homebirth bargaining advice needed.(27 Posts)
I need a little advice ladies.
I've recently moved to a new place and registered with the local midwives, I've just come from my first appointment with my new MW at 27 weeks.
I'd like a home birth for various reasons (local hospital is not a place I want to be, intervention statistics linked to home V hospital births etc). Whilst MW didn't say "you can't have one", she did give me a schpiel about "already having several home births booked the month I'm due" and me "requesting a home birth quite close to my due date", she also showed me pics of the local hospital birth unit and talked at length about the labour and birth facilities. I don't want to give the impression that she was obstructive, and I don't want to go in "all guns blazing" demanding my homebirth if my request at such a late stage in pregnancy is unreasonable.
Can I, indeed, should I push harder for a homebirth? My new home area has some pretty good statistics for homebirthing, so I'm not sure if I'm being fed a line or not.
I could, I think, birth relatively happily in a hospital if I got into a MW led unit rather than a labour ward, and if I was allowed the freedom to do it my way, to my timescale, without being chivvied or prevailed upon or (insert horror story). My fear is that if I begin labour at an inconvenient time I may be shipped to another hospital, denied access to a MWled unit, lose control of my birth and end up in a pretty dire state.
Advise me wise vipers, I need your views (research links and stats gladly accepted too).
Oh, this is my first pregnancy, and proposed hospital would be Edinburgh Royal (with punting out to St John's if very busy)
27 weeks is not at all "close to your due date"!
I would definitely push a bit more. None of her reasons are anything to do with your health or the health of your baby. Did she know that homebirths are actually cheaper for the NHS to do than hospital / MWU births? See the NCT Birthplace study.
And have you read www.homebirth.org.uk? Loads of useful evidence-based information on there.
This is a useful summary of the Birthplace study, including information about outcomes for mother and baby, safety etc. The costs of homebirth / MWU / consultant-led unit births are on p9.
and here are links to statistics out yer ears about the various options, including homebirth. Although the www.homebirth.org.uk website is also very good, and obviously just about homebirth!
Oooh Wigeon you star! Thank you. I'm really keen to at least try and homebirth, but because she wasn't directly obstructive I hesitated, I was all geared up for a battle and ended up unsure because she was really quite reasonable and plausible with her excuses. Anyway, thank you for the resources :-)
I have no real insight into home birth but if it is something you feel strongly about then you should talk to the midwifed again. You could try ringing the central midwife no 0131 536 2009 and sew hat they advise?
I have heard really good things about the birthing centre at RI. However you cannot rely on going there if there are any complication. I had my DD in RI in 2011. I had an ok experience- not great not bad. They were not amused to be handed with a bag of sick when we arrived!! I had a bleed whilst in triage so would not have been allowed into the birthing centres if it had opened by then. Didn't like the first midwife, but at 7am shift change got a lovely midwife - my DD has her name as a middle name! They talked a lot about doing this and that in case we need to take you into surgery (due to the bleed and DD having a slow heart rate) but the only intervention I received was at my request. I was not impressed by the ward though- I could not wait to leave and get home.
Not sure if this helps at all but thought it might be useful to share my experience.
I don't even think you need to convince her. My community midwife said from the start that I wouldn't be allowed a homebirth because it was a VBAC but I booked one myself with the homebirth team directly at 39 weeks. It's not your midwife's decision. It's yours.
you can tell the midwife politely that you will be planning for a homebirth, regardless. Staffing issues are their problem not yours. they have 10-15 weeks the prepare and that is long enough. If you ring up when you go into labour, and are told they don't have the staff, you again politely say you are not going anywhere and they have to find someone even if its the supervisor of midwives. You are legally entitled to a homebirth and no one has the right to deny it. if more people had homebirths it would save the nhs so much money and they could employ more staff!!!
I think one thing to bear in mind is that a relatively high proportion of first time mothers who plan a homebirth transfer to hospital either during labour or after the birth. The Birthplace study found that 45% transfer - see page 8 here, and I've read another study which found 40% transfer. This partly put me off a homebirth for my first baby, who I had in a midwife led unit attached to a hospital.
However, transfer rates for planned homebirths drop dramatically for second and subsequent babies - I can't remember the exact stat, but I think it's either 10% or 20% transfer. So I planned a homebirth for my second. We were told that hardly anyone in my area was down for a homebirth, it was all fine, there were no midwife shortages which would affect it etc etc. But when I was in established labour and we rang for a community midwife to come to my home (with the gas and air!) we were told that all midwives were busy in the weekly clinic at the hospital and no staff were available. We were told that if someone came out to me, they'd have to close the clinic and turn away 40 women...By this time I was in very established labour and unable to argue. Because we didn't think that there would be a problem, DH and I hadn't discussed what to do if they refused to come out due to shortages, so he didn't argue with them either. So very reluctantly we went into the midwife led until and I had DD2 an hour later. Went home again 4 hours after she was born, so I consider that I had mostly a homebirth, even if the actual birth bit was not at home!!
