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

[Amber17]

What do you recommend for the space people choose to give birth in at home? Do people usually end up rearranging the furniture to clear space for a pool etc? What about pets - I can’t see that cats and an inflatable pool are a great combination 😂

With the 45% transfer rate, do you find that you can predict who is more likely to transfer in or is it quite random?

[MidwifeAMA]

Absolutely.
It's only in the last decade or so that we have swerved massively away from it. It carries more risks than a head first birth for sure, but they can vary between individuals. If you given birth before, baby is a normal size and in a good position that's much more likely to be straight forward than if you're having a first baby who is 4.2kg and it's feet are first.
I'd recommend being in a hospital as breech births are much more likely to need additional support and equipment.

[MidwifeAMA]

@Amber17

What do you recommend for the space people choose to give birth in at home? Do people usually end up rearranging the furniture to clear space for a pool etc? What about pets - I can’t see that cats and an inflatable pool are a great combination 😂

With the 45% transfer rate, do you find that you can predict who is more likely to transfer in or is it quite random?

Space wise, it's usually living room/dining room or bedroom as these are often the bigger rooms.
Space around a pool is important in case you need to hop out.
We come to your house to look at the space and risk assess. You absolutely don't need a big house or a big space. We might suggest saying downstairs if your bedroom is on the third floor with a circular staircase for example.

[MarinaBu]

Thank you MidwifeAMA! I am currently pregnant and looking for a private midwife in London, and it looks like there are not that many and lots of them are already booked 8 months in advance! Is being a private midwife not very popular or is there just a nationwide widowed shortage??

[MarinaBu]

Nationwide midwife shortage* rather

[MidwifeAMA]

@Amber17

What do you recommend for the space people choose to give birth in at home? Do people usually end up rearranging the furniture to clear space for a pool etc? What about pets - I can’t see that cats and an inflatable pool are a great combination 😂

With the 45% transfer rate, do you find that you can predict who is more likely to transfer in or is it quite random?

Pets normally not too much bother.
Has caught a cat licking a placenta in a bathroom though once
We had a pair of tortoises who stood at the front of the tank watching the whole thing too.

Transfer in, much more common with first births, and for a variety of reasons. Usually not urgent- with first births it's usually that things fizzle out and progress stops, sometimes for further pain relief as we have limited supplies.
Sometimes we transfer in at speed for bleeding/changes to babies heart rate etc.

[MidwifeAMA]

@MarinaBu

Thank you MidwifeAMA! I am currently pregnant and looking for a private midwife in London, and it looks like there are not that many and lots of them are already booked 8 months in advance! Is being a private midwife not very popular or is there just a nationwide widowed shortage??

There aren't many private midwives, there was quite a lot of difficulty over insurance a couple of years back and without adequate insurance they can't practice.

[MidwifeAMA]

And you run the risk of being sued and losing your home, so some private midwives used to put their homes in their partners names, but that's a really vulnerable place to be

[heartbroken22]

What's the easiest position to give birth in?

My first baby I was on my back and it hurt. 2nd I was on my knees and it hurt much more (not sure if it was because she was breech) but then when they took me to the theatre room I was on my back again and didn't feel as much pain so I'm confused.

[sleighbellsjiggling]

No questions but I wanted to say thank you to you and your colleagues. My DS was born very quickly and unexpectedly at home and it wasn't until the home midwife arrived (after the birth) that I could relax. The fear was awful but the calmness of the midwives was awesome once they arrived and checked us over.

Also the shoelace bit made me laugh. My OH was taking a lace out of his shoe with me watching on like 😳. He just yelled, "999 told me to!!!"

[SurpriseSurprise]

Have you ever had to deal with babies dying during labour? As a mum to be that’s my worst fear

[MidwifeAMA]

@heartbroken22

What's the easiest position to give birth in?

My first baby I was on my back and it hurt. 2nd I was on my knees and it hurt much more (not sure if it was because she was breech) but then when they took me to the theatre room I was on my back again and didn't feel as much pain so I'm confused.

Best to go with your instincts on where you feel most comfortable, but generally your pelvis is a u bend- if you lay on your back you are effectively pushing your baby up hill. You also close the diameters of the pelvis as your sacrum and coccyx can't move back and make space.

Stand up tall, put a finger on your pubic bone and a finger on your coccyx, then push your bum out like a twerk position. That shallow squat type position will make those two points the most far away. It's the same position you are in on the loo, but also when you see women on tv pulling their knees up- but without the benefit of your coccyx moving back or gravity.

