advice for getting the homebirth i want when "decision" wont be made until 36+5

[nannyl]

At the moment in 28+5.
Im having an uncomplicated (first) pregnancy, and I always see my (lovely wonderful) community midwife on a Friday so Im always X+5.

Anyway i have known since before i was pregnant that I intend to have a home birth. Now im pregnant and have researched it even further i know the decision is right for me.
Its what i want, what i have a right to have, and MY choice.

I also know that midwifes / NHS like to think its their choice, but the reality is its mine.

I have been talking about having a home-birth since my 9 week booking appt. My midwife has always maintained that they dont make the decision until my 36week apt (which i will have at 36+5)
(I have not yet bothered to have the "its MY choice" discussion cause i dont see the point... at 9 weeks anything could have happened and even now i could have a premature baby and have to go to hospital)

The midwife has always said they dont decide until 36 weeks as there is lots of paper work, and no point doing it, if there are last minute complications, which i understand.

However if my baby is breech (today she was head down but of course can move) I will STILL be wanting and insisting on a home birth. (Im sure that wont go down well!)
Also in the event that my BMI is slightly above the limit of 35 (I doubt it will be, im only a size 12) I will still be choosing a home birth.
Or if there are any other minor risk factors which matter to NHS (but not to me) I will still be choosing a home birth against their advice.

It strikes me that on the Friday, less than 48 hours before i become term on the Sunday, i could have to start my battle for my right to a homebirth. (and this doesnt give me much time to fight my corner if necessary)
Also when Im so close, i want it to be all sorted and not wondering at 36+4 if i will be allowed to give birth at home!

Does anyone have any ideas?

Also if baby is breech, and NHS really have a strop id happily go for an IM, but it doesnt give me much time to find one, if i only call them, when i could go into labour at any moment, and they will have bookings / plans etc.

Id rather use the NHS (and have met 2 lovely community midwives out of the 5 that might attend already) though, and on the positive side, because i live so far from the hospital home births are very much supported in this area, much more so than in many other areas.

I have already been admitted to my hospital (I have no choice regards to hospitals, there are no others close enough) with HG, and (unless in an ambulence for an emergancy) i do not plan to go their willingly, at all, ever. It was awful (another thread lol)

Of course if there are complications during the birth i'll have no choice, but to go in, which is fine, and if baby is transverse (or if placenta was in wrong place; its not) I accept that a homebirth is positively stupid, and id be admitted for a CS, but otherwise i intend to at least try to give birth at home, as is my right.

Has anyone else had the decision made SO late in pregnancy?
I am normally super organised with everything (i have my birth pool, towels, waterproof sheets etc all ready ) and I find it stressful that its my decision and im not allowed to make it until just a matter of hours before becoming "term".

Also i know the midwives here like to deliver home birth stuff so its ready. Well if i dont get 'booked for a home birth' until Friday at 36+5 will they really get the stuff here before Monday? 37+1?

(and yes i know as its my 1st im highly likely to go overdue anyway, but i still want to be all ready!)

Any advice welcome!

[squiggleywiggler]

It seems pretty standard across NHS trusts that they don't commit to providing home birth care until your booking in appointment somewhere around 36 weeks. That being said, it seems as if they are treating it as 'no homebirth until we say so', rather than (in my area for example) you see hom birth midwives and assume you're having a homebirth and the 36 wk appointment is just bureaucratic i-dotting and t-crossing.

I think there are 2 courses of action here. One is to trust in the likelihood of it all working out. Only 3% of babies are still breech at term - it's unlikely yours will be. But you could call around a few IMs and sounds them out now, or in a few weeks if that would make you feel a bit more secure. BMI unlikely to be an issue if you are a size 12, unless you are also very short. Roll with the system and you're very likely to find all is well. Especially as you know full well it is your right and you plan to do it anyway, this might save you hassle.

If this makes you too anxious then I'd suggest speaking to your local supervisor of midwives. It's their job to liaise with you and work with you to make the system work for you. You can ask for her details via your maternity unit. I'd ask to meet her and explain your concerns. Talk through the scenarios above and see what their response is. Let them know what your plans would be if the baby stays breech/your BMI is too high etc. Get your wishes documented in the notes so that foundations are laid if you need to negotiate anything later on. You also have the contacts in place to do this speedily if necessary.

