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

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Thank you for this thread. I'm pregnant with baby number 2. No risks and as with first time on the fence about whether I would feel more comfortable with a home or hospital birth. On the one hand I love the idea of my 4 year old being asleep in bed and

@MidwifeAMA they didn't check either until 28 weeks. And these are things I could easily check at home, not that I've ever had an issue.

We live on the edge of 3 different hospital trusts and that seems to be causing a problem. I won't be prematurely evicting the baby without a good reason. I'll just have to get my head around the ambulance plan.

It seems quite clear the tories have completely destroyed the NHS and services are stretched beyond what is safe.

... posted too early... waking to a baby, plus the emotional positives of being at home, not worrying about when to do the 40 minutes drive to the closest maternity unit. And my dog being around, though he'll likely leave the room.
On the other hand, I had a good epidural experience, and I would want emergency care on hand. Also, first birth was just shy of 37 weeks. How early gestation would you attend a home birth?
I'm 23 weeks pregnant, what should I ask at my 25 week appointment to help me decide?

I think over emphasis on 'normality' is problematic in many ways. Balance always.

I don't judge women for their pain relief choices, none of my business. Everyone's experience is different, we don't know what trauma has come before, there are definitely labours that are more painful than others with luck residing over some of it.

Pain relief is amazing when we need it, everyone's experience of labour is different.
I had a long complex first labour and had an epidural. My second was quick and straight forward with no pain relief. The second one was much much more painful but a much better experience for me. It's all about what you hope to achieve. If your goal is no drugs we can work towards that, if your goal is as little pain as possible we can work towards that.

There are mental health impacts by any scenario where you leave feeling you have failed. That's why flexibility is good in childbirth.

If baby is before 37 weeks we recommend hospital birth so baby can be monitoring more closely in labour and afterwards.

All areas have a different homebirth set up, it's worth getting familiar with what yours offers. Is it well staffed? Are the midwives experienced in home birth? How long does it take to get to hospital from your house? Do you have a designated team or do you have to hope a community midwife is available?

Bp and urine checking starting from 28 weeks was common in covid times but we are working away from it. It's unusual to have issues such a preeclampsia prior to 28 weeks so while it's not ideal we've not seen any adverse incidents due to it at our hospital. They will also be checking growth of baby etc.

Have you contacted the other hospitals? You can choose to book with whatever hospital- but worth looking to see if anyone else would come to your address for hb. Also, escalate it up if you've not already. We send out midwives if anyone is about to 'BBA' ie baby is coming super fast and you need someone asap, it's odd to me that this is not something that happens fairly often and they have a plan for. Maybe go further up the management chain for a plan. Find the details if your hospital PALS service

I have had 2 babies, born vaginally and in both cases I wanted a midwife centre birth but was sent to hospital as my blood pressure went up in labour (it wasn't pre-eclampsia).

My experience with my first was horrible, I was on a drip (syntoconin?) to speed things up because she was in no hurry and it was horribly painful despite pethidine, I was on the verge of getting an epidural when they told me it was too late because I was fully dilated.

My second I had a lovely midwife in the hospital who wanted to intervene as little as possible and my daughter came in her own time on only gas and air.

My question is why does high BP in labour cause such alarm when my second was born under those circumstances with no difficulty? I feel like I was 'interfered with' for no reason for my first, rightly or wrongly.

This was 12 and 14 years ago now btw but I haven't forgotten it!

When blood pressure gets very high you become at risk of, amongst other things, brain haemorrhage caused by the pressure of your blood, and of the pressure separating the placenta off the wall of your uterus (placental abruption) both of which are life threatening. We take blood pressure very seriously because the outcomes can be really tragic.

Sorry last question this thread is extremely interesting and you have been answering alot of questions I've neen wondering for years after trying to work out why the experiences were so different.

Do you think that skills kinda " dull" for want of a better word working in a hospital setting vs attending home births.

In hospital they seemed to forget you existed as a person..you were a.print out on a monitor. Something that can just be ignored unless they press a button. The file of notes seemed irrelevant. Like what's the point if them if no one reads them and none of the staff arw aware of what's in them. You had to explain everything all the time to everyone.

At home the midwives didn't have the machines to do their job. They had theit knowledge of me.my words. My explanations of what i was feeling. Their stethoscopes and their hands and eyes.

