To have an independent midwife?

[MrsMuffins]

We’re planning for another baby, and I’m considering booking an independent midwife. We live in an area with extremely high rates of interventions, and I desperately do not want a hospital birth. There are basically no home births in the area, so I’m concerned about either not being supported to have one, or planning one and then the midwives either making me go into hospital or being inexperienced in caring for women at home. So I’ve been looking into independent midwives, but at nearly £4K it’s a lot of money - does anyone have any experience of having one, is it worth it?

@Sindragosan yep no hope of seeing the same midwife here, it’s luck of who you get on the day. And community and hospital midwives are completely separate. I can see your point about the benefit of having two midwives - I believe my local IM works with a partner, but I will check.

YABU based on my sample size of one.

There was a IM at home birth support group we went to when we were considering this for our baby. She herself had tried to have a home birth 3 times but ended up going in for a caesarean each time - and she didn’t think there was anything particularly notable about attempting a home VBAC after one then two sections, which definitely would have been against medical advice. Now that’s up to her - but I think to gloss over this fact when talking to a group of women considering home birth was concerning for a professional.

You’re worried a NHS midwife would be too eager to bring you in, but would an independent midwife be too hesitant to bring you in if you neeeded to be?

Like I said, sample size of one though!

Just saying, bloods aren't repeated due to not wanting to acknowledge the IM's existence, they're repeated because Trust's HAVE to have their own set of bloods on system. Exactly the same as if you move from one UK hospital to another - you could've had bloods taken that day but if they weren't with the Trust you're moving to, you'd need them re-done. In an emergency it's imperative that bloods would be on system in cases of blood transfusion etc, and checking that staff members are not at risk of harm from infectious diseases.

@Doccc not sure I see your point - why would her experiences of VBAC be relevant to a home birth support group? It’s not the case that VBAC is always against medical advice - I know lots of women who’ve done it successfully.

Wow £4K it's gone up a lot in 10 years. When I had DS1 it was between £1-2k to hire one. Still expensive. I suppose if you compare it to the cost of giving birth somewhere like the US it might seem more reasonable? Even after insurance I've heard birth there is usually about $2-5k.

A doula might be a good interim step if you're not sure about the cost.

@littlemissalwaystired that makes sense!

I had one and she was totally worth having. She enabled me to have a home birth which would not have been supported by the NHS. The second time round I had moved so was able to access an NHS caseload team and they were fab but in no way was it as bespoke a service as I got from my IM. She spent hours with me before the birth explaining stuff and making sure I was calm and prepared and hours in the days afterwards helping me with a difficult start to breastfeeding. She was so good and taught me so much that I didn’t actually need her the second time.

VBAC at home is very different from VBAC in hospital though. And VBA2C at home is riskier again. I would be nervous about being looked after by someone who encouraged VBA2C at home. I had ds1 at home and it was amazing but I was high risk for my others so they were born in hospital.

I had an IM after a difficult birth with DC1. She was worth every penny and I only wish I'd had one for my first delivery as it would never have gone the way it did had she been there.

I suffered PTSD after my first delivery and as a hypnobirthing practitioner, we spent a lot of time working through that before my second delivery. I tested positive for GB Strep so decided to have a hospital delivery with IV antibiotics, so she essentially acted as my birth partner (DH stayed at home with DC1) and I could not have felt better supported. She would have been happy to deliver me at home even with a positive GB Strep test had I wanted that, but I decided I would prefer to be in hospital Some of the best money I have ever spent.

I used an NHS funded independent midwife with the intention of a home birth. All my appointments were at home and scans were done in the community which was great. However I had to be admitted during labour and she wasn't allowed onto the Labour ward and none of my test results were on the bus system so it was a pain in the arse getting the hospital staff caught up with my pregnancy and labour (saying that I was admitted and having my c section within 45 minutes so I should complain)
My after care was lovely though

@MsFrosty it seems crazy that there’s no link up. I wonder if there’d be value in keeping the NHS antenatal appointments just in case one ended up in hospital?

