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?

t midwife consultant will have seen still born babies and mothers dying in childbirth

Yes but so will an experienced community midwife. Community midwives have hospital experience but the opposite is not always true. The risk is not one directional - if intervention was only ever positive everybody would be doing it. Intervention can also cause problems so should be used only where its actually needed.

I can understand that medical opinions might vary on whether or not to induce at 38 weeks plus. But I don't think there's an obstetrician in the country who'd recommend a home birth to a 45-year-old mother.

A doula has no medical knowledge at all and is basically just support in labour i.e. Hand holding , making drinks etc etc she is not s medical personnel and you are paying for support . She will not know what to do if an emergency arises . Some love to think of themselves as midwives and can often get in the way of the professionals . I worked on maternity for 10 years and some doulas truly believe they are the font of all knowledge with regards childbirth ! Very annoying they are at times

The NHS should be using the cheapest and most efficient was to deliver the baby safety for both mother and child. Mother's wishes, sensibilities and demands should come a lot lower down on the list.
Do we all agree the NHS needs to save money?

A HB is likely to be much cheaper! IOL is generally a long slow procedure involving a few days in hospital, expensive medications, often an epidural and possibly theatre. Especially at 38 weeks as baby often just isn't ready to come yet. If the IOL fails to start labour a caesarian will be necessary, which due to there not being contractions, increases the likelihood that baby will end up in NICU with TTN (respiratory distress).

These outcomes are less likely with a homebirth.

Also, do you really think that midwives can induce someone without consent? Of course women do and should get a say in their treatment.

OP this is a very difficult decision for you however I do not accept the idea that you are deliberately putting your baby at risk. It is very clear that you are weighing up the risk of stillbirth (which is definitely increased, but look at the stats - it is still low) with the real impact that IOL may have on you and your baby. You need to carefully look at stats and also find out what monitoring would be offered should you wish to decline IOL. I think you should be looking for CTGs, scans and dopplers 3 times a week at a minimum. Perhaps you can reach a compromise of IOL a little closer to term even? Even waiting to 39 weeks would increase the chance of successful and straightforward IOL. However I personally wouldn't wait unless there will be appropriate monitoring in place. I have to be honest, if it were me, I would look for a compromise but I don't think I would want to go past 389 weeks, and definitely not past 40 weeks.

Why do people think telling the OP on these threads that their births ended up with CS or some other complication is relevant?

I have had four babies. All births were straightforward.
Is that any more relevant?

OH was looking at maternal death rates this week. The USA has an incredibly high rate for a developed country. Yet they surely have the most medicalised an expensive system.

Its not a simple issue is it?

However, they cannot deny you a home birth if you are committed to it. Tell them you want no further discussion, you are going ahead at home and expect to receive appropriate support

Rubbish. You can't force midwifes to attend to a home birth they know should not be happening. You can't make them take responsibility for your choices.
If you want a home birth against medical advice the onus is on you to find your own midwife and pay them privately for their services.

Totally agree that personal anecdotes are irrelevant.

The UK has a higher stillbirth rate than most of Europe. Not sure how we compare to the USA.

I haven't read the whole thread, but of course it's your decision. Personally, knowing that the risk fo stillbirth goes up after 38/40 at your age I'd want the baby out and healthy. If you're willing to accept a higher risk of stillbirth for your choice of birth place, it's up to you. I think a healthy a baby is the only thing that that matters. Others feel the experience is important. Personal choice, but you'll have to own any bad consequences. Good luck.

What is IOL?

Depends though. I was "fortunate" really that when i went along to have the 41 week appt with dc3 i had very high blood pressure. The following day i had her, shoulder dysocia, i had pph, twas grim. But what was grimmer was the reflection that they would have let me have her at home if i had asked. I had 2 normal births before and my reflection is that age does play a factor.

Induction of Labour cathf

Also MissDuke, you are assuming a best case scenario for the home birth and a worst case for the IOL, whatever that is, to prove your point.
Are you a health care professional?

Thanks Gale 😁😁

If that is the case, which I doubt, then it shouldn't be. No midwife should be forced to do a home birth that she does not feel is safe.

