Can the hospital dictate my birth choices?

(38 Posts)
babsie007 Sun 15-Sep-13 15:02:24

Hi I am 22 weeks pregnant at the moment and I have so many questions! This is my first baby and we are expecting a baby girl (very exciting!), and I am really looking forward to the birth. I am looking to have as natural and as active a birth as possible. I will be having my baby in Sunderland Royal Hospital and ideally I would like a water birth.

I have a high BMi (42 on booking) so can this be denied by the hospital because of the risk?

My midwife hasn't discussed any birth options with me yet - when will this happen? And how much choice do I have?

i have some worries during labour:

-I won't be able to labour at home for as long as I wish.
-the hospital will have me laying in a bed and linked up to all sorts of machines during labour as I am medium risk (bmi)
-I will be pressured into having an epidural
-will be decline a water birth or just told the birth pool is in use

Can anyone help me with some advice or share any stories? Thanks!!!

Boobybeau Sun 15-Sep-13 21:34:59

Hi, congratulations on your baby girl. There's so much to think about that I think it's totally normal for you to have concerns but sounds like you really need to discuss these with your midwife. My friend was able to get a copy of the hospitals policies as she had a bit of an unsupportive midwife the first time round and she fo

Boobybeau Sun 15-Sep-13 21:36:26

Found this quite empowering. X

scarlettsmummy2 Sun 15-Sep-13 21:50:10

The most important thing is not hat sort of birth you want but what sort of birth is safest for you and your baby. That may well be a mid wife lead delivery, but I would take an open minded approach and look at all the options. I also think it is unlikely that you will be forced to have an epidural.

mercibucket Sun 15-Sep-13 22:11:20

you can choose to say no eg no to hospital at all, no to induction, no to continuous monitoring
but you cant make them say yes eg to a water birth
having said that, with discussion and maybe involving the supervisor of midwives you might be able to persuade them to do some things you want and they are reluctant to do

Littlefish Sun 15-Sep-13 22:13:41

If the birth pool is already in use, then you obviously won't be able to use it. One of the hospitals local to me allows you to bring your own birthing pool with you.

TheContrastofWhiteonWhite Sun 15-Sep-13 22:15:21

Yes, what Merci says. You cannot be forced to agree to anything you don't want - e.g. epidural, induction.

You can, however, be told no to things you are asking the hospital to do. For example, some hospitals have policies on BMI for water birth linked to being able to safely remove a woman from the pool if there was a problem. Likewise, if the pool is in use and there is only one, not much you can do!

princesscupcakemummyb Sun 15-Sep-13 22:17:53

hi they can decline you say a water birth they can only advise you on what they think is safe but you do not have to listen it is your legal right to decide what you want no matter what anyone thinks each hospital has a diff policy so def ask i had a high bmi in my second pregnancy it was 34 or 35 i think cant remember exactly but def close to that the hospital gave me the GTT test and extra scans how ever even know when delivery day came i was not forced to go into hospital at the first sign of things i stayed home till my contractions got to 3 mins apart and i was allowed to move around as i wished no extra monitoring just general checks and all went well

Hodgies Mon 16-Sep-13 00:28:20

A BMI of over 40 would make you high risk for most hospitals so the chances of them agreeing to midwife led care and a water birth are slim I'd say. The reality is that the chances if intervention and complications are much higher the greater your BMI. The worry of a water birth would be that if something did happen that they would struggle to get you out of the pool.

As for being stuck on a bed/epidural etc, these things are all within your control but you may well be advised that it would be in your best interests. If you do need continuously monitored there's no reason why you have to stay on the bed though, you won't be able to dance round the room but nothing to say you can't stand/sit on a ball beside the bed. Or it could be fine, you have no issues and they're happy to monitor intermittently.

My BMI is much higher than yours. First baby, I had to be induced early for medical reasons completely unrelated to my weight. The hospital never mentioned my weight as an issue in how I gave birth.
Second baby, I went into labour at home, went to the hospital, got sent home, went back again, popped out the baby. This was in spite of my high BMI and being having issues with my blood pressure in the last month of my pregnancy. Neither of these experiences were in the MW-led unit as I was high risk - but I only saw MWs even though I'm sure a consultant was lurking around somewhere.

IME the hospital were aware of my BMI, but through out labour they responded to how I was coping. They didn't try and dictate anything, just responded to the needs of the baby and me.

babsie007 Mon 16-Sep-13 08:04:55

I think I have been googling too much!

With this being my first birth experience, I have been worried about what to expect. Although I am not apprehensive about labour itself - I am looking forward to that part and I am confident in my ability to birth this baby naturally. I appreciate this may change closer to the time if there are any complications in my pregnancy. I too have extra scans booked in due to my bmi so they can check the baby size as measuring my stomach won't be accurate.

