To think that midwives should not be punished when high risk women have a home birth which goes wrong

[ReallyTired]

I am in favour of homebirth and my second child was born at home. For low risk women it can be the most sensible option. I have also had a consultant led birth because I had a flu during the the birth of ds. Being in labour with flu is a different experience to being healthy and being in labour. The body is having to work so much harder.

Giving birth when you are ill is high risk. I feel that Mrs Bird chose her homebirth and the risk that it entailed. It is not rocket science to know that childbirth when you are ill is risky. It is tragic that she lost her baby. In the UK a woman has the right to change her mind at any time during a homebirth.

www.bbc.co.uk/news/uk-england-beds-bucks-herts-17094924

I think the midwife is dammed whatever happens as a woman has a right to a homebirth however stupid. I feel that high risk women who have a homebirth should sign a disclaimer. Ie. that they take financial and ethical responsibly if the birth goes wrong.

I feel concerned that punishing the midwife for the stillbirth will make community midwives reluctant to attend homebirths.

Benbird, I'm so sorry for your loss.

I had a high risk HB. Risk is relative. I was HR due to being 42+3, and being 4 days post asthma attack and 'flu. I wrote to the hospital to absolve them of responsibility and to make sure that it was very clear that I had listened to all of the risks and was still refusing induction and having a HB.

I had the full support of my (very good) MW - had they advised hospital during labour, I would have accepted it. They didn't.

The problem with "not allowing" HR HB is that the definition of HR is often arbitary and can be and is used by HCP who have an ideological opposition to HB to scare women into hospital. If I trusted that a full individual risk assessment would be carried out, with an accurate guess as to risk, then I would be a lot more confident. Currently the guidelines are not individualised at all.

Benbird I am so sorry for your loss.

OP I think your point would only stand if the mother was going against medical advice which is clearly not what happened in this particular case. This case appears to be incompetence on the part of the MW and she should definitely be held accountable for that.

I quite sure Mr Bird had he known that he's daughter was in distress would have urged to go to the hospital,he was not informed until the ambulance had been called that his daughters heart rate had dropped!

Like i said before as first time parents we put our hands in the people who are qualified to do there job, we rarely question the procedures that Midwifes follow unless we have had more children!

So very very sad, I am so sorry for your loss, i cannot imagine. I am stunned that a MW persuaded a first time mother to have a home birth, I think that is where the fault lies to be honest. I was told by my MW that first time mums are not encouraged to go for HBs. Again so very sorry Benbird, I really hope you find some peace soon.

I've read the nmc trial hearing and I have to say it's all very sad for both sides, the paper fails to mention that when the mw left she did not leave her alone she left her in the care of another mw. Her temp and pulse are not hugely abnormal and could easily seen to be within normalish ranges for labour, nothing that would ring alarm bells for me, the failure to document often happens when it's all go. The liquor I'm assuming should have been reported although when I was having my dd I was told that the liquor is very commen in post dates babies the consultant even said that if you were at home we'd probably have a much higher threshold for ignoring it but as I was in hospital I had to have continuos monitoring, now whether that is right or wrong itvseems a very wooly practice.

The nmc clearly states that the mw has not been found guilty of acts or omissions which resulted in the outcome ie, this may be all normal practice in her team but on an occasion when the outcome goes so wrong then that practice is open to scrutiny. The protocols should be standardised nationally to protect both parents and midwives.

Let's not forget consultant obstetricians frequently make mistakes too, that doesn't cause us to doubt the practice of giving birth in hospital.

My understanding (which may be wrong) is that there is no legal right to home birth per se, though there is govt and NHS policy that women should have choice over place of birth. However, midwives cannot refuse to attend a woman in labour (I think this is what makes people think there is a right to home birth). That doesn't imply that they have to give professional care wherever the woman sees fit - they (or their employer) are perfectly entitled to say, "I will give you care but only in hospital because it is too dangerous for you to give birth at home".

Should a woman refuse to go to hospital, though, the midwife can't reasonably refuse to go to her, however unreasonable the woman may be being. So you can get a kind of stand-off where home birth hasn't been agreed, but the woman digs her heels in and gets one anyway (I've seen women being advised to do this on MN and elsewhere). It does not mean she has a 'right' to that, however. In this situation, the midwife would not be held culpable for the woman's decision to stay at home against medical advice.

I haven't read the details of this case yet, but I think it would be a mistake to conclude - as someone did upthread - that first births shouldn't happen at home. There is not nearly enough evidence to support that. There are risks and benefits of both home births and hospital births, but part of our problem in the UK is that there isn't a sufficient critical mass of home births for it to be as safe and cost-effective as it could be.

This might be a bit hair-splitting: a mentally competent woman can insist on staying at home so in that sense there is a right to a homebirth; there is no law which states that women must deliver in hospital.

The difficulty comes with defining what standard of care she is entitled to.The health authorities only have an obligation to provide a maternity service, there seems to be no obligation to provide a home birth service.