So generally if left to it most will go all fours, if your unstable because of epidural or exhaustion then laying on your side works well

[elliejjtiny]

I had a homebirth for my eldest 16 years ago and then a transfer to hospital in early labour with my 2nd. Straight forward birth in hospital with my 3rd, elective c-section with my 4th and attempted induction turned emergency c-section with my 5th so I've done it all!

I've seen a lot on the news and social media about people waiting for hours for an ambulance these days and I'm curious about how this affects women having homebirths now. Does it make you nervous? I don't think I would attempt a homebirth now knowing that I couldn't rely on an ambulance getting me to hospital in an emergency.

Also if a woman with a high risk pregnancy wanted to give birth at home (with you caring for her) would you think that was great or would you be scared of something going wrong. I sometimes hear of women having VBA2C at home and think that must be very nerve wracking for the midwife.

What is your opinion of freebirthing? It sounds lovely when it goes right but extremely risky and definitely not something I would ever have considered.

[MidwifeAMA]

@sleighbellsjiggling

No questions but I wanted to say thank you to you and your colleagues. My DS was born very quickly and unexpectedly at home and it wasn't until the home midwife arrived (after the birth) that I could relax. The fear was awful but the calmness of the midwives was awesome once they arrived and checked us over.

Also the shoelace bit made me laugh. My OH was taking a lace out of his shoe with me watching on like 😳. He just yelled, "999 told me to!!!"

Bless you, it's scary when it all happens so fast. Glad you felt safe with your midwives.
The bloody shoelaces! Haha we keep telling them but they don't change it

[MidwifeAMA]

@SurpriseSurprise

Have you ever had to deal with babies dying during labour? As a mum to be that’s my worst fear

It's really rare for a baby to die during birth in the uk. We are listening to them and in the first whiff of trouble we are taking action. We have so many safety nets to keep babies safe.

[MidwifeAMA]

@elliejjtiny

I had a homebirth for my eldest 16 years ago and then a transfer to hospital in early labour with my 2nd. Straight forward birth in hospital with my 3rd, elective c-section with my 4th and attempted induction turned emergency c-section with my 5th so I've done it all!

I've seen a lot on the news and social media about people waiting for hours for an ambulance these days and I'm curious about how this affects women having homebirths now. Does it make you nervous? I don't think I would attempt a homebirth now knowing that I couldn't rely on an ambulance getting me to hospital in an emergency.

Also if a woman with a high risk pregnancy wanted to give birth at home (with you caring for her) would you think that was great or would you be scared of something going wrong. I sometimes hear of women having VBA2C at home and think that must be very nerve wracking for the midwife.

What is your opinion of freebirthing? It sounds lovely when it goes right but extremely risky and definitely not something I would ever have considered.

Ambulance availability can vary between areas quite a lot. In an emergency ours are very good and send us paramedic ambulances at top priority. You may wait longer for a non urgent transfer in, but if mother and baby are well this seems reasonable.

'High risk' homebirths are a mixed bag really. It doesn't take a lot to be classified as high risk, but sometimes it's a very marginal increase in risk and I feel comfortable with it.
Sometimes women choose very high risk homebirths that I would never choose for my baby in a million years, but there's the crux of it-it's not my baby and women can choose whatever feels right for them.
I do worry about the trauma to midwives, watching something tragic unfold, with minimal support, in an entirely predictable scenario is very very difficult. We don't get to choose to opt out, we have a duty of care, but we are still humans.

[MidwifeAMA]

@elliejjtiny

I had a homebirth for my eldest 16 years ago and then a transfer to hospital in early labour with my 2nd. Straight forward birth in hospital with my 3rd, elective c-section with my 4th and attempted induction turned emergency c-section with my 5th so I've done it all!

I've seen a lot on the news and social media about people waiting for hours for an ambulance these days and I'm curious about how this affects women having homebirths now. Does it make you nervous? I don't think I would attempt a homebirth now knowing that I couldn't rely on an ambulance getting me to hospital in an emergency.

Also if a woman with a high risk pregnancy wanted to give birth at home (with you caring for her) would you think that was great or would you be scared of something going wrong. I sometimes hear of women having VBA2C at home and think that must be very nerve wracking for the midwife.

What is your opinion of freebirthing? It sounds lovely when it goes right but extremely risky and definitely not something I would ever have considered.