I also wonder whether the latter option might be a good idea in terms of building a relationship with a senior midwife who you really trust? There are some (rarer than many people think but still existent) situations where you might want to take the advice not to have a homebirth or to transfer in. Most likely not, but getting to know a senior midwife who understands your anxieties might give you a line in to someone whose advice you feel you trust if necessary.

Oh and if they don't get the stuff there in time it doesn't matter. My daughter was born at 37+4 and they'd forgotten to bring the stuff. Dh just reminded them to bring it when they came to the birth and all was well.

[Tangle]

Sadly, it does seem quite common that PCTs won't proceed with HB plans until 36 weeks or so. I can kind of see their point of view - it is additional work for them and everything can change at the drop of a hat rendering that work irrelevant. With resources so stretched I can understand that they don't want to be doing any more paperwork than they have to.

But I can also very much see the woman's point of view (having been there). It is stressful and it feels as though they're just not listening.

Things you might want to consider:

• talk to AIMS and ask for advice
  
• join the homebirthUK mailgroup and ask for advice
  
• write to the Supervisor of MWs and/or Head of Midwifery and say more or less what you said in your OP (you have considered the pros and cons and you are letting them know that, subject to no major changes in your pregnancy, you have made an informed choice to plan a HB and that you anticipate their support in this)
  

You might also want to be proactive and start looking for and talking to IMs - I'm sure you wouldn't be the first woman to call them up as she wasn't sure the NHS would be supportive and wanted to know whether there were any other options that could be called upon at the last minute (I've talked to a few and they've all been very generous with their time and experience - and even if it was an initial inquiry that we both didn't think would go anywhere, many said they'd happily talk through any other issues I might have if it would help me).

Re. talking to your CMW, tbh I think I'd get a bit firmer with her. I'd state that, as she is aware, you have been intending to birth at home since you first came under her care and that intention hasn't changed. You appreciate that her unit's policy may not be to finalise place of birth until 36 weeks but that, as far as you are concerned, you are planing a HB and will not be deviating from that plan unless for good medical reasons. I'd also add that you are starting to find it stressful that you appear to be unsupported in this decision at this point in time and ask if there's anything you can do to chivvy things along (such as writing to the HoM ).

Your MWs job is to be your advocate and support you to make informed choices and then support you to carry them out. It IS your decision and you CAN make it any point during your pregnancy (and you have) and you can inform them of your decision however and whenever you see fit - and if they don't listen or say that "we'll make that decision at 36 weeks" then you can say it louder and clearer (and start copying it to more people, like the PCT manager, PALS, MSLC, anyone you can think of that might have any influence...).

Ultimately you're the service user. You're the client. You aren't there to make their job easy - you're there to get prepared for the birth of your baby. Their job is to make your job easier. Or it should be! In 9 months time you'll be another case in the file for the MW (however much of a fuss you make), but the birth of your first baby will still be fresh in your mind.

Lastly, don't worry about whether or not they've delivered the HB kit. And actually, don't worry about whether or not they've given themselves time to do all the paperwork. Or even about whether they've deigned to listen when you've told them you're planning a HB and expecting a MW to turn up. Women can and do choose a HB when they're in labour - and they get supported, even though they've given no notice whatsoever. The MWs can bring whatever they need. Just have something obvious to stick outside to make your house nice and easy to find and they'll have no excuse :)

[superchick]

Similar situation here. I decided on a home birth from day one and let the midwives get on with what they needed to do. I have a high bmi but my gtt checked out fine and I have always known things were going to go as planned. I accepted that they wanted to wait til 37 weeks to fomally book the home birth but i just busied myself getting things ready. It never crossed my mind that they wouldn't 'let' me whatever language the mw used. You said they are generally supportive of hb in your area so as long as you and baby are healthy and on track they will have no issues. In your position I would try to relax and wait it out.

[LoveBeingAbleToNamechange]

Could you be worrying a little too much? You have no risk factors AND your area is supportive of hb. There is no reason whatsoever for them to try and stop you from having the birth you want. You are lucky that you know so much about it and know your rights. That should give you confidence not make you think you have a fight on your hands.

[Flisspaps]

Relax :) Seriously, getting stressed won't do you or the baby any favours. Certainly, once you have your newborn you might have to learn to let things go out of your control a bit (take it from someone who was absolutely desperate for a HB and also tried to retain control of a normal life once DD arrived. You only make things hard on yourself!)

