S&S for me, and I am booked in for inductive acupuncture and will begin EPO and RLT at 37wks.

But then I have the question hanging over my head... IF baby doesn't budge before 38wks at home, what then? Will I stay at home to birth? Or will I head into hospital to birth? Whilst the risk of stillbirth is still low'ish - its still a higher risk than a regular birth. Which begs the question - if I had a stillbirth, would I prefer to do it in the comfort of my own home, or in a hospital? OR if I had a stillbirth at home, would I have wished that I had gone to hospital? Babies die in hospital more frequently than they do at home and my midwife would pick up any minor changes a lot faster at home than in hospital... This is a question I have never really pondered - and whilst I'm feeling confident that we're going to be able to successfully self-induce at home (because premature labour is common with both IU and OC) I still feel like I need to just speak the issue out loud and just be at complete peace with what I come up with.

As a homebirther, where would you prefer to have a stillborn baby? Do you think a hospital could prevent a stillbirth more than an IM at home? I have complete faith in my midwife, and I truly feel that it is in my babies best interest to stay at home - but IF something happened, would I be able to still feel as strongly as I do now??

[Gandalf]

Tough question, and definitely one i hope not to have to face.

If i *knew* without a shadow of a doubt i was going to have a stillbirth, i'd want to be at home, no questions asked. If i thought that the hospital could save the baby, i guessed i'd go to hospital...but then a part of me wonders whether babies who are likely to be stillborn are more likely to die of other complications (sids? - total speculation, but that's where my head goes). in which case, i think i'd want *my* birth....but i'd also want however much time i could have with the baby if i consented to an induction or caesarean.

I'm not sure whether i would trust an IM over a hospital or the hospital over the IM though. that's probably the part that's hardest for me. I'd want to trust her whole heartedly, because, by birthing with her that's what i'm doing...but at the same time - hospitals *do* save a lot of babies. and most of those babies don't later die of things like sids.

Where's the unbearable itching? Palms of your hands or everywhere? And are you craving coke?

[i'm sorry - my ramblings probably haven't helped you. But i hope you either manage to shake this baby loose in the next few weeks, or at least, end up happy with whatever decision you make. and i'm SERIOUSLY that this baby isn't stillborn]

[MilkOnTap]

The itching has stopped now which is why my IM believes that I don't have the OC - but from the reading I have done the level of itching is indicated by the bile acid levels, and in my blood tests those have remained low and within normal range, so I feel that its not surprising that the itching has gone. It was on the palms of my hands and soles of my feet, and spread up my arms and legs onto my torso. But now it has gone. So like I said, IF I have OC then its really a mild case anyway... still - IF it is OC, mild or not (because my other liver levels have risen) then I don't particularly want to muck around with it.

So hard to know what to do - and I really do feel that I just have to trust my gut instinct to get baby out by 38wks.

[Gandalf]

Honestly, I think your gut instinct is probably the most important consideration.

[Merla]

Isn't the increased risk of stillbirth for OC currently being debated?

If natural induction fails you really have 2 choices, medical induction in a hospital or wait it out to birth at home. Medical induction carries risk, waiting supposedly does too.

Increased risk of still birth, what does that mean? Does it mean the baby is more likely to suddenly die in utero or does it mean it has a higher chance of dieing during birth? If its the former it won't matter where you are, though I would go to the hospital to confirm the death before birthing at home to save an forced autopsy, DOC's involvement and a police investigation. If it has increased chance of dieing during birth what would the hospital offer that home can't? Would you consider an elective c-section? Constant monitoring? Induction drip? Epidural just "incase"? How much of the hospital intervention do you want? How much do you think would change the outcome?

[MilkOnTap]

Merla - there will be no medical induction nor hospital intervention since I'm a VBAC.

From what I can gather, increased risk of stillbirth is prior to birth - so essentially location of birth will make no difference to outcome.

And yes - risk of OC is being weighed up but there is very little research that is peer-reviewed available whereby one can base their decisions.

Thanks for your gentle thoughtful post whilst I'm making these hard decisions.