I have an appointment with my midwife middle of October so I will have to speak to her and put my mind at ease. I haven't found her to be very good so far but guess I should give her the opportunity to help me before I dismiss her efforts.

babsie007 Mon 16-Sep-13 08:28:17

I should also add that my pregnancy to date has been very healthy with no complications and my worry is that because of my bmi, they will automatically assume that the delivery will be difficult. I just don't want to be generalised and want to ensure that I am dealt with based on my own pregnancy.

TallulahBetty Mon 16-Sep-13 08:37:04

I had a completely low-risk pregnancy. Textbook was how my midwife described me. I was set ona waterbirth.

But then I had to be induced immediately and the waterbirth went out the window. I was on the consultant-led ward and had intermittent monitoring.

My point is that they can and do say no to things; often well within reason. It's good to have a list of things you'd like, but you need to be realistic that some things won't be available to you, or might be, but then that changes. Good luck smile

scarlettsmummy2 Mon 16-Sep-13 11:24:16

You still have a while to go so don't worry yet. I went mid wife led both pregnancies, but neither time did the mid wife confirm if I would be allowed to use the MLU until about 37 weeks. You have to be full term. I almost didn't get to use it second time due to my iron levels and had to really stuff the iron tablets in! I ended up with a totally unplanned water birth.

rallytog1 Mon 16-Sep-13 13:19:32

No one can force you to have an epidural. For one thing, you have to sit REALLY still for them to get it in, which no one can physically make you do, especially while you're in the throes of labour!

The most important thing is to remember that you're going to have a baby, not a birth experience. Things may happen that you wouldn't necessarily choose but they may be required to deliver your baby safely.

The best thing to do is to research all the different options for giving birth, pain relief, interventions etc. Think about what your preferences would be both if things are going well or not to plan, and whether anything in particular is totally unacceptable to you. Eg I was adamant I didn't want pethidine so when the pain became unbearable to me I went straight to an epidural.

babsie007 Mon 16-Sep-13 15:38:12

Thank you for all of your comments. I guess I need to stop worrying about all the "what ifs" and have a discussion with my mw in the first instance.

I have read that many horror stories online - one woman was advised by her consultant to have an epidural as she would likely need one to give birth due to a high BMi - hence my panic.

I know that weight can sometimes cause complications in pregnancy and birth but I want to keep it as natural a pregnancy as possible, and be as active as possible during my labour.

Fingers crossed for me!!

Doodlekitty Mon 16-Sep-13 16:04:03

I gave birth at SRH too! When I was there they had no water birth facilities but I believe they have a pool now. I would still imagine you would be lucky to get it.
During the actual labour I was very impressed with how much they allowed me to dictate the pace and decide what I wanted. I ended up with an epidural but that was very much my choice.
My biggest regret was allowing them to induce me at 11 days overdue because if my high bmi. 3 days in hospital, induction that wouldn't take and waters force broken despite 0cm dilation. I would not be induced again unless in an emergency.

scarlettsmummy2 Mon 16-Sep-13 20:17:22

Why would you need an epidural if you have a high bmi?

The only possible reason I can think of for recommending an epidural would be if a woman had high blood pressure associated with her high BMI - epidurals can lower blood pressure. However I think it is seen as a useful bonus on top of the pain relief, not a fix for the blood pressure on it's own.

But it's a bit early in the day for the Op to be worrying about that yet.

FloraDance Mon 16-Sep-13 20:59:07

The usual reason given for an epidural with a high BMI is to get it in early in case of intervention (which is more likely but probably at least aprtly down to restrictions on mobility, hospital policies, etc) as they are hard to site with the spine being more padded but a GA is even riskier with a high BMI.

Alibabaandthe40nappies Mon 16-Sep-13 21:05:24

I am confident in my ability to birth this baby naturally

With the greatest of respect, none of us know how labour is going to progress. The aim is to have a healthy baby, the means of achieving that don't actually matter in the great scheme of things.

I know when you are pregnant with your first, all you can think of is the ideal birth and how you are going to do it such and such a way - but you need to research all options and make sure that you know what would happen in the event of needing an epidural, or forceps, or a section or whatever, so that in the heat of the moment you know what your choices are.

LaVolcan Mon 16-Sep-13 21:58:59

The aim is to have a healthy baby, the means of achieving that don't actually matter in the great scheme of things.

Sorry, that's not the whole story - the mother's welfare is important too. The means of achieving the outcome is important. A birth which leaves you traumatised is bad for your mental health, and that matters.

