To add context to my post, i should note that I live in New Zealand. Our maternity system is very different here what I understand the situation to be in the States - maternity care is overwhelmingly led by independent midwives, who work with hospitals, and is almost totally state funded. We have a strong principle of informed consent, meaning that you have the right to accept or refuse treatment for whatever reason you wish, and that you must be given appropriate info to make an informed decision. Having said that, the norm here is still medicalised hospital birth, and our hospital stats are still way too high for interventions and c-sections. i have heard of and witnessed births that were mismanaged by the hospital and resulted in the 'cascade of interventions.'
I'm struggling to come to terms with my birth choices. This is my 4th pregnancy, i have had one live birth. The rest have been miscarriages - from when I was 18 to now (I'm 34), so spread over a long period. The reasons for those aren't my issue here - my issue is what happens after.
Every pregnancy, including the birth of my DD, ends in massive haemorrhaging. DD's birth was the worst - I lost 2000mls of blood and needed 4 bags transfused. I always need surgery after for retained placenta. No-one seems to know why this is - I've had opinions ranging from atony to accreta. I suspect I have multi-lobed placentas. I'm going to request an MRI when I see a specialist at 30 weeks (I'm 20 weeks now), to check out the placenta.
I birthed DD at home and the labour went smoothly - it was longish (50 hours), but I got her out with no complications. I had a healthy pregnancy. 15 minutes after the placenta was born, I had a pph - placenta seemed complete, but then i lost 1500ml in one big go. We transferred to hospital (5 mins away), and I was monitored for 5 hours until staff decided surgery and transfusion was needed. They removed retained placenta in the surgery and after that and the transfusion I was fine.
So, my question - should i birth at home this time? My midwife (homebirth midwife, same as last time) would prefer me to birth in hospital but says the choice is mine. The 2 OBs I have spoken to (in the context of my miscarriage between my pregnancy with DD and this pregnancy, so wasn't really a formal opinion) say hospital is a must. The thing is, no one has described the risks to me to my satisfaction. I was fine with how my last birth went. The PPH will happen no matter where I am, so why not birth at home? Plus the fact that they monitored me for 5 hours at hospital - while I lost a lot of blood over those hours, it wasn't exactly urgent.
The clearest explanation I've had so far is that the biggest risk is me bleeding out so fast that they won't be able to get a line in for blood. We've moved since DD's birth and are now a minimum 40 minutes from hospital so I guess that could be a concern. I am less comfortable with homebirthing now than i was before DD, because of my experience of pph. I don't want to bleed to death, but no-one can give me the odds on how likely that is.
I would be happy to birth in hospital if I could have a guarantee that it would be just me, DH and the midwife, and that the hospital staff would leave us alone. My main worry is that I am giving up too easily on homebirth, and putting myself into the hands of a system where, because I am labelled as high risk, I will have to fight against unnecessary monitoring, interventions and scare tactics.
On the other hand, i don't want to bleed to death at home, but I'm not sure how likely that is. Is the risk any higher than it was with my birth with DD, where my m/c history was known but not judged to be a risk? Is it any higher than it would be for a pregnant women with no history of complications?
Sorry for the long post, but I'm struggling to get my head around this. What would you do?