Unsure of when/how to book homebirth? Also is my experience of midwives/antenatal care typical?

[marigoldilocks]

I have decide to have a homebirth for my first child and am 26 weeks. I have never had anything to do with hospitals and am becoming increasingly uneasy about having my baby there. The hospital I am booked into offers a number of natural birth rooms but there would be no guarantee of one being available and I dont want the uncertainty of it all hanging over me. The hospital website says that it supports homebirths but there is no info about booking one.

Also I was wondering if my experience of midwife/antenatal care is typical?

I am very confused about who my midwife/wives are and time seems to be running away from me. I met a midwife at my booking appointment (8 weeks) and she told me I was under a 'team of midwives' she didnt say if she was in the team and at the time I didnt think to ask. She was very nice and helpful but I didnt have any questions at the time so didnt get much information about how the whole hospital/gp/midwives system worked.

At my 12 week scan I met the sonographer and a nurse took my blood (dont know if she was a midwife, she didnt offer any advise or ask if I had any questions).

Since then I have seen 2 different GPs (only joined up with the GP practice when I found out I was pregnant, so dont have a regular GP). They cant answer any questions I have asked about the hospital either.

I have looked at my appointment schedule and apart from my Glucose screen test at 29 weeks (dont know if I will see a midwife for this) I will only see a GP at my 30 & 32 week appointment.

So basically it seems that my second 'midwife' appointment will be at 34 weeks.....Is this too late to arrange for a home birth at this time? I have my midwife-run parentcraft classes one week before this so hopefully there will be a chance to ask questions about this then.

I was just wondering if this it typical of antenatal/midwife care? Things I have read have said that you will get to know your midwife (or team of midwives) well during during your pregnancy but I cant see this happening as I wont be meeting them until fairly late. This is making even less happy about going into hospital. It all seems very late in the game to be meeting the 'team' of midwives in appointments after the 34th week? But is this usually the way it is?

Oh forgot to add I also had my 20 scan and didnt see anyone apart from the same sonographer from my 12 week scan-no midwife.

Different areas do work in different ways. Some areas have quite small teams b (about 6) of community midwives attached to a GP clinic.
There is no need usually to see a GP at your visits, you should usually be seeing a midwife, but the levekl of continuity you get depends (some women might see the same midwife for nearly every appointment, others might end up seeing a different one each time, especially if there are midwife vacancies or a high sickness rate).
Have they booked you in for antenatal classes?
They quite often prefer to leave talking about and booking homebirths till later on (34-36 weeks) as some complications only show up towards the end of pregnancy but you should be able to bring it up at earlier appointments.
Again different areas have different routines, they may guarantee one of your 'team' of midwives is at your homebirth, here, one of the team come if you labour on a day shift, but at night there is a rolling rota of all the community midwives in the area (could be anyone of about a hundred women) and the hospital midwives are different women again from the community midwives (this ius why some women choose to have an indepeandant midwife or doula to make sure they have some continuity)
You are not alone! Its not an ideal system, in any sense, but its the way the nhs manages.
HTH
Selina

It sounds pretty normal to me. Here is a schedule of what you can expect at each appointment.

I don't know how your hospital operates but where I am there is a team of midwives and you are assigned to one for your antenatal care. You may or may not see the same one twice, and when you go into labour they may or may not be on duty at the hospital. Here the homebirth team is separate. I think 34 weeks is probably fine to book a homebirth, since they won't book you in until they know your pregnancy is proceeding in a "low risk" fashion (or so I gather: I have not booked a homebirth, but you have to book a midwife-led hospital birth here, and that happens in your last month).

If you have questions, make sure you ask them in your MW appointment, The person who took your blood may have been a phlebotomist (who can't answer any questions) and if there are things you need to know now, call your midwife team, tell them you are confused and either get them to help you on the phone or get an extra appointment to see them.

IME the NHS is very busy, very stretched and the squeaky wheel gets the grease. If you are not assertive the midwives will assume you are fine and happy and will carry on accordingly. So if there are things you need to know, do pipe up.

Congratulations on your pregnancy. If they're ignoring you it means things are fine - so that's a good thing!

I never saw a gp in pregnancy. I saw a mw every 6 weeks from 10 weeks, then the gap closed to 4 weeks in the last trimester, 2 in the last month. I booked for hb at 34 weeks.