It's still some way to go for the OP, but there is no harm at all in her researching her options. As for staying at home, it should be her choice as to when she goes in. As for the birth pool - it's their equipment, so if they say no, you can't use it, then you can't.

Remember also that what the HCPs say is advice, even if they say 'you've got to do, this, this, that or the other'. Unfortunately, sometimes the advice is more to do with hospital protocols than what's best for your own health or that of the baby.

scarlettsmummy2 Mon 16-Sep-13 22:51:05

Thanks Flora, that makes sense.

Alibabaandthe40nappies Tue 17-Sep-13 02:04:00

LaVolcan - the surest route to mental health issues stemming from a birth is to be blinkered and narrow in your thinking about having a 'perfect' birth. I speak from experience, and I stand by what I said that the means is unimportant in the end.

ExBrightonBell Tue 17-Sep-13 02:18:35

Babies007, I hope you get the birth that you are hoping for.

However it is worth spending a small amount of time considering that no matter how confident you are that you can labour and birth your baby naturally, sometimes in a small percent of cases it doesn't go that way. Not because the women involved were not confident, or that they weren't active - just because sometimes nature conspires to be bloody awkward. My ds had a large head and then decided to flex his neck and be a brow-presentation. This meant it was physically impossible for his head to get through my pelvis. An emergency c section was the only option. 30hrs of active labour had had no effect other than to squash his head into an odd shape.

So please do consider all the possible outcomes, and don't put any pressure on yourself to "succeed" in a natural delivery. If you do then it is too easy to feel that anything else is a "failure" when it isn't. You have very little control over what nature will do at the end of the day.

catellington Tue 17-Sep-13 02:34:22

The thing is, if you are doing hypnobirthing or breathing techniques or some method of drug free pain relief, the success of this relies on your faith in the method. So if your mind starts to listen to anyone who with best intentions offers you the epidural or says to keep an open mind....well the whole point of hypnobirthing is to As you say have confidence that your body can do this natural process. So it is really hard to balance that with staying open to an alternative IF there is a real emergency.
My advice from experience is to stick to your guns, do what you want and to keep reiterating what that is on every shift change because with the best will in the world the staff may not have time to explain all this to each other in the middle of the night etc.
they cannot force you to do something such as have epidural, be induced etc but that doesn't mean they won't try.
If possible make sure you have a birthing partner who is well briefed on what you want too.
Best of luck and even if it doesn't go exactly to plan as mine didn't you can adapt quickly if you relax and feel in control and still have a peaceful safe delivery.

LaVolcan Tue 17-Sep-13 10:17:09

LaVolcan - the surest route to mental health issues stemming from a birth is to be blinkered and narrow in your thinking about having a 'perfect' birth. I speak from experience, and I stand by what I said that the means is unimportant in the end.

Yes, but I too spoke from experience, and I wish to God that I had been better informed for my first pregnancy, especially when it came to the 'you've got to do' malarky which was 90% to do with protocols and 10% to do with my health.

With my second pregnancy my attitude changed from being 'it's just one of those things' if it goes wrong to being one of 'I'll do my damnedest to make things go right', which for me was getting as fit as I could before pregnancy, and having one to one midwifery care, and not being afraid to ask questions. This is not necessarily what OP needs, but is the sort of thing IMO she needs to think about.

babsie007 Tue 17-Sep-13 16:13:25

Thanks everyone - I do appreciate what you are saying about the perfect birth and I know that things could change come the time.... I could end up going into labour prematurely (I hope I don't!!), I could end up needing induced, baby could be breach etc. so this is best case.

If I am fit and able though, I don't want to have my birth options dictated too much because I'm overweight. If I able to birth naturally (and safely), then I want that option.

hotair Tue 17-Sep-13 16:41:57

I had a very similar bmi when I delivered dc2. Despite being told by more than one hcp that I would "have" to have an epidural, continuous monitoring etc I did not. I did have to reiterate alot, including more than once during labour, that I was declining the epidural, monitoring etc and meet with the supervisor of midwives before hand.
You are taking the right approach- yes as you are overweight you are at increased risk, but that increased risk remains minuscule. Insist your midwife/ consultant treats you as an individual, not as a statistic waiting to happen and make them follow an evidence based approach to your treatment, not a blanket "this is hospital policy" approach. Keep as active as you can during the pregnancy.
I ended up with a totally natural birth- no gas and air, no tears and 30 minutes of pushing. You can do it! (Oh and it was a vbac).

LaVolcan Tue 17-Sep-13 17:24:58

babsie007 I could end up needing induced

That's exactly the sort of thing I was thinking about. You could ask, 'why do I need to be induced? What are the alternatives?'. Expectant monitoring is an alternative. It would be up to you to decide whether you were happy with the answers. Some people don't mind if the hospital has a policy of inducing at 40 +10 - others would mind very much.

