Is it possible to bring an independent midwife into hospital with you during labour?

[Kwini]

That's it, really. I'm quite concerned by what I've read about short staffing on maternity wards and really like the idea of having someone with me whom I've known throughout the pregnancy. Would prefer a midwife to a doula as (I assume) the former would have medical training, so could be a useful advocate if things get hairy. But I have a sneaking suspicion that hospitals probably aren't in favour of IMs being brought in by patients! What would MNs advise?

I think it is one or the other but you cant have both, independant mw or hospital, but not totally sure tbh.

Thanks, JL - that's what I'm fearing. So a doula really is the best compromise?..

Depends where abouts in the country you are, some IMs can get contracts with hospitals to care for clients there, many can't. It would be worth contacting your local IMs to ask, there is a search facility on the IMUK website to locate your closest IMs.

You can bring an indie in with you. However, they won't be able to act as a midwife - so no VEs or monitoring or making any sort of midwifery decisions at all. So she won't be able to use a large part of her training.

I'd think carefully about doing this. What if she is advising you one thing and the hospital midwife another? Who will you listen to? What if things go "wrong" and you feel she "should" have done something different but she explains she felt stymied by the hospital environment, will you want your money back?

I'd meet some indies and see what they say. Beware of any that go "yeah, no problem at all!" It is a problematic thing you are asking and a decent and honest indie will discuss all of the potential issues with you.

of course an IM will have had the midwifery training which covers normal and obstetric emergencies but so will every midwife, regardless of workplace.

as another poster has said some hospitals will have contracts with IM that allow them to care for women in hospital otherwisw the IM can accompany you and advise and advocate but cannot provdie clinical care.

Thanks, curlywurly. I've just checked the IMUK site and see that

"currently a complete package of care will cost you between £2000 and £4500 (approx)"

!!

Are doulas also this expensive?

Yes, IM's can provide ante-natal care throughout pregnancy and them accompany you during a hospital birth.

However, I understand that in the hospital they're often acting in the capacity of a (very qualified) doula or birth partner.

I had a homebirth but my IM also provided care for hospital births. She definitely would have stayed with me throughout if I'd needed to transfer.

I never asked what the attitude of the hospital staff was to her presence. (As she used to work at the local hospital and has been practicing independently in the same area since leaving, I didn't imagine that it would be a big deal.)

Do interview some IMs. Having 1:1 care from someone who knew me well, was very experienced and held views in line with my own was very important to me. I think that it was a strong influence in having such a positive birth experience with DD.

Having an IM at the birth of DS2 was the most incredible experience that I can not recommend more highly. The birth of DS1 was terrifying - I was very frightened. The birth of DS2 was exactly the same but I never ONCE felt scarred even at the point of going into theatre for intervention. The IM was with me from the beginning at home, came with me to hospital (which was full - she persuaded them to get me a room asap) and didn't leave till I was tucked up in bed with my baby breastfeeding. I then saw her postnatally every day for 6 days and then once a week for 6 weeks. You do not receive this level of care on the NHS and private care costs £10k+ (with no postnatal care).

Thanks, all!

Addictedtofrazzles, it's lovely to hear that you had such a good experience. Had you been planning on a home birth, or would you have hired an IM to come to hospital with you?

HardertoKidnap, you make a good point about conflicting advice. I suppose the advantage of an IM would be that, ideally, she'd be someone I'd have got to know quite well and therefore able to fight my corner should I find myself being pressured into something I may not want. But I do see what you mean...

"currently a complete package of care will cost you between £2000 and £4500 (approx)"!!

And worth every penny.

We're not rich, but I'd go as far as to say that I wouldn't intentionally become pregnant again until I'd saved enough for an IM fee.

The NHS maternity provision is great in some areas (you can look online at information about your local maternity services) but it's a bit of a lottery depending on postcode and shift changes in terms of the care you'll receive on the day.

With DD2 we wound up in hospital with our IM. From our experience the midwifery staff were extremely respectful of her, but the consultants would (literally) walk into the room and turn their backs to her .

