Can you insist on an attended homebirth?

[Aubergines]

I have a close friend who has been told she cannot have a home birth due to complications when she had DC1. She is very upset.

I want to tell her she can insist on midwives attending her at home - am I right in thinking that? If so how does she go about it? Her consultant is pretty scary.

[theyoungvisiter]

I'm not an expert but AFAIK if you call from home and say you are in labour they HAVE to send somebody. But that might be a paramedic, not a midwife.

There is a lot of info on this site homebirth.org.uk

Having said that, I think a HB with unsupportive midwives would be pretty hellish, she might do better to speak to the head of midwifery and ask for his/her take on the situation.

Failing that perhaps an independent midwife would be an option? But (IMO) it needs to be someone who's happy that it's safe for her to labour at home, not only for practical reasons, but also for her peace of mind and so that IF they do make the decision that she needs to transfer, she's happy to trust that decision.

If she's at home with someone who's been against the idea from the outset and they say "this is an emergency, you need to transfer", how will she know whether to trust their judgement or not?

[Aubergines]

Good points.

An independent midwife is a great idea.

She transferred last time so I think she would be prepared to do so again.

Part of the problem is she really wants to labour in water and her hospital does not have any pools.

[theyoungvisiter]

is it rude to ask what the complications were? Only because you might get good specific advise about questions your friend could ask her consultant/head of midwifery.

Lulumama is brilliant at advising on that sort of thing.

[theyoungvisiter]

specific advice - one of my pet hates in spelling mistakes, I should know better!

[reikizen]

I would suggest it really depends on what the complications were last time, and how this pregnancy progresses. An independent midwife is a great idea if you have the money.
I am not sure if having someone attend you at home who does not wish to be there (for whatever reason) is a very good idea as it will defeat many of the lovely positive things about being at home. Much better to try to foster a positive relationship, perhaps by gathering appropriate evidence and having a meeting with a supervisor of midwives or your consultant midwife if you have one.

[Tangle]

IIRC theyoungvisitor has it pretty well right - you can insist you're staying at home and, once they know, the MWs has a duty of care to look after a woman in labour. But that care doesn't have to be provided in the form of a MW (although it usually is).

I'd definitely 2nd the IM option if she can afford it (and its always worth talking to them as they can be very flexible with payment plans and bartering) - DD was born as a breech baby at home with IMs and it made such a difference feeling totally confident in what the MWs were doing. It is important to talk to a few and make sure you're on the same wave length, though - no one gets on with everyone, afterall!

Its also worth remembering that your friend doesn't have to see the consultant if she doesn't want to - it may be policy within her PCT for her to be under consultant led care after the complications she experienced last time, but as she's not their employee she's not bound to abide by it.

If she wants to stay within the NHS then I'd recommend discussing what her HCP's are concerned about, what the risks of that happening are and how it would be handled differently at home vs in hospital. Once she understands all of those she's in a much stronger position to write to the head of midwifery stating that she's aware of these issues and, assuming no further risk factors arise, she is making an educated decision to birth at home and expects to be supported in that choice. Or she may choose to go to hospital aferall - but if she doesn't understand why they're saying she "can't" have a HB its difficult to argue her case (and IMs may well give her a generic response on an initial inquiry, so another useful source of info).

In addition to the website linked to by TYV, both the homebirthUK mailgroup and AIMS are usually very informative and supportive, with a lot of experience in dealing with obstructive protocol.

Hope your friend has an easy pregnancy and a more straighforward birth this time round