I can't have a homebirth because...

[trufflesbum]

I'm 36+5 with my first baby. Midwife has claimed all the way through that she is supportive of my plan for a homebirth, but is constantly throwing things in the way. So far, everything has been by the book, but she tells me I'm "not allowed" a homebirth if baby might be big (he's measuring perfect), if he's early, if he's late, if my BP is high (it hasn't been), if there's meconium... There's also a large list of resons why I "have to" transfer.

I also "have to" allow the heartbeat to be listened to every 15 minutes, and must allow an internal at least every 4 hours. I am not wholly happy for either of these, and she can provide no logical reason for this other than it is "policy".

The most recent was at my appt yesterday, where she noted that the baby is not yet engaged. He has been head down for some time now but is yet to engage, which I gather is not all that unusual. Midwife says that if he's not engaged I "will not be allowed" a homebirth.

My reading suggests that some babies don't engage until labour starts. I'm also aware of the risks of cord presentation/prolapse and still feel that I would like to continue my plan for a homebirth.

Any stories of babies that didn't enage until labour started? Or suggestions of what to say to the midwife? I feel like she's determined to get me into hospital!

That's rubbish sponge. They try and force persuade first time mum's because there's no previous birth experience to judge how 'easy' it will be. If you've not been on the receiving end of it you don't know how persuasive they try and be!

Even my dad (retired GP with many home births under his belt) suggested hospital may be best first time but agreed afterwards it had been a perfect home birth. And yes he goes on and on about the women he would see in his clinic while working in 3rd world countries who would drop their babies and be back in the fields the next day

I asked the consultant when I saw him about my iron level (being vegi) and he said it was bordering on low but not of concern and just to bear it in mind and eat more iron rich foods. I got home to my mum insisting I immediately had to go to the doctor for iron pills as my iron level was dangerously low! If I hadn't of asked at the hospital I wouldn't of been any the wiser and probably paniced. The results were the same, it was just the interpretation that was different.

OP if there are no complications and your pregnancy has been normal then what are the concerns exactly? Ask her what they are, ask to see the policy and be insistant that you are having a home birth and that's that. People stopped trying to persuade me when they could see how determined I was and there was nothing in my pregnancy that they could point too as a possible complication.

Mine didn't engage until labour started.

I had a straightforward vaginal delivery with no complications, but he did go back to back when he engaged, so I had an epidural, which obviously wouldn't be an option in a home birth.

Porkchopster's second link is what I came here to post :) The page used to be called "You can't have a homebirth because..." and then has counters to all the arguments. (They've changed the title to 'can I have a homebirth if...' now. I prefer the old one)

I'm not suggesting that I won't transfer to hospital, or that I won't listen to her! I'm simply saying that I don't appreciate being told I'm "not allowed" to do somthing that I absolutely am! Especially when I'm not given a valid reason.

Sponge, she hasn't given me any reason why she would think this. I might be more undertsanding if she did. OnEdge - If she can evidence her advice I will be happy to listen. She Simply states it's policy. I'm a nurse myself and not all of the policies I am expected to follow have a firm evidence base.

Wow how supportive of her.

What a load of crap quite frankly. Not all babies engage before labour starts, my last 3 didn't.

I have had 2 HB's and I didn't have any internal examinations with either and was only monitored with hand held doppler very few times and most certainly not every 15mins!

It just sounds like she is determined for you to have a hospital birth.

Very nice of her to be concerned and all but it's your choice.

I hope you get your HB and get 2 lovely kind, caring and supportive MW's there.

you are absolutely right to be annoyed at her saying 'you are not allowed' etc as it is a load of bollocks. the onus should not be on you to have to refuse things, the onus should be on her/medics to convince you that any intervention is necessary of advantageous. you will know at the time obviously if interventions are necessary.

if all is going fine, i'm pretty sure there is no NEED for you to be monitored every fifteen minutes. like i said, the onus would be on her to convince you why on earth this would be necessary in a labour that is progressing normally.

good luck and i hope you get good mws too!

I have had three our of four of my births at home - my first was in hospital because she arrive at 36 weeks in a bit of a hurry after i had gone in for a check up...

Look the thing is with first time babies is that you have no idea at all of how you are going to be feeling when it happens - the transfer rate to hospital is much higher for first timers hence her trepidation - My midwife does home-births all the time and she is really confident about it but i do know she is less keen with first babies - she says these women end up transferring mainly because they end up with not coping emotionally - sometimes getting very scared - sometimes being overwhelmed by pain and how long the process it - I am not saying this is going to happen to you (personally all my births have been as nice as pie) but this is her opinion.