If you're on "shared care" you do see a GP (that's what happened in my first pregnancy) instead of going to the hospital. It's perfectly normal.

OP I thought you were me writing this post .

I've had exactly the same experience as you (at almost 30 weeks now) and sort of wondered if this is how it was supposed to go - and in my case I'm fairly low risk and otherwise healthy but if I were the worrying type I would not have been super confident that the NHS knew what it was doing.

I've also chosen for a homebirth and have been told that I will probably get a midwife I've never met on the day - not that it matters as I was booked in by one midwife (a semi-retired woman "filling in") and only just met a full-time midwife on the team a few weeks ago for the first time at my 28 week appt. Between the first appt and the last I've seen a mix of GPs at my surgery (not even "my" GP), locum GPs, and the semi-retired midwife again. So not exactly consistent treatment. I guess that's why we carry notes.

In any case, I'm not too worried about it, like I said I've had no problems and the fact that everyone else seems so blasé about my pregnancy means I've stressed less about stuff than I maybe would have iykwim. I'm also pretty assertive and have no problem asking questions of anyone, demanding information as I've needed it, and making my wishes known. So unless things go completely tits up I feel like I'm where I need to be with my own comfort and confidence level.

I highly recommend you read as much as you can about stuff though, anything that comes to mind where you have a question, just start googling and reading all about it. I think because I felt so fobbed off by my GP surgery and this invisible team of midwives where I live, I've felt more responsible for keeping myself informed of the choices I have, the routines that are set forth, how things generally work, and all that. Self-informing is very empowering!

Hope this helps.

i see my midwife lots here

and i want a home birth and have known this since before I was even pg!

Told mid-wife at 5 weeks

she told me how they are very pro-home birth in this area and that she is part of "the red team"
She also said that they will not deicide weather i am eligable for a homebirth until 34 weeks at the earliest.
I need to have an uncomplicated pregnancy, and so long as am low risk at go into labour naturally between 37 and 42 weeks it should be fine...
but crucially they wont decide that until 34 weeks

Im happy to hear that booking for homebirth at 34 weeks isnt too unusual. I booked my own parentcraft course through the hospital and they are run by the hospital midwives so hopefully I can get some more info from them there.

I think my hospital must do shared care with the GPs but there doesnt seem to be any communication between them. The GPs had no access to my notes until I collected them at the 20 weeks and took them to my 25 week appointment.

Im not too concerned about not knowing the midwife who attends the birth, I know there will be limitations on this and we cant afford doula/private midwife. I still think the positives of staying at home will outweigh this. Am a lot happier now knowing that it isnt unusal to arrange one in the last 6 weeks of pregnancy

barelyutterly: Glad Im not alone. I keep reading about people talking about their 'midwife' and kept wondering when I was going to meet him/her!! I need to work on being more assertive I think and plan more questions before each appointment. That is true about it being good that they arent worried about you. Hopefully we stay low risk!

If you did want a doula, a trainee doula can only charge expenses and Doula UK have a hardship fund.
See-
doula.org.uk/
S

Hi - We are trying to increase our homebirth rate at the hospital I work in, and if someone asks for a homebirth they are referred to one of our teams, who will book them right from their earliest visit to the hospital or from when we receive the referral. They will stay with their named midwife, who will see them for each appointment and hopefully will attend them at home to help deliver baby. Most of us want to be called for our own patients even if we are not on duty, as we build up a relationship with the women throughout the pregnancy.
When we take on someone for homebirth, there is no need to see the GP, hospital doctor or anyone else for that matter unless there is a problem and most visits are done at home. For my last homebirth, my patient had not seen anyone except myself for her entire pregnancy since she was referred to us.

Obviously this is not the case elsewhere but I feel it is a great service for women in our area (central London).

For women going through the NHS clinic system, you will have a named midwife but probably wont see her again and you share care with the GP / surgery midwives who will carry out most of the antenatal care, only attending hospital for a few visits such as booking, usually about 36 weeks and for induction at 41 weeks if necessary. Also for scans and bloods etc with the sonographer or phlebotomist. Its rare for someone to have met the midwife who will deliver baby in labour ward.

Hope all goes well for you.

