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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!!!

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.

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.

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.

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?

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!

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???.

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.

StarlightMcKenzie Tue 17-Sep-13 17:44:48

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.

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.

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

Message withdrawn at poster's request.

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.

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.

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.

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.

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.

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

Thanks Flora, that makes sense.

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.

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.

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.

MrsCakesPremonition Mon 16-Sep-13 20:32:48

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.

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

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

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.

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!!

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.

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.

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