I too planned a homebirth from day one, and wasn't able to book it in until 36 weeks. This is normal. You shouldn't have to battle for homebirth, but if you have a breech baby then perhaps be aware that the main issue is that midwives don't have a lot of experience of delivering them vaginally now, as a few years ago a c-section was thought to be safer (although I now believe this advice has changed) If you want to write to the Supervisor of Midwives to make clear that you wish to have a homebirth and that you wish to make clear you will not go into hospital because of apparent staff shortages or because of anything other than an immediate medical emergency, then you can do so, but it shouldn't be necessary. Have you looked at the Homebirth site?

In the end I went to 42 weeks and agreed to induction.

[Finallygotaroundtoit]

Just to add - your BMI shouldn't be recalculated, it's your BMI at booking and that won't change!

A BMI in late pregnancy would include baby,fluid,afterbirth etc etc and wouldn't be your BMI at all

[nannyl]

Thanks all

yes perhaps i am worrying over nothing... probably lol.
I guess the reality is that so long as i continue having an un-complicated pregnancy and being low risk for another 8 weeks or so everything will be fine, and there will be no issues with me choosing the home birth I want (and they really promote for "low risk" mums anyway!)

The midwife(s) that i see for my check-ups are part of the homebirth team, and i will be sent whoever is on call at the time of labour. (Would be fab if it were my midwife )

I am other wise very very impressed with my midwife and the excellent care i have had throughout my pregnancy, so perhaps i should stop worrying and go with the flow.....

& I completley agree that it would be stupid for them to do all the paperwork for people before, as it would waste so much of their very precious time, and many of these may turn into 'not home' births.

[LadyGoneGaga]

Nannyl just be aware though that things could change. I was absolutely set on a homebirth, like you, especially after having planned one last pregnancy that ended in transfer due to bad positioning. This time round at 35 weeks I was diagnosed with Gestational Diabetes that pretty much rules out homebirth. I'm actually ok with it having had time to get my head around it. I think it's great to plan what you want but also bear in mind that things could change in the next 9 weeks - your blood pressure could go up, you could get protein in your wee, positioning could change, you could get GD. Chances are you won't but I think it doesn't hurt to prepare mentally for every possibility as childbirth can often throw a curve ball at you!

Good luck and hope you get a great home birth .

[Secondtimelucky]

Nannyl - I've seen you on quite a few threads recently and you've had some great advice here. Just to add my two pence worth.

I am not super organised as such, but I am in a profession where you have to be a bit of a control freak, so I sympathise with how you feel about having to wait for the homebirth booking (even though you've said you now understand the reasons). But labour, birth and babies don't really fit in with that way of doing things. If you hold onto it all too tight and worry about the x million possible problems that haven't happened yet, you will drive yourself demented. I would try and see this as a bit of an exercise in taking a big deep breath and chilling out. It's something I had to learn two years ago with DD1, so I'm talking from experience and hope you don't take it the wrong way.

I would also say, midwives, like HV's, sometimes say stupid things. I had one say that they wouldn't 'let' me have a homebirth if I had low iron levels and giving me a lecture on the importance of pregnancy vitamins. This was ridiculous not only because, as you know, it's not a question of allowing me a homebirth, but also because she wasn't even suggesting she wanted to take a blood sample, so how she was going to find out my iron levels I don't know. I take the view that, as long as it's not actually impacting a decision or a treatment or something now, and is merely a bit of inconsequential chat, I smile, I nod, and I ignore. This works very well with comments on breastfeeding/sleep routines/weaning, etc later on too.

ps. Had an amazing homebirth a couple of weeks ago with DD2. Hope it all works out for you too.

[findabetterolemodel]

Or if there are any other minor risk factors which matter to NHS (but not to me) I will still be choosing a home birth against their advice.

Against their advice? Sorry but you sound like a selfish inflexible idiot.

If the doctors tell you that a home birth is a bad idea perhaps you should get off your high horse and actually listen to them? Amazing how irresponsible people will be just so they get the birth THEY want - what comes first is your baby's safe delivery, not having a home birth! Please remember these people are experts and you are not, maybe you should actually listen to their advice - I doubt you will though, you are obviously completely set in your ways and unwilling to change your plans for anyone, even your baby - very typical of women who have homebirths sadly. It makes me so angry to read posts like this from women who are not prepared to listen to medical advice and think they know better as they've had 'advice' from a few women on mumsnet and read a few biased articles online. This is your baby's birth, not a lifestyle choice. Please stop banging on about your rights and think about your responsibilities to your unborn baby.

(Hides thread)

[nannyl]

thanks for that find a better....... [hmmm]

home is the safest place to have my baby, so thats where i choose to have it.