I work with my local maternity service and often speak to bereaved mums - in my area they wouldn't let you use the midwife led unit either, although they may let you use the alongside unit. You could request a home birth but they would seriously advise against it and you would be putting the midwives in a very unfair and difficult position in my opinion. They strongly suggest early induction in women of your age for very good reason - a home birth would certainly be cheaper, they're not doing this for the fun of it. Ultimately it's your decision but sadly the realities of risk of still birth are rarely made clear to pregnant women (this is a complaint I hear from bereaved mums all the time) - when a consultant midwife or anyone else is strongly underlining the risk of stillbirth to you, you should take this very seriously. I almost lost one of my twins - things can change so fast. Thank god for my medical team being proactive and saving my boys,

Pengggwn you're right, we do have a duty of care to women but as far as I am aware, inductions do not take place at home, well they certainly don't where I work.

OP

I'm a HCP. You need to be given all the information to allow you to make an informed decision. You are, statistically, at higher risk of IUD/Stillbirth and complications given your age. Guidelines are based on evidence, they're not just dreamed up on a whim.

You are at liberty to ignore the advice and guidelines, and have the birth at home. As long as you know the risks, that's fine. But please, please make sure you know and understand the risks.

Also, I would say that you need to be careful of being pushed the other way too- by the doula and group you are attending. These often are well intentioned, but have their own agenda and beliefs too. Look at the evidence and make an informed decision.

Perhaps ask for a 2nd opinion from your obstetrician?

@curry

How much do you know about medical ethics? Midwives do not throw strops and say “I refuse to attend a birth I don’t agree with”. Just like a doctor can’t refuse to perform an operation, or any other sort of treatment, on a horrible criminal.

Cath, yeh I am a mw. I have read enough evidence to know the stats and I know HB's in multiparous women are more likely to be straightforward than an IOL is. Labour is much more likely to progress normally in ones home environment and without medical interventions. I also see it with my own eyes day in day out but am basing my comments on evidence. The birthplace study is a good place for some stats on this. I of course also see SB's more than I would like hence my comments about compromise. I genuinely am not saying a HB is a good idea but just explaining I can see where the OP is coming from.

I have 3 children and opted to have them all in hospital. I wouldn't want to have been forced to have them at home just because stats show it would be likely to be cheaper. Which I kind of think is where your insistence on the cheapest option being done would lead to.

Midwives definitely have to attend births regardless of their opinion on them. Its in our code that we can't refuse to attend.

I was 40 when I had ds(5). I was told about a trial at the time where 40+ age mums were induced at 38 wks & asked if I wanted that (first mentioned at 37 wks & I said no). I asked to speak with the consultant because throughout my pregnancy I was told induction if you go 2 weeks over and also induction was something to be avoided as awful, much intervention etc.

As it was, the consultant said I could go up to a week overdue as long as I kept a really careful eye on movements & if the baby wasn't moving as much as usual to eat chocolate & drink icy water & if that didn't make him kick to go straight in as an indication of placenta failing which is a big risk for overdue babies of older mothers.

I was also told epidurals are the scourge of the devil and my epidural was in fact the best thing ever.

Ds & I were both fine but I have since read of many who were not similarly ok. I only realise now about the risks and our high stillbirth rate.

Honestly I would ask to speak with the consultant obstetrician and have a proper discussion with them. Have a private (paid for) consultation if needs be.

Also I had a brilliant midwife who always told it to me straight. She said don't do a home birth.

We have lots of additional care for 40+ mums where I live & I was grateful for the extra checks. I was also grateful for the 20+ years of births my consultant had been involved in prior to seeing me.

There is a lot published and said about childbirth, mothers' choices etc. We don't hear so much about what happens when it goes wrong but our job as a mother is to put our child and their safety first. Think again about this one OP. Don't let the way this woman spoke to you cloud your judgment either. Good luck whatever you decide xx

The behaviour of the Consultant midwife that you have described in your OP does sound strange and unprofessional (putting your hand on her tummy).

However, she is giving you her informed medical opinion based on statistics. To suggest that she is scaremongering for informing you of the increased risks seems strange. Most units now suggest an induction before term for older mothers and you will be amongst the oldest at 45 years and therefore at statistically higher risk.

Other posters anecdotes about their pregnancies and deliveries are irrelevant. Statistically, you are higher risk and the midwife is doing her job correctly by telling you this. You are potentially choosing to accept a higher risk of still birth is you decline induction, go over term and then insist on a home birth. Ultimately, it is up to you.