Midwife Consultant bully!

[libertysilk]

Expecting my third child, and, as I'm 45, am monitored quite a lot. I have 3 weeks to go. I've had a complication free pregnancy. Scans and tests all normal and within expected parameters.
Due to my age, I've been refused the option of giving birth in my local birth centre as its not attached to a maternity ward. I challenged this, and was booked an appointment with a midwife consultant.
She wants me to be induced at 38 weeks, due to statistics of women my age having problems. She keeps saying I'll haemorrhage or have a still born. In a meeting on Wednesday she took my hand in hers, and placed it on her stomach. Said she wants the best for me and wished me well.
My midwife has ok'd me for a home birth, and disagrees with the consultant.
I feel I'm being scare mongered, and bullied.
I'm part of a group run by a midwife and doula with 38 years experience between them. They support me along with my midwife, and say I am healthy and fit and perfectly able to have baby at home. They've said the midwife consultant is behaving professionally and is bullying me, and I should report her.
I'm in two minds.
I'm not naive, and will not put my baby at risk, but, this is putting huge stress on my pregnancy, including confusing and upsetting the father too.
AIBU to be upset?

My stillbirth was before term. I had planned a hospital birth but could have had a home birth if I had wanted that and was offered that as an option.From what I have been told and read since the largest group of unexplained stillbirths occur in women like me.

(Question to self: why do I allow myself to get sucked in to these threads?! I genuinely don't really know).

None of our experiences have ANY bearing on the OP's situation.

None of all the quoted examples of good or bad outcomes of hospital or home or MWU deliveries can possibly give any guidance to the OP.

We all have different levels of risk we are comfortable accepting.

The OP has to make her own decision, and her HCP are obliged to provide her with ALL the relevant information. What she then does with that, is up to her (and that is how it should be).

Hand on stomach is still just plain weird though.

Unexpected intrapartum stillbirth is rare. Only been one i can think of in the last ten years where I work.

Unexplained antenatal intrauterine deaths are much more common sadly. Obviously these result in a stillbirth in hospital. Women with a dead baby don't choose homebirths.

'The OP has to make her own decision, and her HCP are obliged to provide her with ALL the relevant information.'

They might, but they don't. The OP hasn't been given the differential between likely stillbirth rate in hospital or at home.

The OP hasn't been told of the risks of induction.

The OP hasn't been told that C-section could be a possibility if she is adamant that an induction would never be consented to.

The OP hasn't been told that the regular adrenaline injections from the bright lights, the staff changeovers, the monitoring, the disturbances, the noises, the depersonalisation will increase the chances of her baby's life needing saving - which will no doubt be easier in a hospital than at home, but at home unlikely to have developed that way in the first place.

The OP has been given none of this information by the Consultant Midwife, though possibly some of it by the Community Midwife and doula.

I have nothing against HB
And I agree that our birth stories bear no relevance

But the OPs age IS an issue surely I thought geriatric births are higher risk generallly ?

@C8H10N4O2

We don't actually know how experienced the hospital midwife is. We can assume she has a certain amount of experience to be in that position but we don't know what it is. The OP's regular midwife has extensive experience in practical delivery and as a community midwife has to have both home and hospital experience.

The midwife who suggested a hospital birth was a consultant midwife - essentially amongst the most clinically senior and experienced grade of midwife in the system, even if some posters are dismissing her and just a nurse.

The OP explained that the meeting happened because she was refused the option of giving birth in my local birth centre as its not attached to a maternity ward. I challenged this, and was booked an appointment with a midwife consultant.

The midwives in the birth centre and later the senior midwife who would have absolutely reviewed the OP's records and discussed the specifics with her midwife and possibly a doctor or with a clinical MDT before the meeting gave a professional opinion, backed up by stats and robust national guidance about safe clinical practice.

OP can take this as bullying, but being mature enough to be a parent means having the courage to understand why fact based clinical information os spelled out to imform her decisions even when it doesn't meet an ideal world view.