[Secondtimelucky]

Findabetter - I've seen you on a few threads where you make essentially the same point, so I'm going to respond even though you say you have hidden the thread. What others have gently tried to point out is that not everything a pregnant women gets told is actually evidence based medicine. Whilst it would be nice to think that the midwives you speak to are 'experts', actually a lot of the time they are not experts in the particular thing you are discussing. If you have researched and understood the issues, there are many things that the NHS would consider a counterindication to homebirth which are not particularly evidence based. Some are serious (I agree, if someone had a proven transverse baby who wouldn't physically fit out and still thought that a homebirth was a good plan I would question their judgement) some less so, some basically irrelevant. There are also direct safety and other benefits to a homebirth which should be weighed in the balance. Nannyl understands the issues. She's researched this a lot. It's not about prioritising an experience, it's about choosing the right thing for mother and baby.

To illustrate my point about midwives not always knowing what they are talking about, mine told me I shouldn't put my baby in a hat inside because 45% of heat is lost through the head. Now, babies overheating is a serious business, but hmmm. Not homebirth related, but hopefully you can see my point.

Oh, and finally, it really gets my goat the attitude that some people have that only the baby is allowed to matter in birth. Very few women would knowingly risk their baby's health, and people who choose homebirths (me included) would walk over hot coals for our children. But birth trauma is a real and serious problem that can affect bonding, impact on PND, etc. Interventions like episiotomy and forceps (which obviously doesn't happen at home, but which is more likely to happen in a hospital labour that starts out normal than a homebirth which starts the same) can have impacts on sex lives, continence, marriages, self confidence and families. Supporting the mother to have a birth which leaves her feeling mentally and physically good is important, both because the mother matters as a person in her own right and because it is best for the baby. Every mother has the right to make a choice which takes into account not just her baby, but herself and her family.

[Withwoman]

Every woman in the UK has a right to birth her baby where she chooses. This should be a well informed choice. Midwives practice within specific boundary and some women will be referred to talk to a supervisor of midwives if her care falls outside of what would be expected of a midwife. For a midwife to be able to care for women without the imput of a doctor a woman must be between 37-42weeks and have had an uncomplicated pregnancy. It is unsafe to deliver a baby at home before then. This is why the birth chat often happens around the 36w mark.

Have a look at www.homebirth.org.uk A good site for those considering a homebirth.

[LiegeAndLief]

I also think this is pretty standard, although I can understand how you feel, as I had exactly the same worries at 28+5. Dead set on homebirth, midwife wouldn't do the paperwork until 36 weeks.

Unfortunately I was hospitalised with pre-eclampsia at 29 weeks and had ds by cs at 34 weeks. I guess this kind of thing happens often enough for it to be a waste of time booking women in for homebirths earlier in pg. I'm sure if your pg continues to go smoothly it will all be fine. Good luck!

[nannyl]

thanks

I have no issues at all with them not doing the "paperwork" I just feel 36+5 is quite late, and given that as far as NHS are concerned im not having a home birth, until that point, that they might find some excuse such as no staff avaliable or something.
Its also 36+5 on a Friday, so next working day i'll be 37+1.... and surely midwives dont do tedious paperwork over the weekend do they? Just deal with important stuff that cant wait?

I think i just need to give up stressing about it..... and if they have "no staff" then they can find someone

[babyonbord]

God you're crazy, having a first baby as a homebirth? That's insane, what happens if you have a really long labour and want more pain relief than gas and air, if your doctors advise you to have a hospital birth it is in the your best interest not because they want to control you. If your baby is in breech you will need a c section for you and your babies saftey. I would never ever contemplate going against a doctors advise, they know what they are talking about, clearly you don't. You can't judge how you will cope with labour, you've never been through it. There are no prizes for how or where you give birth, the only prize is the healhty baby at the end of it are you really willing to risk that because of what you want, what are you six, i agree with findabetterrolemodel, i think you are being selfish and stupid and you will probably wake up and realise that when you are 4 centimeters dilated and want an epidural.

[nannyl]

if i want more painrelief or labour is long then i'll go to hospital.... i dont HAVE to stay at home.
At home i can have basically every pain relief EXCEPT an epidural. Also have a guaranteed pool available as its mine and no one else will be in it.

No reason at all to have a C section of breech. Ask any independant midwife.... 50 years ago being breech was of no major concern or issue to a midwife..... It was just a variation of the norm.

