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

You've got this

Do you have more freedom to make decisions or are you subject to thr same kinda arbitrary rules , for example length of time after waters break befire administering anti biotics, and kengty if Labouring time, as the hospitals in your area?

Having had one of each I have to say i would take ny chances with a paramedic in the hospital car park before o let my local.maternity unit touch me or my baby if I ever had another. I've never felt so abandoned and uncared for. The home birth was amazing. Was a few years ago now though so maybe much has changed

how fascinating!

1. did you have home births yourself?
2. what is the biggest factor for an ‘unsuccessful’ homebirth?
3. has anyone ever refused to go to hospital?

By factor i mean ‘risk factor’ if you see what I mean

Do you get frustrated by the attitudes coming down from consultants/hospital and how do you support women to assess the information (pressure)?

I had a textbook HB, then EmCS (footling breech & v early labour, all discovered at a routine 39+6 appointment), then finally a HVBAC. I was summoned to appointments with consultants and senior midwives re the HVBAC, to have risks quoted at me, scary scenarios described and more. I'm stubborn and happy to do my own research, but I imagine many people would have been terrified (bullied) into changing their mind.

I was close to a home birth with my second and chose to go into hospital as I thought I'd get more of a rest there! I did however go back to the hospital and gave some cards and gift vouchers to give to the midwives who delivered my daughter, do these actually get received I always wondered as you never hear back obviously!

We have the same guidelines as the local unit. However guidelines are just that, they aren't law. Usually they are based on good evidence, but again it all comes down to risk and perception of risk.
A 1 in 100 risk of it happening is also a 99% chance it doesn't, very much down to the significance you put on the risk v the benefit as a decision maker.

We discuss the BRAIN
BENEFIT what's the benefits of this
RISK what the risks of this
ALTERNATIVES are there any alternatives
INSTINCT what does my gut tell me
NOTHING what if we do nothing

And we go from there..

@MidwifeAMA yep it's frustrating. I had the record for the most amount of births over the phone (64 I think)
The scariest was a 26 week baby and she didn't know she was pregnant

Sorry last question, what’s the ‘highest risk’ homebirth you’ve attended and did it go ok?

Also, thank you for doing what you do. My home births were positive empowering experiences. Unfortunately my hospital birth experience was horrid, post-natally especially.

Would you choose to have your own children at home or in hospital?

I've had terrible experiences with midwife's and as an ex medic myself I'm wondering whether the training is similar, in that it's largely taught from a medical model perspective.

What are your thoughts on current training programmes? Do you think theyre fit for purpose? How much of a shortage do you think actually contributes to the countless cases of mishandling of births and even deaths?

I didn't. I booked a home birth with my oldest but then things changed which made it less safe and I decided to birth in the hospital.
I had higher chance of bleeding heavily with my second, I decided to birth in the midwife led unit as I preferred not to birth on the obstetric unit but closer if needed additional help/drugs etc.

The biggest factor is probably whether you've given birth vaginally before. First vaginal births are more likely to transfer in- national audit says about 45% go in. Often this is when labour has slowed, or further analgesia is required.

I've personally never had anyone refuse to go in during labour.
I have had women who have said if there's no staff to attend they will freebirth. If the team is already at a homebirth we can't be in two places at once. Everyone is told of the limitations when we book them.

Thank you for this thread, it's lovely to hear all the home birth positivity.

My first 3 were quick home births (4h, 90mins, 2hrs), mw arriving about 10-20 mins before each birth, no issues, tearing etc. but my fastest was scarily intense and so fast I was shaking and shocky afterwards.

I'm now expecting #4 and have been told there is no home birth provision available to me. Nearest hospital is 45 mins away and I'm terrified. Two matrons (from the nearest 2 hospitals) have both said not to risk travel (travel would be via motorway which is temperamental with road works or country lanes with tractors etc a problem). They said I need to call 999 and birth with the ambulance crew in attendance, parked on the drive.

I feel a bit abandoned and it's been quite emotional over the whole thing. They've now found me a mw that lives locally and will try to attend if she can (on her own time which I think is wrong).

But now I feel completely despondent about appointments, I can't see the point in them at all, nothing seems to happen in them except the making of yet more appointments (that I have to travel 30 mins to get to) and I now feel that I have to mentally prepare myself to freebirth, which I don't really want to do. I also have no faith that if I did need a cs or any hospital care that a maternity provision would be safe there either.

My question is, how do I prepare effectively for freebirth? Are appointments really necessary? Because I just find them really stressful. And how can I rebuild my confidence in a mw/NHS care/maternity service?

Doctors, like midwives, are a mixed bag.
Some are very supportive of home birth and some less so.
They have a very different background from
Midwives, we have a duty of care so we have to attend a women in labour whatever the circumstances (unless already busy with another) whereas doctors don't have that obligation.
There are extreme ends of the spectrum on both sides. Doctors who scare monger women with biased approach. But also freebirth/anti establishment groups which paint maternity services/staff as terrible runners of birth who can't be trusted. I find it really challenging when women have read so much online that they just close the door to anything you say. Occasionally they want you to sit downstairs just in case it all goes wrong but not let you give any care, that's the worst.

Yes they do get received and they make everyone really happy. We love love love a card

Do you come across hostility from hospital staff. I once over heard 2 colleagues discussing home births in an extremely negative way as if they all ended in disaster that required hospital transfers.

In fact it was that experience, over hearing in hospital that pushed my final decision for dd1 to be a home birth. I felt they would care more abounding proven right than they would about me and the baby.

Ironic given 4 years later witg dd2 where I was ignored for hours despite being high risk. Left in wet sheets and stuff missed signs of a possible placental abruption ( thankfully only patial) despite me telling them about the blood bours before.

I've been to very straightforward vbacs.
I've had shoulder dystocia and haemorrhages and baby resus but all unexpected rather than high risk at onset. All of the above did well.
We have some very high risk births booked at the moment, there's a definite shift in who is booking homebirths nationally.

Wowser! I've done a few over the phone, there's nothing better than hearing the words "oh I can see the ambulance"

I would choose home if everything was straightforward. I would choose hospital if there were complications or likely to need additional support/equipment. I would choose a midwife birth unit over an obstetric unit unless I was very high risk.

I think maternity care as a whole across the globe has become more medicalised over the last few decades. We live in a litigious society, we are less risk tolerant, we expect good outcomes always.
Midwifery training has a solid focus on physiology but the liver experience is that the majority of births take place in an obstetric unit so high risk, medically managed birth is becoming the norm.
Everything is about balance.
Too little too late and too much too soon are equally problematic to me.

Staff shortages is our biggest safety issue by miles. Chronically underfunded by a Tory government. Midwifery staffing crisis totally ignored despite knowing we had an aging retiring midwife population.

Please go to your midwife appointments. It might seem trivial but bp checks and urine dips save lives.
Do you have another hospital you could consider?
Another option you could consider would be planned induction of labour. Of course it has pros and cons but if your biggest fear is rapid unattended birth then it may be an option to look into.

Yep. There's always a couple.
The best way to address I think it is to give excellent care, have brilliant outcomes and flaunt your statistics.

Do you privately think women who ask for pain relief / need intervention have failed in some way? Or put another way, do you have more respect for women who manage to be completely intervention free? Do you think there are mental health impacts caused by the pressure to be totally natural?