I had Home births with all three of mine. First with NHS midwives - endless challenges to choice, refusal to consider a waterbirth, pressure to book induction even before due date. Told to push before ready and ended with a tear. Was lucky that birth was pretty straightforward but felt I had to fight my corner the whole way. Used the same independent midwives for 2 & 3 and was brilliant. All appointments at home, relaxed, not a single internal exam, calm and supportive even though 3nd labour tougher than first. Lots of them allow you to pay in instalments and if you can afford it it’s worth every penny.

@Musmerian great to hear, your first experience is exactly what I was worried about- if I even manage to get a home birth with midwives attending, then them being massively inexperienced in caring for women having a ‘normal’ birth, let alone at home.

All of mine have been home births. I am 22 weeks pregnant and planning another one. I have lived under 2 trusts and both have been extremely supportive. Where I live now has a dedicated home birth team. I only have to go to the hospital for my 2 scans, everything else is done at home by the midwifes including blood tests and antenatal visits. That being said, I wouldn't hesitate to contact an indepentant midwife if there was no support for a HB from the nhs midwifes. If you are low risk I would go for it, statistically speaking the safest place to give birth is at home if you are low risk. Which I think you already mentioned OP.

@namechanger2019 it’s so sad (and frustrating) that your maternity care is reliant on your postcode

I totally agree. We should all be able to access the same quality of care regardless of where we live.

My friend had one. Obviously it's just anecdotal, but her experience really worried me. A big issue for my friend was that this midwife would, if she needed a hospital transfer, come to the hospital and continue supporting her. In the event, my friend had a very long, painful labour at home and the midwife kept insisting she shouldn't transfer, using some very guilt-tripping language about it. My friend eventually did transfer to hospital, at which point the midwife suddenly said she couldn't attend.

The baby survived, but it was a nasty emergency section and quite clearly her life and my friend's life were both at risk.

@SarahAndQuack that’s interesting to hear - I would hope that I would have developed a more trusting relationship with the IM than this?! I wonder how different your friend’s experience might have been in a MLU or in hospital - it’s difficult as we don’t know what the midwife was basing her advice on. Possible though that she would have had the same experience - an IM doesn’t use any different monitoring tools than a midwife in hospital using intermittent monitoring, so would have picked up any issues just as well.

My midwives had an agreement with our local hospital and if I’d had to transfer could have cared for me. Disagree with poster who said why pay if you can get a Home birth for free. I had both and the independent midwives were so much better.

@MrsMuffins - well, yes, you'd hope so! She did have a couple of warning signs the midwife wasn't great, but wrote them off as it was her first baby so she wasn't sure. She did get compensation, so I think it was fairly clear that the care was substandard, but I suppose what is worrying is that this woman was practising in the first place.

I realise you can have less than ideal deliveries anywhere, but my fairly strong impression was that this woman saw it as a failure if a labour 'had' to transfer to hospital.

OTOH my SIL has had two home births with NHS midwives (and a doula), and she's been very happy with both. I mention that so you can see I'm not grinding some axe about home birth in general.

I have no experience of independent midwives, but both of mine were born at home in a low home-birth area, and I can't fault the care I received from the attending midwives both times. I got the definite feeling they were really excited to beat a home birth because they don't get the chance to do very many, and they were completely competent and confidence-inspiring. They were very respectful of my birth plans. I know it's only an anecdote, but low home births in your area doesn't necessarily mean poor care. I would definitely speak to some NHS midwives and try to suss them out a bit before you make any decisions.

@sarahandquack

That is exactly the kind of thing I would be worried about the independent midwife I mentioned doing. Allowing her own attitudes to childbirth to impair the standard of care that she provides.

@Doccc it’s a valid concern I guess, but I would think these cases are very much the exception and not the norm. IMs don’t practice to keep you at home, they practice to provide the best care possible, which isn’t available for most on the NHS.

Well I hope so anyway but who knows. Good luck in finding your midwife and for the rest of your pregnancy.

SarahandQuack I knew my IM had transferred her own family members in for C sections, she'd not keep me at home if there was a problem.

My NHS home birth however involved rupture of membranes (not good at a HB) - oh and without consent. They yanked at the umbilical cord to get the placenta out - again, not good practice. They gave me syntocin after I'd refused it saying "I've drawn it up now" - stabbed it in as I repeatedly said no. And then, in a complete change of direction in doing things I didn't want; when the baby vomited meconium everywhere they said it was normal and they weren't going to do anything especially not transfer us in like I requested.