Free birthing makes me sad.
Sad about the risks to mum and baby and family, as birth is natural and powerful and with that comes unpredictability. Things which a skilled midwifery presence will 100% save mothers and babies lives at times.
But also sad that those who make that decision are often there because of previous trauma caused by birthing in a system which is not always woman focused.

[Luckystar1]

I’m due baby #4 next month. I have had 3 very straightforward labours and I’m hoping to have this baby at home.

But, I’m a lot more anxious this pregnancy. My DH says he thinks it mostly stems from the fact it was a massive surprise and I wasn’t particularly happy to find out I was pregnant. Having previously had 4 miscarriages, that initial feeling of being very upset was hard for me to process!

I’m now also worried that this anxiety is some sort of premonition and that the homebirth is a bad idea (even though I’ve always wanted one and always gelt
it would be a very good and acceptable option for me!)

Can you recommend any reading for me to do to try and allleviate my worries please?

My overwhelming concern is the baby having difficulties immediately post birth and there being no equipment available to deal with that…!


(It hasn’t helped that I’ve watched some very old One Born eventually minute recently and it scared the shit out of me!)

Thanks so much!

[LadyGardenersQuestionTime]

How do you feel about suturing tears?

I had a truly fabulous home birth 29 years ago, but DD was a chunky thing, a short fat 10lber delivered in three contractions, and I had a substantial tear. I’m about to get my vag assessed by a pelvic physio as I’ve never been convinced it healed terribly well (I’m searching the attic for my notes now!).

If a mum tears badly do you suture or do you refer for repair? What are the criteria?

[MidwifeAMA]

@Luckystar1

I’m due baby #4 next month. I have had 3 very straightforward labours and I’m hoping to have this baby at home.

But, I’m a lot more anxious this pregnancy. My DH says he thinks it mostly stems from the fact it was a massive surprise and I wasn’t particularly happy to find out I was pregnant. Having previously had 4 miscarriages, that initial feeling of being very upset was hard for me to process!

I’m now also worried that this anxiety is some sort of premonition and that the homebirth is a bad idea (even though I’ve always wanted one and always gelt
it would be a very good and acceptable option for me!)

Can you recommend any reading for me to do to try and allleviate my worries please?

My overwhelming concern is the baby having difficulties immediately post birth and there being no equipment available to deal with that…!


(It hasn’t helped that I’ve watched some very old One Born eventually minute recently and it scared the shit out of me!)

Thanks so much!

Babies needing resus at birth is rare and almost all of those babies at home following a low risk birth who need resus will need a small amount that the midwives are very experienced at giving effectively.

Try to surround yourself with positive birth, don't let people tell you their horrible stories, don't watch obem. I'd recommend some Hypnobirthing, do a full proper face to face course if you can, I think you'll find it so helpful.

See how you feel at the start of labour, keep open minded as to where you want to be, and stay home or go in by what your gut tells you.

[MidwifeAMA]

@LadyGardenersQuestionTime

How do you feel about suturing tears?

I had a truly fabulous home birth 29 years ago, but DD was a chunky thing, a short fat 10lber delivered in three contractions, and I had a substantial tear. I’m about to get my vag assessed by a pelvic physio as I’ve never been convinced it healed terribly well (I’m searching the attic for my notes now!).

If a mum tears badly do you suture or do you refer for repair? What are the criteria?

We grade tears according to which bits of anatomy are involved. 1st degree usually will heal naturally, maybe a couple of sutures to align. 2nd degree heals better with sutures. Midwives are confident doing this as we do it a lot. 3rd/4th degree tears involve the muscles around your bum and need to be stitched in theatre by a doctor.

[MidwifeAMA]

We are about a million times better at assessing and repairing than we were 30 years ago and I suspect some 3rd degree tears were missed and not repaired as well as they should be, leaving women with lasting issues.

[PeloAddict]

@MidwifeAMA if it helps the 999 script is an American system technically and unless the academy approve it, it can't be changed
So call handlers have to keep reading it or they affect their audits which can lead to being dismissed

[Luckystar1]

Thank you so much! You are right, I have always gone with my gut and I will do the same this time. Thank you for the reassurance.

[MidwifeAMA]

@PeloAddict

@MidwifeAMA if it helps the 999 script is an American system technically and unless the academy approve it, it can't be changed
So call handlers have to keep reading it or they affect their audits which can lead to being dismissed

Yes, I sympathise with the handlers. We've tried to escalate and had this response.
Worrying that the USA genuinely think a cord is just a pipe and all the blood might fall out of the baby