Humans have naturally and safely birthed breech babies for... well the entire history of the human race really.

If I am low risk me and baby are significantly MORE likely to die in hospital, than at home.
Baby is also more likely to have a poor apgar score, we are both more likely to get an infection, and i am more likely to need intervention, and then me and baby have to deal with all the issues of intervention.

Not only is a home birth safe, it is actually SAFER than being in hospital (if low risk)

Even the NHS maintain its "as safe" which is WHY they support it

Personally going to hospital unneccessarily is not a risk im prepared to take

[EggyAllenPoe]

60% of all first timers deliver their baby at home. the other 40% that transfer in - mostly do so for pain relief. you can change your mind half way through.

babyonbord many HCPs know very little about HB, and the altered risk factors for it (faster labour, less pain reported, fewer tears, halved chance of emcs). Therefore taking medical advice as gospel = not wise.

op i would find it annoying. my first MW did not book me in at all - another MW did at my 40 week appt! (in fact, we did the paperwork at my first appt, but she never forwarded to hospital...supporting my choice? i think not.)

[babyonbord]

i know 2 women who had home births with their first baby, they had low risk pregnancies, one lost her baby as she lived an hour from the hospital and the ambulance couldn't get to her fast enough, the cord was wrapped around the babies neck, if she had been in a hospital the baby would have survived, the other a very close friend of mine nearly bled to death luckily she lived 10 minutes from the hosiptal and got there in time for a transfusion. I think having a homebirth is taking an unneccessary risk, if hospitals were not the saftest option women wouldn't give birth there would they. Before hospital births and medical intervention there were a lot more childbirth related deaths and women still die during childbirth. Nobody is really "low risk". During my first pregnancy i developed a dvt, i shouldn't be able to get them not only do i not smoke, i am not overweight and on top of all of that i have a clotting disorder that prevents my blood from clotting properly, no one can explain why i got one but i did the point being you can be as low risk as you can get and things can still go wrong. But if you want to risk it then more fool you.

[MavisCruetTheFairy]

But 50 years ago all midwives had experience of delivering breech babies vaginally; today many (quite possibly most) of them will have never done it before. If you are going for a homebirth of a breech baby when you've never had a vaginal delivery before (given that vaginal breech delivery is generally higher risk in a primagravida than in a mother who's had a previous non-breech vaginal delivery) I would say you really really need to have a good midwife who's attended plenty of vaginal breech births before, and these days that is likely to be an IM rather than an NHS midwife.

However if (as is overwhelmingly likely) your baby isn't breech it sounds very unlikely that the NHS will have any issue at all with your homebirth. So I do think you are over-thinking this, although understandably.

[EggyAllenPoe]

that is what is called 'anecdotal evidence' - you can't base decisions on that.

the evidence says HB is just as safe. deal with it.

[fotheringhay]

I hope you can have a home birth and it all goes well.

I'll just add my experience in case it's any help. I planned a home birth then had to be transferred in (for something that turned out not to be a problem). So I'd say be prepared for that to happen. My midwife said that out of 7 planned home births in the previous month, 5 had ended up in hospital.

Also having been through it once, I'd only have hospital births from now on. Mainly for the resources I might need. Someone said/wrote once (can't remember where) "it's not your birth, it's the baby's".

[EggyAllenPoe]

and i would also say you can never know how something could have gone, were it in hospital/ in a different hospital/ at home/ if you did x, y, z....

some babies die. in hospital they may have more tools to attempt resus with, but they don't always work. you cannot ever say that that baby would have made it at hospital. It is an unknown.

[MavisCruetTheFairy]

While we're at it, though, I know a woman who had a hospital birth with her first baby and the baby suffered massive brain damage because she was shunted off into a side room and not monitored properly. If she'd been at home she'd have had two midwives with her and gone in as an emergency transfer and the baby would almost certainly have been fine.

See? Horror stories happen both ways. Statistically homebirth is just as safe as hospital birth for low risk pregnancies. Some fatalities happen at home that wouldn't have happened in hospital but equally some fatalities happen in hospital that wouldn't have happened at home, and unless you have a crystal ball to know whether you are going to be in one of those groups all you can do is look at the overall figures rather than focus on individual stories.

If hospitals were automatically the safest option then the NHS probably wouldn't tell you that they are statistically no safer than homebirths; that considered judgment made by experts after reviewing all the evidence is likely to be a better indication than "well, if they weren't safer women wouldn't have babies there".