Midwife, specialising in home birth, AMA

[MidwifeAMA]

Hi :)
I'm a midwife of 15 years. I've worked in all areas of midwifery but mostly in midwife led birthing units and now specialising in home birth.

AMA

What the funniest thing to have happened, but you weren’t able to laugh?

What is the most potentially serious situation you’ve faced?

So how does it work? Do you have a set list of clients and basically need your phone on 24/7 near labour? Or do you have shifts and deal with whoever is in labour at that time?

Is there anything you don’t like about homebirths?

how safe are home VBACS?

I can't think of a laugh but can't laugh scenario right now... we do a lot of laughing with women, there's lots of birth that is better done with warmth. Sometimes men drop a clanger, or get a spicy insult from their partner during birth and it can be quite funny.

I've seen quite a lot of life/death scenarios, fortunately all have come good in the end. Cord prolapses are quite hairy- where the cord drops out before the baby and it's very much an emergency where every minute counts- fortunately these are rare and it's only happened to me within a hospital. It's a very long dash up the corridor under a sheet with your fingers pushing baby's head up a bit to keep pressure off the cord all the way to theatre, and when the surgeon takes the baby up from the other end it's very strange.

We have a rota for attending births, so you might not be going to the home of someone you know necessarily. We try and make the whole team really visible so when we come to you we are all at least a bit familiar.

I don't think there's anything I don't like about home births in themselves, but we do get some births where the risks are increased and that can be quite nerve wracking.

VBACs aren't something that make me particularly nervous at home. There are increased risks, but still the absolute risk is low. Every birth is individual and the chance of problems depends on lots of factors. For example, if you're having a VBAC but have already had a vaginal birth since your Caesarian section that greatly improves the chance that all will go well. Bmi/age/previous births/reason for previous CS all give us more of an idea about success rates

Do people constantly ask you about homebirth safety, or is that reduced because you are a healthcare professional? All my children were born at home and whenever birth comes up in conversation I get a barrage of questions about safety which sometimes are borderline accusatory and it means I’m reluctant to even mention my own experiences any more.

how long do you stay after the birth? I always felt like my midwives were gone very quickly after birth, which suited me in some ways but any form of aftercare was seemingly harder to find than i have heard in others hospital birth stories.

No questions from me, but my home births were amazing, so I just wanted to say thank you.

There was something so calming about being scooped up by another woman who had seen it all before and knew exactly what to do. It was my most vulnerable but most powerful experience.

I am training to be an antenatal teacher
What would you want me to know?

What’s your least favourite bodily fluid to be confronted with?

Have you ever delivered multiples? Do children ever attend the births and how do you feel if they do?

I had two of my three at home and agree that people saw it as inherently risky and there was a very real implication that if anything went wrong then I would be blamed for it.

Having had an awful hospital birth first time round, I was so much happier and more relaxed at home, I just know the birth would have been harder elsewhere, but there was a feeling from most people I talked to that hospital is the only responsible place to have a baby.

How do you deal with that attitude?

Yes, there are lots of very deeply rooted preconceptions about home birth. Just last week a older man told me his very, very dangerous they are. It takes lots of time to change the culture around birth but we make those changes one positive birth at a time

We stay at least two hours after birth but usually the first midwife stays a bit longer to support mum to shower, pass urine, feed, etc etc and the second midwife goes as soon as everything is well.

Scooped up and nurtured in whatever way feels right for you is the goal

What would you do if you found the baby to be an undiscovered breech? My midwife wanted me to have a home birth because I would be 'her dream'. Err no thanks, so glad I said no and went to the hospital where they found baby was breech!

Flexibility is really important.
Birth is powerful and somewhat unpredictable. We only have so much sway on what happens with a big dollop of luck. Being able to roll with it, use those positive coping mechanisms etc if birth heads in an unexpected direction leads for a more positive emotional outcome.
It's really damaging for parents to feel like they've "failed" before they've really begun with parenthood.

Sputum. Google at your peril!

No, I've not had multiple births. Probably because I've mostly worked in midwife led birth environments, and multiple births generally take place on an obstetric unit/delivery suite/labour ward.

Not many children attend births. Often parents feel they relax more if older children needs are being met by a relative. Or they stay asleep in bed and wake up to a lovely new baby.

What's your opinion on home births for first babies?

I think it's best to plant little seeds of change. With a good solid evidence base.
Some people will never be convinced otherwise and it's good to know when to not waste breath!

It depends where we are in the process at discovery. Early in labour We'd recommend transferring into the hospital so we had extra support and resources.
If our first indication is we can see a pair of testicles we just support the physiology as best we can as it's unlikely we will be getting an ambulance transfer before baby is born.

Would you say homebirth is a more hand off experience for the mother? I’ve been told the midwives will want to examine me every 4 hours in hospital, is it the same at home? I’m a survivor of sexual assault and the thought of being examined every 4 hours makes my blood run cold. It usually takes me a year to build up to my smear test after it’s due.

Every planned birth will have a discussion on pros and cons, there are so many individual factors to consider.
There is a small increase in risk to baby when having first birth at home compared to in hospital, but overall that risk is still small. Risk perception and tolerance is also very individualised. What one client finds worrying, another feels very comfortable with.
There is also around a 45% chance of transfer in in labour according to national audit of home births, although this is much lower in our team.

It is routine midwifery care to offer vaginal assessment around 4 hourly. OFFER being the important but here. Nothing is ever obligatory, your body, your baby, your choice.
Sometimes vaginal examination can be really helpful for making choices and decisions, and the reason for offering should be discussed in advance. You can then decide how you feel about it.

In my case there was a leg found first. Would you just have to deal with it? Like do you know what to do? I was taken to the emergency room and had 7-8 doctors midwives etc helping each other. It was scary. A midwife who came home the next day said if it was a home birth baby could have died by the time we reached the hospital in an ambulance.