High Risk and Homebirth?

[vmcmurdo]

I am not pregnant yet but would love a homebirth for my next baby... For my now 7 month old, I initially wanted to give birth in a Birth Center in ABQ but risked out due to a very mild asymptommatic heart defect called Aortic Stenosis. I had a great pregnancy throughout, even after being diagnosed with super mild pre-eclampsia (there were trace amounts of protein in my urine and a slight raise in BP). I went on to have a natural drug free birth after induction and did bleed some - not enough for a transfusion - but quite a bit. 

I am also going to visit a cardiologist to see about my heart defect (it was diagnosed when I was a newborn) as they are unsure I even have it.

I want to preface my question with this --- I am not seeking medical advice here on the forum, just more to see if anyone has a similar situation? If it comes out the heart is actually fine, would the history of hemmorhage alone be enough for me to be too high risk to have a homebirth? I know midwives probably wouldn't take me on.

I hope it is possible... I know it is a long shot. It would just be my dream to birth somewhere comfortable... in a place I wasn't constantly slogging through the trenches of protocol. But. If it's the hospital, it's the hospital. I always tell myself that if I can have drug free birth after being induced, I can do anything... Wowzers, I did not want to be induced! But you have to just take the situation and get focused! My plan is to contact the midwives in my area and inquire about it but before I did that, I thought I'd try posting here just for general feedback.

Anyway, just curious if anyone has had a similar situation. I need to make up my own little acronym.. like... HBAH... Home Birth After Hospital. Haha. 

[JamieCatheryn]

A previous postpartum hemorrhage might not risk you out of homebirth midwife's practice - it usually doesn't, and protein traces with slight bp rise wouldn't either if it doesn't really count as a pre-e dx (how slight? did it rise over 140/90 for 2 readings? did they do a 24 hr protein test? have any other symptoms?). If your heart condition has gone ignored and without symptoms all your life I doubt that can stop you either, but regulations might stand in the way so definitely check that out. I know any midwife using training and common sense won't risk you out with your history alone, and doubt state regs will either. But with a history of PPH a midwife might take extra care to monitor your iron and diet in pregnancy and watch your blood loss after birth, encourage the bleeding to slow quicker with breastfeeding right away, and have supplements, herbs, and Pitocin on hand to treat any trouble.

[vmcmurdo]

Thanks for your feedback! I did two 24-hour urine tests and (forgive me, can't remember exactly) but it was trace amounts over the 24 hours. I remember that it was literally at 1. If I had never gotten my BP checked or the urine samples, I would have had no idea I had mild pre-e. I still wonder if it actually was anything at all, but that is neither here nor there at this point. I did have a NCB friendly OB as he worked from a family practice, so we delayed induction as long as we could -- I was diagnosed and watched closely (fetal monitoring every other day) around 35 weeks. Gave birth at 38. My BP was in the 130/80s towards the end (would fluctuate a bit, at times a bit lower but no higher) and maintained that, so elevated but not critical. I was put on bed rest to keep it from creeping up. I think he thought it would continue to rise.

I meant to say that I would welcome a home birth or birth center in my original post, so hopefully I can talk with a CNM in the area and get their thoughts. When I had my first appointment with the midwives, they were concerned about the heart defect, and that was the initial reason I started going to the OB (the one who coordinates with the birth center). 

I am hoping that since I went through a stressful labor (very long after induction and stalled) and my heart did perfectly fine that they might take me on. I did breastfeed within 15 min of her being born, did skin-skin, and placenta a couple days later (did capsules and raw in smoothies). I recovered nicely. I was concerned about the blood loss, so I'm eager to find out what might come of all of this... I suppose this is all just wishful talk since I am not actually pregnant right now or anything, but I wanted to see if there was hope beyond just a hospital birth for gals like me.

[IdentityCrisisMama]

There are a lot of things there and I'm not a MW so take what I have to say with a grain of salt. I don't think the hemorrhage would risk you out but from what I've heard of pre-e, that may raise some red flags. As far as the aortic stenosis -- if it's asymptomatic, you may ask a cardiologist if you can just leave that out of your medical history. Having some asymptomatic abnormality isn't necessarily a medical condition.