From the Royal College of Midwives:

Research and education are also key aspects of the consultant role. Consultants are ideally placed to bridge the theory-practice gap and to critically evaluate new evidence. The minimum level of education for postholders is a Masters degree. The ideal is a PhD.

www.rcm.org.uk/news-views-and-analysis/analysis/consultant-midwifery-defining-a-new-role

Starlight that's massively disingenuous. Of course most still births happen in a hospital.
Most births in this country are hospital births.
Any home birth where the baby is in distress will move to a hospital.
Still birth is more likely in babies that are overdue (or at full term in women 40+) so those women are more likely to be induced and therefore in a hospital
Any baby known to have died will be induced in a hospital

Of course most still births are in a hospital. That's a ridiculous statement. Once a homebirthing mum is transferred a hospital, that then becomes a hospital birth, if difficulties are clearly happening, they wouldn't be remaining at home unless they refuse to go in.

When I was having my twins I was told I needed to have them by 38+6 to minimise risk. I was told I needed to have an epidural and have them in theatre in case of a problem. Quite a few people told me I could refuse all this and my response was always "why would I do that?" - I was and am terrified of birth, terrified of hospitals, terrified of needles, massively traumatised by past gynae treatment and abuse. But they were advising me this was what was safest for my children so I agreed to everything.

As it happened, one of them stopped moving and their heart rate became static at 35+1 and without being pressed to go to the hospital by my midwife because I "just didn't feel quite right", my son wouldn't be here.

Of course I wanted birth to be a pleasant, non-traumatic experience, but my emergency section and the following horrors pale in comparison to what would have happened if I'd insisted on what I would have preferred (no hospital, staying at home etc).

When risk is low, women should be supported to have whatever birth they choose. When risks are higher, as they indisputably are here, it is NOT scaremongering to be made aware of those risks and what is statistically the safest option for mum and baby.

And consultant midwives are highly trained and experienced - there are not nearly enough of them in this country for the target ratios because the criteria to qualify is so high. I would be taking the opinion of a consultant midwife very seriously. I work with a few and they are extremely well informed and skilled.

Becles

The midwife who suggested a hospital birth was a consultant midwife - essentially amongst the most clinically senior and experienced grade of midwife in the system

Yes I'm aware of that. Hence I said we could assume a certain level of experience. However seniority is not automatically guarantee of the best advice in every individual case. Just like population statistics don't work for every individual. Both are good indicators but not the only relevant information.

"consultant" implies a degree of communication and ability to build trust with a patient, even if you are giving them news they don't want to hear. In this case she alienated her patient by some fairly odd behaviour and giving rules without explaining the reasons in a way that the patient could comprehend. She also should have covered the risks of IoL, even if just to draw a comparison.

Add to that two other very experienced midwives, actively involved in the OP care who disagree with the most senior - I'd want another point of view from the hospital as well and its not unreasonable to question it.

but being mature enough to be a parent means having the courage to understand why fact based clinical information os spelled out to imform her decisions even when it doesn't meet an ideal world view.

And being in a consulting role means being able to communicate and inspire confidence in your patients.

Can I just say, I have spent this entire thread riveted by the irony of cathf coming on to say people should listen to medical professionals - and then repeatedly arguing with pingu and viva and missduke who are alll....... medical professionals.

Putting the medical factors aside... I can never see the attraction of a homebirth... in my head I imagine being in the lounge in a birthing pool, then the Amazon man bangs the door, then the milkman comes round for his money, then a charity collector.... then when it's all over there's a lot of mess to clear up! I just never got the romanticised view of it and being in your own bed etc.... personally I went to hospital for some peace and to be looked after (and the medical aspects clearly). I know others will hold different views on home births but just saying I really don't see it myself.

I don't think I have argued repeatedly with anyone Johnnymcgarth? I have been away all afternoon.
I am also not aware of any medical profession on this thread who has endorsed the OP's wishes, so I am still wondering why she thinks she knows better?