In retrospect I should have prepared my answer to being told there were too few midwives, as BeansandCheese suggests. There is some good info under "Homebirth in the UK" on the homebirth.org.uk site about staff shortages. Also, there is a Yahoo group which has loads of very informed women on it - might well be worth joining that. I found it invaluable, for practical tips, birth stories etc etc etc as well as info on issues like "no midwives available".
So in your case, I suggest you prepare with your DP for the possibility of being told in labour that there aren't any midwives.
look at the AIMS website, there is a letter to send to your local authority if you have been told a homebirth won't be available
27 weeks isn't late at all to be booking it. Here you can't book for one until 36-37 weeks because, for obvious and sensible reasons, a baby born before 37 weeks then should be delivered in hospital. I had no problem having one with DS. The one thing I would say is keep an open mind. You've not failed if you decide to go into hospital on the day and during labour or if medical reasons overtake and it becomes sensible and safer to be in hospital.
Looks like you're near Edinburgh. Get yourself along to this place they are very knowledgable and supportive. I had some issues with a mw team near Edinburgh and went to PPC for advice. I ended up with the most amazing experience and a very happy birth at home. I realise I was incredibly lucky, but if I can do it...
Pm me if you want more details, I'm not employed there, btw, just a big fan.
Would it help your decision to go and have a look around the mlu?
Honestly although people say if they don't have a midwife on the day - demand one. I think this is niave. If they can get one, they can, if they can't they can't and I wouldn't want to risk my labour being obstinate. So I think its good to have a plan b.
Also a look around might help if u go for a homebirth and then have to transfer. It might keep you calmer and ready for the transfer.
As others have said, this is your decision and not your mws. 27 weeks is very early to be booking a hb, I didn't officially book mine until 37 weeks although I had mentioned it to the mw before that and there was no issue with it being late. I was warned that they would need me to go to hospital if there was no mw available on the day but I think this is just a standard thing that they say to all women planning a hb, I just made sure I called them very early on in labour to give them a chance to organise themselves.
You definitely have the right to a HB - and their staffing issues, as mentioned by another poster, is their problem, not yours. It is not a good enough reason not to send a MW - particularly when you are giving them very fair notice. I would second the tip that AIMS has great info AIMS. Go to Journal and then click on HB.
I think your MW's reaction tells you all you need to know about her preferences - it is easier for them if you schlep yourself to hospital. She is being quite clever, by not being 'directly obstructive' it puts the pressure on you as you probably don't want to be seen to 'kick up a fuss.'. I would ask myself, if she is so reasonable, why she isn't directly supportive? But you can play at that game - you don't have to be obnoxious, just clearly state your preference. Repeatedly .
It is your choice. I think some people confuse 'choice' with 'luxury' and try to make you feel like you are being unreasonable to stand up for what you want.
My other bit of advice is get a doula (trainees charge less). Although everyone was very smiley during my labour, they had a very definite idea of where, when and how they wanted my labour to be. I could only decline their 'suggestions' so many times before I relented. They weren't horrible to me, but the chip-chip tactic really got to me. Labour was hard enough, I didn't need another battle at that time. I think a doula would've been helpful in advocating for me 'She's said no, three times. Back off.'
Hi all, apologies for going AWOL - real life did that distressing thing where it intrudes and demands to be dealt with. I've now hoofed it back out the door and will sit and read what you've all written.
I don't see what point there would be looking round the MLU. If OP does need to transfer it would be to the CLU, not there.
There's the Homebirth UK Yahoo discussion group that is vvv used to issues like this. Join it
missrabbit I'm so sorry you had a bit of a rough time (am amused by pukeparcel though). I think the birthing centre looks and sounds lovely, but it has such a tiny capacity, and I'd rather deal with the uncertainties of a homebirth plan than arrive at the Simpson all geared up to birth in the centre and either be shipped up to labour ward or herded off to St John's for want of staff/space. I know birth is by nature very unpredictable, but I'd like to try and nail down a few things if possible. Namely: birth at home unless all goes tits up anyway (in which case labour ward at Simpsons is probably the best place in Scotland to be). I'm also DESPERATE to avoid the post natal ward, everything I've heard from friends/acquaintances about it boils my piss or gives me the jitters.
Beamae good for you for doing what you wanted. A bit confused as to who the homebirth team are though? Are they not the community midwives? My MW is my community MW, I didn't think there was a separate team I could appeal to?
Beans I had my first antenatal class yesterday and I trotted out your quote about it being cheaper for the NHS, MW gave me a look and said "yes, but we would need more staff so it would cost more in the long run". I was to say the least. Makes me wonder who supplies MWs with the info the pass on to women really...