Despite the lack of technology they were just so much better. Why is that when the training must he the same

It's all about what you get experienced in day in day out.
Delivery suite midwives often work in extremely high pressure environments, usually with not enough staff, unachievable time pressures, not enough rest or support. Things are really bad at the moment due to covid sickness and burnout.
I think there are still lots of really passionate hospital based midwives giving amazing care, I see them daily and they are incredible.
But then there are some who are fried. They are junior and feel frightened at lack of support, they know there's another woman in another room waiting for them too so they do their tasks as quickly as possible and become task focused rather than woman focused. Or they have a teething toddler who's been up half the night, and they come to a 13 hour shift where they know they won't get a lunch break again, and will have to exist on custard creams until they get home to their grumpy toddler and another night of it. Or they are jaded from trying to give excellence in a struggling system and they've gone down the self preservation route, I will do the best I can but I can't emotionally invest in this labour or my heart breaks again in the car park home and I leave feeling like a terrible failure.
Have a look at the "March with midwives" Facebook groups and help action change- midwives working conditions are womens birthing conditions.

Thank you so much. I hope I do get to the hospital but it is good to know what to do if I don’t.

I won’t be tying the umbilical cord with a shoelace. That is bonkers and very unhygienic.

Thank you. I asked because my latest grandchild was breech and arrived the day before the planned c-section. Everything happened so fast and when I was taking my daughter to hospital I was scared because of how fast the labor was going. When she was wheeled into theatre about 45 minutes later she was fully dilated but i was so scared in the time leading up to that in the prep room place and was thinking god almighty, what’s going to happen next. She was scared as well and I was able to hide I was also scared but to be frank having been at the births of all 8 of my grandchildren, including another two that also last two hours from start to finish, I honestly could have cried with fear for her and the baby.

Sorry - I’m glad it would have been okay and it wasn’t her first baby.

@JellyBellyNelly I know what you mean my Angel was breech and I though she would be born dead because I came to the hospital pushing, midwife finding out she's breech being shifted to the emergency room with the alarms going off and then giving birth vaginally. God bless the doctors and midwife's who helped that day x

Don't be daft.

Thank you @MidwifeAMA for the reply. I initially spoke to PALS but it was all so demoralising I've lost the will and energy to push for anything better. They can't just magic be a mw, apparently the hb team has gone from 8 to 2 so they closed it and that's that.

Maternity care has changed massively since I had my first baby 10 years ago it's quite frightening for me and for the FTMs they just don't know any different.

Another thing I've noticed is the hospital refers only to 'pregnant people' now, how to do feel about the removal of gendered language from maternity care?

I'm 100% against removal of the word woman.
I'm happy with the addition of 'and birthing people' but think we need to be incredibly cautious about how we handle gender, sex and maternity care in the next few years.

You mentioned you’d prefer hospital only if likely to need additional support - but it seems 50:50 though? Like, even when it’s a low risk birth, 45% still end up transferring to hospital - so how do we ever know who is ‘likely’ to need additional support?

I’m pregnant with my first, and just can’t even contemplate a vaginal birth. I can’t understand how the statistics could possibly be interpreted to suggest a vaginal birth is a good idea - let alone a home birth.
19% turn into EMCS
14% require forceps/ventouse. Together with EMCS these have terrible mental health and physical trauma outcomes
20% born back to back
50% of women don’t get the pin relief they asked for in their birth plan
90% of women tear (55% are second degree, and 11% third and fourth degree!)

I’m ‘low risk’, but even the lowest risk birth seems to have a 50:50 chance of it all going wrong.

In your experience, does being tiny, having very narrow hips, make a difference?

I’m a size 6, and my hips are tiny, like a 9-year old boy! My Mum, Gran and one of my friends had the same build, and all had the most horrific births.

Interesting stats, I wouldn't say these all line up with my experience.
But it's a really good example of perception of risk being a very personal thing, and about what value you place on each of these things. Your definition of "all goes wrong" is different to mine I think.
For example, not getting the pain relief asked for in birth plan? Birth plans are fluid- we need to look at what women ask for in labour as that's more key to a positive experience.
And back to back babies, not in itself an issue. Can extend labour for some but also many of them born very easily.

But these are your important values and your perception of risk says you aren't comfortable with these, so that's how you make your decisions and plans. Horses for courses.

Generally babies are like goldfish and they grow to the size of the tank. There are many countries where women are small and their babies are correspondingly small. Obstetricians used to measure pelvic sizes and feet sizes etc but it's not at all useful. Most likely your body will grow a baby that fits.

When I said I'd plan a hospital birth if likely to need additional support, for me that means if there's a clear risk at the onset of labour which would be better managed in a hospital- so for me personally things like breech/preterm/placenta praevia/etc the safety outcomes of home birth if me and baby are generally healthy and well having a straightforward pregnancy and anticipated birth are comfortable and acceptable to me. We are all different

I have a friend who is way smaller and slimmer than me yet always boasts that she didn't tear in any of her pregnancies. I know it's because she's had very small babies (2.7kg or under)...but please tell me it's because she has a bigger vagina than me!! 😂 I'm actually glad I tore because it made sex less painful than before pregnancy.

Also what would you do if a patient was extremely scared of having a c section? Is there a way to avoid it? I watched this is going to hurt on bbc iPlayer and a c section is scary!