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

We would just follow all our training. We are updated every year on breech birth and do practical simulations. Most midwives have very limited experience of actual breech vaginal birth as it been uncommon over the last decade. It's preferable to be in a hospital environment as there are more pairs of hands, more equipment should it be needed etc, but saying that there are also many breech babies who are born very easily, we just don't have the crystal ball to know who might need that extra help.

Thank you MidwifeAMA. The midwife that was gone 20 minutes after birth was a fast one then. She was the sole midwife at that birth too. None of mine have stayed as long as two hours - maybe it’s because they were a few/several years ago now.

GodspeedJune - they can offer intimate/internal examinations if they want to but you do not have to consent if you do not want to. I’ve never had an intimate/internal examination and I’ve had three children and several pregnancies. Please do not worry

Our trust rule is that we don't leave until at least two hours after birth. In reality it's usually more like four hours by the time everyone is settled, paperwork is done, toast is eaten.

What pain relief is available at home?
Have you ever turned a breech baby before delivery?
Do you clean up afterwards?

I don't have a question but I'm placemarking. I had a wonderful home birth with my third baby, one of the best experiences of my life, so I'm really interested in this thread.

Pain relief/comfort measures in our area includes things parents source like pools/tens/paracetamol/aromatherapy etc
In terms of drugs, we carry entonox ( gas and air, not a huge supply), and you can ask the gp to prescribe pethidine although it rarely is requested. Generally homebirthers use less analgesia than average. It's not very common to transfer in for epidural but is always an option.

If a baby is breech at 36 weeks you are offered a chat about options, one of which is ECV where baby is (if successful) manually turned to a head down position. This takes place at the hospital as requires doctors/scan machines etc

We are really careful with mess, usually there's no sign of birth except in the laundry basket

@MidwifeAMA thank you for being honest and bless your heart x

1. how many time have you had waters breaking on you? My mums did and she was lucky her midwife started laughing.

2. how do you stay strong when you see your patient in pain especially those like me who cry and scream during childbirth?

3. have you watched call the midwife? 😂

Do women who have high blood pressure during pregnancy have to have a c section?

Thank you for sharing your experiences and perspectives. Your narrative on risk and evidence is clear and helpful.

What could someone do to prepare for an accidental home birth without any support. How would you deliver the baby yourself? I am very much not planning on doing this but after my last birth this is one of my fears.

Thank you OP and also @HorribleHerstory for your reassuring message.

I am 39 and considering studying to be a midwife. It's 4 years total with an access course before the degree. I would love to specialise in home birth as you do.

1 - have I missed the boat? I feel very conflicted that I am just too old to be starting a new career and will struggle with the energy needed to get into the swing of things.

2 - any tips on how to direct a midwifery career into specialising in homebirth.

3 - if you have children, how do you find juggling childcare with your shift pattern.

Thank you - keep up the good work x

You learn very early on to not be in the wrong place at the wrong time! It only takes one time as a student midwife to be peering a bit too intently at someone's bits when their waters break and bounce off your chin!!

Generally I don't care for lots of women who cry and scream. Screaming is usually a fear response, women who feel safe and supported don't really scream, they moo. Lots of tlc and talking about and unpicking the fear often helps. And then whatever meets the woman's needs, which might be mobilising and not feeling trapped on a bed or it might be an epidural and a sleep.

I love call the midwife!

No, generally not.
We treat the bp with medication in pregnancy. It may be that we suggest bringing the birth forwards if the bp is hard to control, but usually this would be by offering induction of labour if you're planning a vaginal birth.
Very occasionally if the high bp is due to severe pre eclampsia a CS is the safest option to get baby here asap so we can stabilise the mother, but it's uncommon.

Thanks. Negotiating and discussing risk is really high on my work agenda at the moment as we have an increasing number of women who choose birth at home which is 'outside criteria', we spend a lot of time looking at absolute and relative risk and what that particular chance event looks like in your living room.
It's a challenging balance sometimes, to give unbiased information in a supportive way. Sometimes women have a lot of external influence to choose something which has really significant risks at home, and as a midwife we need to discuss the practicalities of what that may actually mean without pushing the woman away from our care so they freebirth.

Call up early and advise them that you birth fast.
Lots of women have a really fast second birth but generally the third is much less fast so if it's baby number three you probably have more time to be wherever you want to be.

In terms of birthing without a midwife, if it's all suddenly happening call your midwife, then make the room warm, get some towels and focus on breathing. The midwife will talk your supporter through on the phone so they know what to do. Laying on your side is quite useful as it supports physiology but without too much gravity to need to 'catch' a slippery baby and is protective against tearing if you don't have a midwife watching the area.
Whatever you do, don't be on the toilet- remember it always feels like you need a poo. It's not a poo!
And when baby is born, skin to skin, keep them warm and leave the cord alone.
The 999 workers have a script which advises tying off cords with a shoe lace, don't do this it's bonkers.

You have years of career left, crack on with it now, you'll never have more time than you do right now!

You need lots of experience before you come out to homebirth so train and see how you go. You don't know where you will find your passion yet. You usually get an elective placement at the end of your training, try to go to a really successful homebirth team.

Childcare is tricky, I don't know how people manage without a flexible partner/family support but they do. Most of us work either 7-7:30 or 8-6:30 so you might have to look at childminder etc

I have a horrendously long early labour and baby was back to back. Ended in a c section as after a week I couldn’t manage any more.

do second babies tend to have a shorter early labour? How do you deal with back to back babies?

also have you had women with vaginismus?

Does an anterior/posterior placenta make much difference?

Your body seems to be able to do bits it's done before much more quickly and easily.so if you've laboured to 10cm then had a CS you'll often find the opening up stage goes very quick but the second stage when your baby comes down and out takes 1-2hrs like a first time birth.
If your cervix hasn't opened before then it will be more like a first time pattern of labour.
It's really uncommon for a second time birther to get stuck in a long latent phase, particularly if we can figure out a reason and correct it next time. So if your baby was in a poor position, back to back or on the wonk, but this time it's well positioned it's more likely things will progress.

I think the key to supporting someone with vaginismus is safe/supportive/consenting/patience, lots of discussion, lots of preparation.

Generally not much.
Anterior placentas can sometimes mean baby's movements are less obvious at times. If it's too low and anterior it can be tricky for CS but it's pretty unusual to be an issue.

So can you actually deliver a breech baby vaginally"