LaVolcan - the surest route to mental health issues stemming from a birth is to be blinkered and narrow in your thinking about having a 'perfect' birth. I speak from experience, and I stand by what I said that the means is unimportant.

This is pretty much the furthest from the truth I could imagine.

My first birth I kept an open mind and put my faith in the midwives. Almost 7 years later and I still suffer from PTSD and flashbacks and still have moments trembling with uncontrollable tears. This was a 'textbook' MLU birth according to my notes.

My second and third birth were planned in detail and the best two days of my life.

catellington Tue 17-Sep-13 18:26:05

That was part of my story, they wanted to induce me, prior to due date, because my waters broke and my labour didn't progress as quickly as they wanted. I really wanted to avoid the sytocinon (sp?) drip as I heard that it made it more likely that I'd have to have epidural etc. I had to be really forthright about not having it... I had a sweep and prostaglandin gel after which my contractions started to become regular, but I still had comments from staff such as 'your contractions aren't strong enough so we WILL have to give you the will probably need the epidural etc... I had to keep telling them no, some were worse than others. Anyway I did my breathing and stayed really focused and lo and behold at my only two examinations I was 5 and nearly fully dilated....they hadn't even believed I was in active labour!
Anyway guess my point is that the labour ward is pretty busy place and they have to be very careful about risks etc ... So they have certain protocol they aim to follow and might be pretty pushy. But as I say at the end of the day it is your body and they can't force you, that is the law.
BUT having said that there is luck involved in birth...things can go wrong with babys position etc so sometimes judgment is needed from you, but there is everything to be said for preparing in advance so you can have the best chances of a good birth experience.

catellington Tue 17-Sep-13 18:41:42

Sorry to be more positive, the midwife I had at the end was wonderful and did everything to let me have the birth I wanted .... So like I say some luck involved as to who you get as they aren't all the same of course, and also they go through peaks and troughs in terms of how many women are in, which again is out of your control but you can control how you react to all this,and try to stay calm. And maybe enjoy it???.

Minifingers Tue 17-Sep-13 18:48:56

"However it is worth spending a small amount of time considering that no matter how confident you are that you can labour and birth your baby naturally, sometimes in a small percent of cases it doesn't go that way."

Actually in the MAJORITY of first births, even low risk mothers have interventions. Fewer than 50% of first births that take place in hospital don't involve one or more of the following: emergency c/s, forceps, ventouse, syntocinon, induction, episiotomy.

OP - I think it's a great thing you have confidence in your body. Hold that thought!

If you want a normal, uncomplicated birth you might want to consider the following:

- stay at home until you are in active labour. It's quite hard to tell when this starts, but it generally involves strong, regular contractions lasting at least 50 seconds, perhaps 3 of these in the space of 10 minutes. In first time mums active labour may not commence until she is 5cm dilated or more. Before this point a labour can pootle along, stoping and starting, going on for hours, or if you're unlucky many days.

- consider getting a doula to support you in labour

- ask to go to the midwife led unit if you have one. If they have a policy of no mums with a BMI of above 35 (some do) then ask to see the supervisor of midwives at the hospital to discuss whether it's possible for them to allow you to use it anyway. Our local unit is flexible, though it is protocol to not admit mums with a high bmi.

- always, always - ask for what you want. If a doctor or midwife thinks what you are asking for is truly risky for you and your baby they will make this clear to you.

Don't be put off if they ask you to talk to the anaesthetist about epidural prior to labour - this may be standard practice for your hospital for women with a high BMI. It doesn't mean you have to have one!

Oh, and good luck!

LaVolcan Tue 17-Sep-13 20:06:51

And remember 'we don't allow' should be interpreted as 'we don't advise.' e.g. you are not allowed to go more than 40+10 overdue, should be understood as 'you're not advised to go more than 40+10 overdue, prompting the question, why not?

LaVolcan Tue 17-Sep-13 20:13:11

I have slightly contradicted myself, because if they say 'we won't allow you to use the birth pool because of your BMI', they might mean both won't allow because it's their equipment and they get to say who uses it, but also, they don't advise it for whatever reason.

Bumpstarter Tue 17-Sep-13 20:34:23

I would check if the policies on how women with high BMI vary amongst the local hospitals. You have some excellent maternity units fairly close to you, not saying Sunderland royal isn't, but that it seems each hospital has its own protocols, so in your situation I would definately be comparing them.

Tuon Sun 22-Sep-13 11:58:06

I agree with bumpstarter. I used to live local to Sunderland royal and have experience of the maternity services albeit a few years ago now. There are lots if great units very close which may be worth a look.

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