I've recently given birth at 44 and I was under one of the main London teaching hospitals. Although my midwives were happy for a home birth, the consultants opinion was that he wanted the baby delivered in the 39th week. I'm a medical professional and I'm risk adverse so I didn't take much persuading. But when admitted for the induction, the (different) consultant on call reviewed me and said she disagreed with the other consultant and was happy to send me home to go full term if I wanted. It's all so confusing. But at the end of the day it was my medical background and my attitude towards risk that made the decision for me. And I stayed in for a medicalised delivery (which was speedy and fine!)

I do feel for you as my midwives were also very open in their opposition to the consultants proposed management. It made it harder although I felt reassured that they seemed that confident that I was low enough risk to deliver at home.

I wish you the best of luck. It's so good to be out the other side and now Ithe fact I'm so old is utterly insignificant as far as I'm concerned.

You are being told that on the one hand you personally have no reason to think that a home birth is inadvisable but your age makes you statistically higher risk for unexpected complications. So I think you should make your decision based on the what-ifs. If you live round the corner from a teaching hospital with a scbu and have previously gone into labour at 38 weeks and had uncomplicated labours and expect to do so again then a home birth might be a reasonable risk to take. But you might decide that otherwise you will be induced at 39 or 40 weeks in a hospital setting, but aim for as natural a labour as possible with induction, ie trying a sweep and pessaries to get things going, and all being well being discharged soon after the birth.

Your decision to make with your partner, given the available facilities.

Imhe (births aged 22, 24, and 39) a birthing later in life is a much tougher thing than I thought it would be, and transfer from home to hospital when things got scary was not fun, after a textbook healthy pregnancy. I lived 10 steps from the front room birth pool to the ambulance and 5 minutes blue light to the obstetric unit. If you don't, I wouldn't.

The fact the NHS is free at point of use means we don't put a value on its worth

It's not "free" we pay for it with a very high tax rate, one of the largest in europe.

That's why I said free at point of use fizz, not free.
I am aware it is paid for by taxes but thanks for clearing that up

I bet Fizz voted for Brexit. 😯

Yeah our tax rates are LOW

No our taxes are low when you compare all taxes

OP I wouldn't bank on a speedy transfer in an ambulance, if it came to it. You might be lucky and find one is available, and arrives quickly after being called. However, if the service in your area has been starved of funding in recent years as much as the service has in my area (an inner London suburb), you might find you are waiting a very long time, if your need coincides with a busy period.

In recent months I have had to call an ambulance twice for others, one with a stroke, where the person waited for more than 2 hours, despite recommendations for speedy treatment to avoid long-term damage. Unfortunately, the stroke happened at 11 o'clock at night on a Friday, when all ambulances and crews were tending to drunks who had knocked themselves unconscious.

The head injury happened at 11 o'clock on a Saturday morning, but even at that time all crews were busy as, apparently, there were two suspected cardiac arrests, which took priority. Yes, that's right, it took only two other critical emergencies for the person with the head injury to be bumped. This is within a mile and a half of a major London teaching hospital.

Unless you (not your baby!) are unconscious and not breathing, you could find yourself unable to get an ambulance in time, if needed.

How lucky are you feeling?

I bet Fizz voted for Brexit. 😯

Wtf are you stupid?! We have an enormous tax rate compared to say Spain, where they have private health care. We have a huge tax rate and therefore should be entitled to more benefits including health care because it's what WE'VE paid for as citizens. We're a country with large taxes, and large benefits and there's nothing wrong with that. But we can't operate that way then be stingy with the NHS saying "it shouldn't go on IVF, it shouldn't go on liver transplants to drunks" etc.

What on earth would that have to do with Brexit!? And no I didn't. Sorry but you really are stupid I can't understand how you don't get a simple point. I'm saying if people want to be stingy with the NHS then taxes need to be lowered, because what on earth are they being spent on!? You sound more like a brexiteer / little englander who has no idea how politics in other countries operate.

If you think that we pay anywhere near enough tax to properly fund the NHS then you’re seriously deluded. If we as a nation want it to fund the things you have mentioned then we al need to pay more tax, a lot more. Alternatively we switch to an insurance-based American style system. Expecting our current levels of taxation to cover all our health ‘wants’ (NOT needs) is delusional.