Wigeon I've been verbally beating DH about the face and neck with what I want in re. this pregnancy, will write up a large font list closer to the time. I don't need to be control necessarily, but I need him to fight for me if I can't. Seriously considering a Doula too, it makes me sad that I'm having to think so tactically about this, it's almost like a warroom in my head now... I'm also saddened that you didn't get quite what you'd wanted - I can't decide if it's "low down, dirty tactics" or purely staffing issues that drive these final hour "you'll have to come to us" requests. I'd come across the stats you linked to before, and although they've given me pause I still want to try because I fear that if I labour in Simpsons I have a high risk of a medicalised birth and lots of interventions that might end up making it more of an uphill struggle to attain a homebirth with any subsequent pregnancies. It's just all too many known and unknown unknowns!
Beans thanks for the letter idea, will pursue if I don't start to make headway.
Dino thanks for reassuring - I also thought it was odd to suggest I was late making the decision, I mean nothing is set in stone until it's set in stone... heyho, hopefully all will go well, if I go in by choice it'll be because I need to, and as I've said somewhere above there's probably no better place to be if I do need an intervention...
oddfrog thank you for the offer, I may well drop you a line if I don't make progress. Very kind of you, and am so pleased you got what you wanted in the end.
holidays you raise a good point - a plan b is definitely needed. However if every labouring woman put under pressure to come in to the hospital due to staffing shortages folds and goes in then the staffing issue remains hidden. I work for the NHS and all the staff work to more than our capacity because of shortages, if we worked at the rate we're paid for the NHS would have to hire more staff. We make the rods that beat our backs...
notunder that's a very good bit of advice about phoning early...I will keep that in mind as I get closer to the day. be prepared and all that...
Babywitch you make a brilliant point there about the MW's tactics - I hadn't really thought in those terms until posting this thread, but you're right, if she's not against me then why isn't she with me? I have been toying with contracting a doula - DH can be brilliant under pressure, but I don't know how he'd react if he were being fearmongered-at and pressured to get me to do something I didn't want...
LaVolcan my thoughts precisely, if things don't go to plan I'll end up on labour ward rather than in the MLU.
Frisky I will check it out, thank you.
The homebirth team in northampton are separate to the community midwives. I asked a community midwife for their number. You could probably ring your local hospital to get the details if your community midwife won't help you. In my experience, all the community midwives I came into contact with were very disconnected from and misinformed about hospital and homebirth policies. They all said I wouldn't be allowed a homebirth and that I definitely wouldn't be allowed a water birth, but the hospital and homebirth team were fine with me being in the pool. I suspect a lot of what they say is based on their own opinions rather than actual policies.
I can see the point of looking round the MLU. If you decide as you go into labour that you'd rather be in hospital rather than have a home birth, you could go to there. It is only if you needed to be transferred once labour was established, that you'd end up in the CLU.
Baemae I will look into that, the impression I had got was that they were all one big team, but I will do some digging/poking/asking of questions. Thank you for raising the point.
Dinosnores I think the only thing that would induce me to give up the sovereignty of my own home to go and birth somewhere else willingly would be management of pain, in which case the MLU probably wouldn't be an option anyway. Beyond that the MLU at ERI is 5 beds, and is generally pretty busy, so I'd probably get punted up the stairs to CLU in the RIE or ambo'd to St John's in Livingston. It's a very fine unit though, and if I felt I could control enough of the variables to comfortably birth there I would. Unfortunately this pregnancy has brought home two facts to me: I am a lentil-weaving hippy-in-hiding, and I'm a control freak when I'm scared.
A bit of local info: there isn't a homebirth team in Edinburgh, each team provides a midwife to be on-call everyday. If the midwife from your team is already out with another woman then a midwife from the next team would be called for you and so on. No battle required: I would simply phone the office and say that you plan to have a homebirth and when will the homebirth discussion take place? (a midwife from the team usually comes out for a chat about the equipment, when to call etc). You can ask to speak to the team leader if you prefer and if you are not happy with how that goes you can contact the on-call supervisor of midwives by phoning the RIE switchboard on 0131 536 1000.
I would definitely push for it!!!! (No pun intended!!)
You have the right to choose.
However don't set your heart on it (like I did!) as if the midwives are all out at other home births you may not be able to get one to come out. So if I were you I would have a plan B that you have put just as much effort into preparing for so that if that happens it's not going to be the end of the world.
I so wanted a home birth, but ended up being induced so couldn't have one. However the birth I had turned out really well, and going to hospital wasn't half as bad as I thought it would be.
I think you should keep your options open. Why do you think that a hospital is such a terrible place to have a baby?
I had DD in hospital and was so well looked after that I didn't want to come home. By all means push for a home birth, but try and look at hospital as an alternative option rather than a last resort otherwise, if things don't go to plan, you will feel that you have failed somehow.
I live not too far from you and at a similar stage and we have just started discussing where I will give birth in more detail other than the general "my preference is x" that i said at booking in. My midwife says better to plan for a home birth and change to hospital delivery at a later date than the other way round.
I know a few women in Edinburgh who have had home births in different parts of the city and have felt slight push back from the midwife when first suggested it (I honestly think this has more to do with staffing rates) however, they went on to have home births and excellent care and birthing experiences.
As an aside, the new birthing centre at ERI does look fabulous.
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