At what week gestationally would you feel comfortable with HB? How about your MW?

[Guinevere]

I met with my wonderful HBMW yesterday for the first time in this pg. It was a great visit and we did a lot of chatting. I haven't actually gotten to birth with her yet b/c although she was also my MW in my last pg, it ended in m/c. My 2 yo DD was also a planned HB (with a different MW), but she went into fetal distress at 35 wks. and I ended up with an emergency c/s instead. Talk about a gear shift! Anyway, all this to say that this pg would be my 1st HB.

Anyway, we got to talking about issues that may come up with me closer to birth (namely, delivering pre-term and high BP -- I have a history of both.) The longest I've ever gestated has been 37w0d (with both babies #3 and #4), so I told her that I felt I needed a little more leeway than her typical client and that I was quite comfortable delivering at home at any point beyond 36 wks.

She responded that the usual standard to birth at home is 37 wks., that she was open to wiggle room in my situation, but given that I'm receiving dual care from an OB b/c of my past hx w/BP issues, that *he* might well not go for it and then she would run the danger of him reporting her if I went early and still birthed at home. And then she sort of laughed it off and said that I should be visualizing getting to at least 38 wks., anyway, so there shouldn't be a problem.

Well, I can certainly visualize positively and I plan to do so, but to be honest, I don't necessarily think that's going to keep me pg a full week longer than I've ever managed before. Maybe, but I can't plan on that, yk?

What would you do in my situation? What's your personal comfort level, weeks'-wise, in birthing at home? And is that # of weeks the same for your MW? Do I have any other options here I'm not considering?

I really want to plan for and successfully have a HB this time around (it's also my last shot, b/c this is our last child), but I feel that if the rules are set up in such a way that I will likely fail, why should I even bother? I can totally see going into labor at 36+5, let's say, but still not getting to HB b/c of 2 lousy days in the wrong direction. This whole thing has got me worried and frustrated and I'm barely out of the first trimester. : I'd love some input...please?

Guin

[jenmn]

We're still interviewing HB midwives (currently with hospital-based ones) but so far I've been told that they have leeway. The guidelines are that I can birth at home between 37 and 42 weeks, however, if I go a few days early or a few days later than that they are fine with it. They mainly say that it is up to the mother/family and if I/we feel comfortable birthing at home, they are here to support me/us.

I'm sure that if there were any complications leading up to that point that would make me reconsider, but it is nice to know there is some flexibility in it and that is is not a hard and fast rule. Especially since due dates are no guarantee. From charting, I know I am due 9/14, but an ultrasound at 9w puts it at 9/11, so I figure I have a bit of "built-in" leeway in any case.

If your midwife did truly laugh off your question, I'd be a bit concerned. I'd probably bring it up again and find out what she has done in the past with other Moms who usually deliver on the earlier side. If she has never done a HB earlier than 37 weeks and has done a number of HBs, I'd be a bit concerned and probably make a few phone calls to other HB midwives in your area to see how they practice.

[Guinevere]

Oh, I didn't mean to imply that she blew me off; she addressed my question, and then was trying to reassure me (at least, that's how I interpreted it.)

She *has* attended pre-term births before, but my situation is a bit different b/c I'm receiving dual care, so there is a "supervising" OB in the loop to answer to, which isn't the case with most of her clients. And the climate in my town has changed in the past year (several HBMWs receiving disciplinary action for operating "outside the scope of their practice") such that she probably is more aware of the limits than she ever needed to be before. Does that make sense?

I'm beginning to wonder if my best bet isn't going to be getting my OB on my side in this (which isn't as impossible as it might sound, he's a good guy, very pro-HB, and very unusual for our town.)

Guin

[blissful_maia]

Here in Ontario, the legal cut-off for midwives to attend home births is 37 weeks even. That being said, I have been at home births for a couple of mamas who have all their babies between 35 and 37 weeks with no problems. It depends on the situation. Personally, knowing that my dds baked until 42w5d and 41w4d respectively (and #2 was encouraged out with castor oil), I would be alarmed if I went into labor before 37 (maybe even 38!) weeks. But for you, I think 36 weeks is reasonable. Have any of your babes had breathing problems?

[Guinevere]

I know what you mean, my best gf usually gestates between 40-42 wks. with her babies; it's amazing to consider that she is usually pg a whole 3-5 wks. longer than I have ever been! We sort of both marvel at what variety there can be in "typical" gestation periods for women.

My two 37w0d'ers had no breathing problems of any kind, and were quite respectable weights for their age, as well: 6 lbs. 15 oz. and 7 lbs. 6 oz. They also nursed well following birth, and both labors and births were short and smooth with no complications. These two births are the main reason why I feel comfortable birthing at home a little on the early side, should it happen that way.

My 35 wkr. wasn't breathing at all at birth and had many issues, but it's b/c her placenta failed quite unexpectedly and dramatically and then we later discovered she has Down Syndrome, which likely caused her distress in utero. Obviously, when she stopped moving and I went in to be monitored, I no longer had any intentions of following through with her planned HB; I knew what needed to be done. The emergency c/s saved her life, plain and simple.

And my first two babies were preemies due to pre-eclampsia, which has not reoccurred since. As such, they were in the NICU for several weeks and were clearly far too early (33 and 31 wks.) and I was clearly far too ill for me to ever have considered birthing at home.

Really, if my health issues and length of gestation had not *significantly* improved through my childbirthing journey, I would never even consider a HB. But since they have, I want to give myself the best possible shot to attain my goal, while still keeping safety firmly in mind.

Guin

[Full Heart]

Here in AZ its 36 weeks but I know that sometimes a mw will do a 35 weeker. Really depends on the situation. I always go the opposite direction - 42+ weeks so I have the other problem.

