Advice on answering objections to HB

[KaraStarbuckThrace]

I had an assessment with my MW on Friday with regards to my intention to have a home birth.

I have failed the checklist on the grounds of my BMI, which is slightly out of their expected parameters. They said the upper limit is 36, and said mine was 38-40. However this is based on my current weight and when I used a BMI calculator (rather than a chart) it came out at 37.4. And this is based on my current weight rather than my pre pregnancy weight.

There are no other issues to recommend a birth in hospital, my BP is normal, no indications of gestational diabetes or pre-eclampsia. Apart from my weight and very mild SPD, I am healthy and active.

The main concern is the higher risk of shoulder dystocia with obese women, however I have a very fast straight forward delivery with my ds and no complications. My pregnancy this time around has been uncomplicated(apart from hideous morning sickness!) and I am booked in to the low dependency unit. I am also not quite as heavy as I was with DS and am expecting to have a bigger baby.

Surely if my weight is an issue, they would book me into the high dependency unit?

So I am looking for experiences of other mums who have been in a similar predicament and how you approached objections.

So MW is referring to her supervisor who will call me next week. My MW is actually quite supportive (she actually said, you have 5 weeks to go so we still have time to sort this out!) but obviously I will need to present my case to the supervisor that I fully understand the risks and to make it clear that I will expect a MW to attend my delivery at home (according to AIMS and Homebirth UK they cannot refuse to attend me at home).

well BMI of over 35 is a significant risk and the reason for them advising against homebirth. what did you have last time, hospital birth? Why not go for the same or look for a midwife-led unit locally..btw, i'm speaking here as someone who has had 1 homebirth so i can understand the attraction, personally I wouldn't have gone ahead though if i'd been advised not to do so.

I suggest you contact AIMS

www.aims.org.uk/

They can give you advice on how to get your home birth.

Childbirth carries a risk wherever you give birth. If you have had straight forward birth the first time then surely the chances of an easy birth the second time are good. Even if you have to transfer in, its not the end of the world. There are very few conditions that require instant medical attention. With a homebirth problems are picked up very early as you have one to one care and even if you were in hospital it would take 15 minutes to get theartre ready for a c section.

I had severe SPD (although I am under weight so had the opposite problem) and I had a good homebirth.

There's some useful info on HB and being overweight here: www.homebirth.org.uk/youcant.htm

It really is your choice and all about the balancing of risks. You may feel there are more risks for you in hospital or you may weight things up and decide it's safer to be there just in case.

Could you ask them to point you to the studies they are basing their recommendations on so you can read them?

The supervisor of midwives' job is to try and work with you to get a good solution so she should be amenable to sensible discussion.

Ultimately though noone can deny you a homebirth, they are obliged to attend you if you decide to go ahead with it.

Thanks for your advice, I will point the supervisor over in that direction as well.

Thanks Loopy, that link is useful, I had DS in hospital on my back. Plus I wasn't sure what the rate of occurrences of shoulder dystocia was.

I think the key thing is it's unfair to use your current BMI. Mine is over 35 now, but it was the weight at the 12-week scan which was used to decide whether I was high or low risk and my weight has never been mentioned as an issue. Lots of women (possibly even most women) would move from low to high risk if their weight at 35 weeks was used! I think this means that you have been wrongly classified as high risk.

I also have SPD and this hasn't been mentioned as an issue for home birth.

have you posted on the Yahoo Homebirth Group for advice?

They can be a little militant but some fantastic people there a HUGE amount of knowledge and resources on how to help you

Thanks again, this is the point I will be making MainlyMillie!

And I will look up the Yahoo group too.

Just thought I would update you all.

I saw my MW and the SoMs last week and they have green lighted my home birth.

All the SoM wanted to know was

• Did I know what she was there for? I answered that it was because MW was following the guidance to refer the request as I had failed on point on the checklist
• Did I understand what risks there were with regards to my weight? We all discussed the risks and I made it clear I had researched it carefully, and I was happy to take guidance from my MW as well.
• She had also looked over the notes from my previous labour and discussed that as well.
• I just had to sign a couple of forms to confirm I understood the risks and that I understood that if any complications arose that I would be happy to transfer to hospital.

I did stress to them that if I was worried at all, if I had any unexplained bleeding or other problems which caused me concern I would have no problem taking myself off to hospital.

They had already packed up the HB kit before they saw me so really it was all a formality, really! Kit was delivered the next day as was the entonox!

Anyway thanks to everyone for advice, I hope that others will get some useful info from this thread.

Glad to hear the SoM visit sorted things out. Often it does as they're a more experienced, higher trained MW (supervisor of midwives doesn't mean what it would mean outside - IE that they supervise midwives) so when you go to them they often already know all the ins and outs of the risks and benefits so are happier to do it. They also know what your legal rights are and as long as you know the risks of going against the advice they will support you in that.

I think I have been quite lucky as my MW has been very supportive, she was just following procedure.
Some of the other MWs that I spoke to seemed to be very antiHB - thankfully they are not mine!

You'll find a big variance in attitudes. Something I've been discovering this week! I had a meeting with an SoM and my consultant on Monday to discuss my VBA2C with an inverse T/ classical incision. I was expecting opposition but it was really positive, went over the risks but otherwise it was positive. I had a couple of nights in hospital later in the week, two doctors were even more positive than my own consultant but I met with one who was really anti. I remember one doctor from my last pregnancy who was really dramatic about the idea being really bad.

That sounds brilliant! Glad you had such positivity. Did you find though, the objectionist really knocked you confident? I think it does take one nay-sayer to really make you doubt yourself!

I didn't actually. I'm a Doula and I have one for myself. I've educated myself on the risks and statistics so I'm pretty confident about the decision to do it. By that point I'd seen two positive doctors and the SoM, so I knew it was happening if I had to insist she rang my doctor or the SoM I was happy enough by then I would have.

But I do know what you mean because I did have it early on before I started discussing it.

What a wonderful ending and pleased to here you have been allowed to choose without too much fuss.

I am absolutely determined to have a home birth, but at only 24 weeks the midwives wont decide what my risk is yet. (at the moment everything is fine, fingers crossed it stays that way)

Some how your story makes me feel more positive.

Unless something major i will STILL be choosing to have a home birth, and i certainly wont choose to go to hospital because my BMI is slightly above an arbitary number that they choose! (i dont think it will be anyway, but if it was!)

Look forward to reading an update of your birth in a few weeks time. Hope all goes well

NannyL - funnily enough, they are thinking of ditching BMI and looking purely at weight.For the upper limit they were going to use the maximum weight they will allow in the birthing pool (I presume because someone who is very heavy would have difficulty getting in and out). My weight is well under that limit, from what the SoM was saying. In addition, my local breastfeeding support co-ordinator said they never asked about BMI 5 years ago!

The SoM actually said that she cannot refuse me a HB, all they can do is advise on the risks and ensure that the MWs are protected in case something does go wrong.

She's right. You have a legal right to deliver how you want - your body, your choice - even if it meant putting the baby at risk the most they can do is advise you but then they have to support your decision.

The NHS is trying to increase the homebirth figures because they're a lot cheaper and safer.