Once we were in hospital our IM didn't really give us advice in a "well, if it were me I'd be doing this, that and the other" way. She was very happy to discuss the recommendations that hospital MWs had made, including the likely reasoning and possible alternatives, but it always felt as though she was respecting their professional opinion and was letting them take the lead. That said, I think she felt the MWs we had were extremely good - I can't say whether she'd have been more proactive if that weren't the case.

If we ever have a DC3 I honestly don't know whether we'd plan a home or hospital birth - but I can't imagine going through pregnancy and birth without an IM at my side. For me (and DH), continuity of care made an immense difference to a very traumatic time.

I had an IM and intended to have a hospital birth, but my baby, born 3 weeks ago, had other ideas and just popped out in the bedroom before we had the chance to get to hospital!

I can honestly say my IM was some of the best money I have ever spent. She was supportive of all my decisions, helping me to make informed choices. She even came with me to a hospital appointment I had with the consultant MW in order to introduce herself and assure them that she knew what her role was in the hospital (ie she would not be allowed to give clinical care but would be there to support and advise meas an IM.) The hospital were a bit prickly about it to start with but once they had met her she won them over too.

As it was I had the baby at home and then had to transfer into hospital for stitches. She came into the hospital with us and was treated with professional respect by the other MWs there.

I am still under her care now, and would employ her again in a flash if I ever fell pregnant again. (I hope to stop at 2 though )

Yes, mine came to hospital with me (large London hospital).

It was an ECS for footling breech and it was fantastic to have her there.

Too many benefits to bore everyone with here but one that stays with me was that at 1am when I was scratching myself to pieces (apparently a possible side effect of the spinal block) she pointed out to the midwife on duty that I was incredibly uncomfortable and demanded that I had an immediate shot of anti-histamine. If she hadn't been there I think I would have just scratched my skin off and was too out of it to ask for anything (and the ward midwives certainly couldn't have cared less).

Wow, it's great to hear these stories - and to realise that I'm not being unreasonable to consider paying for continuity of support. Thanks so much, all.

Is there anyone out there who opted for a doula instead - and if so, could you tell me why you decided to go down that route?

I tried to get a doula, but round where I live they would attend only home births, not hospital [sad. Wish had thought of IM.

Thought I'd add my perspective.

Originally I was going to book a doula but due to a number of issues (mainly feeling like I had to fight cos I didn't just want to go along with what everyone else does) I ended up booking an IM instead.

I was planning a homebirth but in the end I transferred in for more pain relief. I went from hoping for a pain relief free home waterbirth to having a hospital birth with gas & air and epidural. My IM came with us (in separate car) to the hospital and stayed until the birth was over and for about an hour afterwards.

I really noticed that the staff were very respectful, much more polite than at dd1's birth and got on well with my IM. They certainly seemed to have no issue with her being there (acting as a birth partner/doula not medically involved though she did give opinions on things). I did notice that the staff weren't as efficient after she'd left (they left the canula in my arm until they were processing the paperwork to send me home for one thing). The anaesthetist who did my epidural and the guy with him (not really sure what he was) were friendly too with the IM, I remember them all joking about people pulling each others trousers down in theatre .

What I will say is that my IM used to work at that hospital many, many years ago (before she went indie) and had a fair amount of contact with them (iirc she'd helped do some waterbirth training with them) so it might be useful to ask an IM about her experience with the hospital.

Even though it wasn't the birth I'd planned, it was very very enjoyable and the money spent was worth every penny. I wouldn't hesitate to book an IM again.

I had my IM with me in hospital after I transferred in from a homebirth. We were both told that she wouldn't be able to provide any clinical care for me in hospital but it didn't make much difference once the door of the delivery room was closed. I passed every decision by her, and she caught my baby in the end. Was thrilled with her care and if a miracle occured and I ever had another baby wouldn't hesitate to book her again.