I do get what you were saying about your mw laughing it off. I've actually been asked before why I think I go to 42 weeks each time (and by an awesome mw I might add). Like I know. Um, cause thats how long I gestate. I certainly don't WANT to be pg that long. Yea I'm gonna visualize going into labor earlier. Yea its all emotional hangups. :

As far as having an ob, I don't want a back-up for that reason. I don't want to have to do something just because of a dr. What if your ob doesn't know about your plans? How does that change things? What if you drop your ob once you get to 36 weeks?

[Guinevere]

Originally Posted by Full Heart

I do get what you were saying about your mw laughing it off. I've actually been asked before why I think I go to 42 weeks each time (and by an awesome mw I might add). Like I know. Um, cause thats how long I gestate. I certainly don't WANT to be pg that long. Yea I'm gonna visualize going into labor earlier. Yea its all emotional hangups. :

I know, right? While I do put some stock in manifesting the things you want, there's obviously a more fixed reason why you seem to gestate 42 wks. and I gestate 37w or less. And all the positive visualization in the world isn't going to change it.

Originally Posted by Full Heart

As far as having an ob, I don't want a back-up for that reason. I don't want to have to do something just because of a dr. What if your ob doesn't know about your plans? How does that change things? What if you drop your ob once you get to 36 weeks?

Well, that's a bit tricky. See, I have developed chronic hypertension since the birth of my last baby, so I'm on BP meds now and will be for the duration. It's usually in the last few weeks of pg that my BP tends to rise (luckily, that's all it ever does anymore, no other pre-e symptoms) and so I usually need my meds adjusted several times in that last month to keep my BP under control for labor/birth. Therefore, I can't really ditch him towards the end, b/c that's when I'll need him most. And he already knows my birth plans; he was actually the one who pointed out that I'm still good to go with a HB after 1 c/s. How many OBs do you know who would actually bring that to your attention? So he's not a bad guy at all, really, just a bit more conservative than my MW.

Guin

Guin

[Overthemoon]

My midwife won't deliver at home until 37 weeks.
I don't have any history of going early with any of my pregnancies, and I feel comfortable with her guidelines. If I went early and had to go to the hospital, she would come and be there with me, regardless.

Good luck to you!

[claddaghmom]

My first was at 39 weeks, so I don't feel that I would be comfortable with an early delivery. Maybe if I had a track record, I would go as early as 35/36 weeks. Depends on the overall circumstances.

[dogmom327]

Around here, HB is legal at 35 weeks but personally I think I'd say 36 weeks.

[Peony]

The law in my state for CPM (which almost all the homebirth MWs are) states that they can only attend births between 37-42 weeks. Some MWs are willing to work around those weeks, say by moving EDDs around or consulting with a CNM who can attend births earlier and then documenting that info. I know some MWs who have those weeks set in stone and will not attend a birth even at 36w 6d, others will you refuse to go to the hospital and sign a form. So after all that, it just depends on the MW here anyway. Personally because I live at a high altitude, I'm ok with 36 weeks but I wouldn't go before that at home, it's not uncommon for 40 wkers to need O2 here. I say that though, but I'm 35wk and 5days right now and it would be really hard for me to go to the hospital tonight if I went into labor....

[MamaQuest]

I went early with my first few kids... 37w6d, 37w0d, and 38w6d, and am personally very comfortable as early as 35w if it's a girl, 36w if it's a boy, and my mommy-instinct isn't setting off alarm bells. I think in your situation, though, I'd put 36w as my cut-off, talk with the OB about it and see if you can get him on-board, and then bring it up with your midwife again.

That being said, sometimes there are reasons you gestate longer or shorter than "typical" that can be changed. Much to my chagrin, I happened to find such reason for myself, and my 4th (first homebirth) was born at 40w6d. Perhaps if you were to find an underlying cause for your BP issues (if you haven't already) and treated that, it might change the whole scenario for you. For me, celiac disease was the culprit for my severe morning sickness, low birthweight, and early delivery, as well as other medical issues not pregnancy-related. Hopefully, you won't have any such drastic lifestyle change in store for you, though .

My first MW was fine with 35+ weeks, and my current MW says about the same thing (state regs say 36w for her, but she can attend earlier than that in "emergency situations" which she has no trouble seeing as "mom wants baby at home" if things look good... same for breech and twins).

[munkeesmama]

My midwife's cut-off is 36 weeks. I'd have to say that is my personal cut-off as well. My previous births were at 39 weeks 38 weeks and 27 weeks. We saw quite a few 35 weekers in the nicu, so i think that drove home my 36 week cut-off as well. I'm now 38 and a few days and still going...

[Munki'sMom]

My midwife has delivered at 35 weeks, but prefers 36 and 37 plus weeks.

[bramblevine]

Mine is 37 weeks, but when I was on bed rest for four months for pre-term labor, she said we would give labor a go at home if it started at 36 weeks.

[JorgieGirl]

I don't think I'd be truly comfortable until 37 weeks. I'd like to think I could do 36, but if it came down to it, I'd probably back out.

[larzanna]

my MW cut off is 36 weeks. 42 weeks and a few days the other direction.

[Talula Fairie]

Normally I'd say not before 37 weeks for a hb, but in your situation I think 36 would probably be ok as long as you watched the baby carefully for breathing issues.

I have a friend who UC'd her 35-and-change weeker with no problems. Not that I'm saying it's something everyone should do, but she was very informed and watched the baby carefully.

[katiedidbug]

My MW will deliver after 36 wks.

[wbg]

My MW's cutoff was 37 weeks with a little wiggle room.
My own comfort level was never based on weeks, but on how the pregnancy was progressing, my history etc. My first was a little early and is the biggest most cooked of all my babies! My smallest baby was the only one to arrive post dates! Go figure! So i would trust my instincts.