Sounds pretty normal. You should have been given a schedule of when your routine checks will be. It's a myth that you have "your" midwife on the NHS. Generally you'll get care under a number of professionals. Even at my surgery where there is only one midwife I've seen at least three different ones because "my" midwife has been training / sick / on holiday. And actually that's fine with me as long as they are all able to do their job properly!

Do ask questions of any of the health care professionals you see though - including "when will my next appointment be and who will it be with". And remember there is no such thing as a stupid question.

I am also planning a homebirth, and mentioned it fairly early on (at 16 weeks I think) - the midwife just confirmed that I was currently low-risk, but their policy is not to book you in for one until you are 36 / 37 weeks. I have been told to bring it up again at my routine 36 week check (in 3 weeks ) and they will arrange a home assessment with me, at which they will discuss homebirth / reasons for transfer/ suitable equipment etc etc with me. To be honest this makes a lot of sense, as you can't have a homebirth before 37 weeks (as the baby wouldn't be full term), and NHS guidelines also suggest that a homebirth is only a good idea if your pregnancy is low risk. And even if you are low risk at 26 weeks you might not be at 36 weeks (eg you might get pre-eclampsia or something in the intervening period).

So personally I am completely comfortable with only "booking" a homebirth and having a proper homebirth conversation with a midwife when I am 36 / 37 weeks.

Hope that helps.

Mintpurple - that sounds like an amazing service! Good on your hospital!

Oh yes, and OP, as well as you being pretty unlikely to know the midwife who attends to you at a hospital birth, you are also unlikely to know or even have previously met the 2 midwives who will end up attending your homebirth. This matters a lot to some people, but again, I'm more interested in whether the person can do their job and care for me properly than whether I have met them, so I'm not fussed.

Nannyl:
She also said that they will not deicide weather i am eligable for a homebirth until 34 weeks at the earliest.

It's not up to them to decide whether you are eligible - no one can force you to go to hospital. All they can do is advise you that you would be better off in hospital. Obviously if you have a good relationship with them, you are likely to take their advice.

true...
but they only homebirth low risk on the nhs (i think)
and given that im at least 45mins from hospital, and in traffic over an hour i will be taking their advice

if my midwives are happy that its safe enough then thats good enough for me, If they have reasons to believe its not ideal for me and baby, then i wont take that risk either, especially being so far away from hospitsal.

would take as long in ambulance as am out in sticks so ambulence would have to get to me 1st and then drive all the way too.... am sure that would be 45mins MIN in total, even with blue lights...

alls ok so far so keeping fingers crossed

After seeing almost every midwife on the team during my pregnancy, I was lucky enough to have my named midwife with me for most of my labour at home. Unfortunately, she was unable to stay after the end of her shift due to other commitments and another midwife turned up to take over. Care was continuous and excellent nevertheless and my named midwife visited every day after the birth.

I think I indicated very early on that I wanted a homebirth but it was only confirmed around 36 weeks as they like to make sure everything is progressing nicely. Actually, now I think about it, it was later than that because baby was breech and only turned at 39 weeks so it was very last minute but the midwife knew that the intention was always to have ahomebirth.

The hospital will always say that they can't guarantee a homebirth if there isn't sufficient midwife cover and you'll have to go to hospital, but stick to your guns and insist if that's what you want. There are lots of threads on here about homebirths and "rights".

I would say that because communication between midwives, hospital and GPs isn't great in this area, I might have slipped though the net a bit so you might have to follow things up a bit more yourself.

Good luck and I hope you have a stress free birth :)

Nannyl - I totally understand why you want to take the advice of the midwives, but just for info it's not correct that "they only homebirth low risk on the NHS". They can advise why they would not recommend a homebirth, but fundamentally it is still your choice. Just like they can 'advise' a c-section for certain complications, but you would still have the right to ignore them. Sometimes people do take an educated decision to overrule a recommendation for a hospital birth (for many reasons) and there's a good AIMS booklet called something like 'am I allowed?' on this topic.

marigold I found writing a list helped me at midwife visits.
I'd forget what I wanted to ask or get distracted by other things which came up at appointments.

Thanks for all your help. I am feeling much more relaxed about it all. Will bring it up every time I see a midwife just to make sure.

I am feeling so much more confident about having a homebirth so hopefully it works out for us :)