"currently a complete package of care will cost you between £2000 and £4500 (approx)"
!!
Are doulas also this expensive?

where do you live?
In london they are around £700+ or i think you can get one who is still in training for £200

I paid £3000, and tbh I think I have got way more than value for money. To date I have had about 15 pre-natal visits, blood tests, an active birthing lesson for OH and me, 2 midwives appearing as if by magic in the middle of the night within an hour of me wondering if I might be in labour, and 10 post natal visits. She has been to the hospital twice with me, once without me (to chase up an anti-D jab,) provided all of the equipment used during my home birth, lent me a wealth of books, and overall been a massive reassurance to me after a difficult first birth (this birth was my second.) She was on standby to come out at all hours of day and night, and I fully believe that if I had been on the NHS I would have had a baby either without medical care at home or on the side of the road on the way to hospital. With my first child I had been in labour for over 24 hrs at home and the hospital were still rather more keen for me to call them in the morning. This labour was less than 4 hrs from start to finish and yet my IM sprang into action when I called her to say I felt a bit strange - at 2am! A hospital would not be happy to hear from a mother calling with a diagnosis of 'strange' but my IM knew me well enough to be alert to the situation.

I also think the quicker labour was down to the level of confidence she instilled in me and the help she gave in the preparation for birth. The birth did not go according to plan - we did not get to the hospital for the delivery itself - but I was not worried to give birth at home with her there encouraging and monitoring me, and in the end it went better than I could ever have dreamed it would. She knew exactly what I needed, and when. A MW who has not got to know you through pregnancy can never hope to catch up with that in the gaps between contractions that she has available to talk to you. The birth was not without complications (baby was huge and very fast, with his hand by his face and I had tearing which needed stitching in theatre,) but it was all superbly handled.

As I said - best money I have spent in a long time!

how about a home birth with nhs midwives (plus doula if you wanted). you get guaranteed 1:1 mw care and avoid the wards completely.

Bubbahubba, I'm in London.

Sanfairyann, I love the idea of a homebirth but would never forgive myself if something went wrong (we're about a 20-minute drive from our nearest hospital). DH is also very, very anti and I'm not sure I have the will or energy to try to talk him round! Choosing battles and all that...

doulas are cheaper because they are far less well trained. I am skeptical of doulas, as they often seem to think they know better than those more qualified than they are!!

One thing I'd say, from a friend's experience, is that if you do get an IM, don't not do classes just because they often do them as part of the package. My friend did that (having paid for an IM, she wasn't going to pay for NCT classes as well and the NHS ones near her weren't good) and as a result of that and her being ill after the baby was born, she didn't make any friends with babies of the same age and now feels like she's "catching up" in that respect.

If you already have kids or lots of friends with babies it's probably not an issue, but for first-time Mums, NCT classes seem the best way to make friends at the same stage as you.

Definitely check with a IM whether she has worked at your hospital, either as an IM or before going indie. That always seems to be key to a good working relationship.

For me, it would far too expensive to consider right now, and I'd feel it was rather a waste of money for a planned hospital birth as they'd be so limited and couldn't be your MW there anyway. But if you have the cash, it does sound nice.

"doulas are cheaper because they are far less well trained. I am skeptical of doulas, as they often seem to think they know better than those more qualified than they are!!"

I understand your skepticism: doulas shouldn't be offering any medical advice. However - an experienced doula may well have a better understanding of the type of emotional support a mother needs in labour than medically qualified people because that's their sole responsibility and concern. Also there's always going to be some substandard, non-evidence based practice going on in maternity care. Doulas (some of who are trained midwives or antenatal teachers) who are well informed and experienced are going observe this going on and are inevitably going to take note. Just because they're not medically trained it doesn't mean they have no knowledge or understanding of what constitutes safe and effective care, just as parents are able to recognise that some teachers aren't very effective, even if they themselves don't have a degree in education.

Interestingly, the NICE guidelines on Caesarean Section state that all women should be told that having continuous one to one support from another woman (with or without prior training) in labour reduces the likelihood of c/s. The reduction is only seen among mothers who are being supported by women who are not members of staff at the hospital where they're having their baby!

"I'd feel it was rather a waste of money for a planned hospital birth as they'd be so limited and couldn't be your MW there anyway. But if you have the cash, it does sound nice."

I remortgaged the house to pay for my IM so will be paying it off long past menopause! The birth was only a small part of the care that she gave me. The antenatal and postnatal support I got from her was invaluable.