Interventions available at a home birth?

[Ilovestackingcups]

Title says it all really. Had an horrendous time with DC1, last minute blue light transfer to bigger hospital, midwives reading things off my birth plan then telling me "it says here you don't want us to do this, but we're going to anyway" during my 24th hour of labour.
So, I'm pregnant again. And keen to avoid a repeat of the first time.
Phase 1 of Operation Birth My Way this time is a planned home birth. I have to rely on the NHS as I can't afford a private MW, so I know I will still have to jump through all the standard-issue hoops during my labour, even if it is in my living room.
What I am curious to know is what interventions are available to me at a home birth? I do not want to have another transfer, but last time I ended up having an episiotomy (specifically said I didn't want one on birth plan) and I worry I'll need one again. Do they do these at a home birth, or is this one of those reasons for a transfer?
I know I ought to ask my MW this sort of thing, but so far she's been less than useful. She forgot to save my notes following a booking in appointment, didn't get things sorted out for my first scan, so I turned up and was told they had no record of who I was, tried to reschedule one of my appointments to run during a mother and baby group she had to attend (lots of space to ask all those private questions...)
Any help greatly appreciated. Especially anyone with one of those heartwarming "I went through the same and it was amazing second time round, you'll be fine" anecdotes. I need those.
Ta!

[Jojobump1986]

I'm pretty sure they don't do episiotomies at a homebirth. They'll stitch up a minor tear though!

Hopefully I'll have a heartwarming story in a couple of months time! I'm just in the process of writing a letter to request that the midwife who attended my last homebirth doesn't have anything more to do with me! DS2 is due at the start of June & I'm hoping to have another homebirth.

Do you have someone who will be with you who can be briefed on what you will/will not accept? My DH was fabulous last time because I'd told him all the information I'd read & exactly what I thought of various things. He refused to let them move me when the MW was panicking getting stressed which is a very good thing because DS1 would probably have been born in the ambulance or halfway out the door! He was absolutely fine btw!

We'll both be fine this time!

[Ilovestackingcups]

My DH gets very nervous under pressure and doesn't like confrontation, so I have asked him to speak out for me this time (he didn't last time, and got to me about 5 minutes before DC1 was born) but I don't want to put pressure on him that he doesn't need either. I have my mum, and a friend who I am going to ask to be there with me during labour as well, partially for the support/advocacy, partially so that we have someone to look after DC1 if I do have to transfer. We live 35 miles from the hospital I would have to go to, so distance alone will hopefully put a MW off transferring me unless absolutely necessary.
Thanks for heads up on episiotomy. I wondered as they can do them at a MLU, which seems to be unable to do anything else. I'm hoping not to need one anyway.
Good luck to you too in a couple of months! I might do the same as you and request one particular midwife be kept as far away from me as she can be...

[SatsukiKusukabe]

that's awful! I can't believe they cut you with out your permission! did you complain?

[CityDweller]

No real 'interventions' are possible at a homebirth - that being one of the attractions for those of us hoping to give birth at home. So, if you need an episiotomy, any pain relief above gas & air/ diamorphine (and the latter usually only if you've procured it yourself via a prescription from gp), etc, they'll transfer you. They can stitch you up at home (up to a 2nd degree tear, I believe)

At my hospital, the homebirths are all handled by the community mw team, who tend to be a more hands-off, pro-natural birth type anyway. Every one I've met has been utterly on the same wavelength as me re. intervention, active birth, privacy, etc, and have been completely supportive of my wish for a homebirth for my first child. Whereas when I've had to go for appointments at the hospital, I've found those mws far less respectful of my wishes and plans. E.g. at my prolonged pregnancy scan this week (I'm 8 days past EDD) the midwife looked at me blankly when I said I wanted to go for expectant management and was declining the induction appointment that had already been booked for me at 41 + 6.

Good luck - I hope you get the birth you want.

[Celia1978]

During my homebirth the midwife told me she was going to give me an episiotomy, so I think they can/do do them in a home setting - no need to transfer. (I didn't have one in the end, but she'd got as far as giving me some local anaesthetic for it. Had a second degree tear instead, which was stitched up on my sofa.)

Good luck - hope your birth goes well!

[BeehavingBaby]

You can't really transfer for an episiotomy, it would be an emergency situation where you had evidence that delivery needed expediting (no less assault without consent though). Very unlikely to happen at a home birth.

[mayhew]

This is a situation where the supervisor of Midwives is very useful. They are senior mws who have a remit to help women get the birth they want. Usually in a unit, one or two of the SOMs have a special interest in homebirth. You can contact them via the unit. Sometimes there are contact details on the trust website. Otherwise a letter addressed to Supervisor of midwives (Homebirths) ℅ the unit should reach the right person. In your letter say that you want to try for another home birth but some of your experience last time is troubling you and you would like thier support to have a better outcome this time.

[mayhew]

That is care of the maternity unit.

[Ilovestackingcups]

Oh, thanks mayhew! I didn't know I could do that. Does that work everywhere? I live in a rural location, have a community MW who works out of the local surgery and answers to the MLU in the nearest large town. The general hospital which the MLU feeds into is actually in a separate PCT, so I'd perhaps need to discuss my requirements with both the MLU SOM and the general hospital SOM to be sure of getting the treatment I want.

In response to a previous poster, I didn't make a complaint. I was dealing with too much at the time (PND, redundancy, new motherhood) and couldn't face getting into a struggle with the people I'd trusted to help me. I didn't want to have to see them again.

Thanks to others for responses re episiotomy. I hope I'll just go all Stretch Armstrong this time and not need one at all. I'm happy to be at arms length from as much of this as I can be, whilst safely bringing my baby into the world. [optimist]

[LucyLight]

If you can go and talk to your midwife. The community midwives are usually really supportive of homebirths. I had my first in hospital and second at home and water birth. Had a tear first time round and nothing second time. Pretty sure it was because of the water and being more relaxed.
Some hospitals have midwives who specialise in supporting women who have had previous traumatic experiences so they have a good time next time round. Don't be frightened to talk to them as they can help. Also is it possible to have someone who can support both you and your husband. My sister was there for both my births and whilst she didn't muscle in on my husband we both appreciated her being there as an extra support person. She could also do the stroppy bit if needed as my husband could focus on me and she could focus on what was needed from the midwives. It was fortunate that we didn't really need that but it was also great to have the extra person around...

[ReallyTired]

Do you think it would be helpful to get your notes from your first birth. It may well help you to have answers on why your birth plan was ignored.

It is possible to have an episiotomy with a home birth although it is only done in extreme circumstances. (Ie to avoid a third degree tear or prehaps should distotia)

Home birth midwives are far more experienced than hospital midwives. It is likely that they would try and get you to change position rather than doing an episiotomy. Most people are more relaxed at home and everything is more loose down there when you give birth a second time.

[mayhew]

You could ask your mw who would be the best SOM to contact. The mw might be able to organise it for you. If you are saying "I want another go at HB. I want to talk through what happened before and try and make it better this time?" that's not threatening or critical of the mw and should engage her attention. However if she's a bit of a flake, however nice, it might be best to chase the SOM route yourself.

[Ilovestackingcups]

Cheers all. Seeing MW this week (unless she cancels again) so will ask then. Whatever happens, this baby's got to come out somewhere.

[squidkid]

My midwife discussed giving me an episiotomy at my home birth when baby's heart rate briefly dipped (didn't have to in the end) so I guess they can do them at home. We tried different positions, she stretched my perineum (I think?) it was fine in the end (didn't even tear).

They were very relaxed and experienced and made me feel very safe. It was a very good experience.