Personally I would recommend a home birth to anyone but you honestly do have to keep an open mind - just smile and agree and do what the hell you want . You do not have to have an examination is you don't want one but really - if she needs to check how far along you are what the hell is the problem. She may not even have to check if things are progressing but there are rough timelines re. dilation etc for the safety of you and your baby. You can choose to ignore these if you feel confident to do so but she cannot - it is her job. Just make it easy on yourself. I have had the same midwife deliver my last two at home and she tells me all the reasons for transfer every time - I even have to sign a paper to say she has told me and that i agree to transfer if any of these things happen.

Please don't be too militant about it all - it can be done but you have to chill a bit. She knows her job and she knows as a first timer you are much much more likely to have to transfer than someone on a second or third child. I would however recommend Mary Cronk too - she is an amazing and inspirational woman and what she doesn't know isn't worth knowing.

And actually there is a need to be monitored every 15 mins - it is a sonicaid on your belly - wtf is the prob with this??????????????????????????

why every 15 minutes pinky?

she's not a vbac?! what could happen?

That all sounds about right except for the engaging bit. No reason to wish that lovely kicked in the fanjo feeling any earlier than necessary!

I had a homebirth and didn't find the monitoring with the hand doppler intrusive nor were the internals but mw asked permission and once we got to transition I barely noticed but it's good to know the baby is being checked - it's one of the perks of one-to-one mw care you get at a homebirth.

Fwiw I had bugger all prep for a hb from nhs. Luckily I had a fab midwife attend... who I'd never met before and trusted my body and had a great NCT teacher. I wish my mw had been at all interested in discussing it with me.

I suspect your mw is just fully preparing you which is good practice because most first timers don't deliver at home.

Re the 15 mins my understanding is that because you're at home they are extra cautious. If there is even a hint of a serious problem (ie something a mw can't handle without assistance) they want to get you to an obstertrician asap so they check for problems more often because if baby gets distressed they need to act fast.

fair enough KatieMiddleton, sounds logical - i was just wondering what can happen 'suddenly' in 15 minutes during a normal well progressing labour (gen. interested - sorry to hijack OP!) i'm not against it at all - clearly not a big issue with a handheld...

sorry - RubyB is peanutdream - wrong sign in!

OP - Pinky gives v reasoned advice.
FWIW as a first timer my midwife never mentioned homebirths, when I went to see the same MW about a year later for DC2 first thing she said was 'So are you going to have a homebirth this time?' she was really keen on it.

I wouldn't think of monitoring as 'intrusive' they are looking after you. And, I may get flamed for this, number one priority is the baby and it won't give a damn where it's born as long as it is born safely.

"number one priority is the baby and it won't give a damn where it's born as long as it is born safely."

And if there was good PROOF that following all the normal hospital protocols (like routine vaginal examinations) while at a home birth actually IMPROVED outcomes then I think there'd be a very strong argument for strongly encouraging them.

Some women choose not to be monitored or examined (unless there's a clear clinical indication for it) - in hospital and at home, for the reason that they feel this may disrupt the normal hormonal cascade of labour and make problems more likely.

OP - I suspect that it's the WAY your midwife is communicating with you which is undermining your confidence in her and in having your baby at home. There are ways of talking about these things which don't make you feel anxious and negative. Your midwife perhaps hasn't got the knack of it, or is betraying a lack of confidence in her own skills and competence to care for you at home. If it was me I'd tell her how this is making you feel.

Wanted to add - NICE guidelines are for monitoring every 15 minutes in labour. This is CLEARLY not happening in hospital much of the time - it can't be if you believe the stats on how much time many mothers are spending alone on the labour ward because of midwife shortages....... Doesn't seem to put people off hospital births.

"I don't appreciate being told I'm "not allowed" to do something"

I'd lose all confidence in a midwife who used this sort of language with me.

Coercive, insensitive behaviour. Not what you want in someone you need to establish a relationship of trust with.

I was all for a home birth in fact if anything I felt my MW's were pushing me into it as he was number 4.
As it happened I decided to go to hospital but from 36-42 they were happy for him to be born at home, he was also big and there would have been an under water dopla thing to listen to his heart beat, I wouldn't have noticed.
They can't do an internal if you're in the birth pool and they don't like to if your waters have gone.

This site also good for homebirth information and is very positive like AIMS who have excellent facts you can use to help you hold your ground against negative midwives.

The reality is you don't neccessarily know when you go into labour if you will have a smooth or difficult birth. Midwives and doctors push for people to be in hospital because if something does go wrong everything they would need would be there already and no time would be lost transferring.

The midwife who assessed me when I first went in to hospital with contractions two minutes apart said to not come back until I couldn't speak during contractions as if I stayed the doctors would want to intervene to speed things along (guess shortage of beds more important than labour progressing naturally as had only been in first stages of labour (not active yet) for six hours!). I wouldn't be offered homebirth now (but could still have if I went private or pushed NHS very hard for it) as next baby would be VBAC after EMCS. DD's head got stuck in funny position, probably because I was made to lie on my back once at the hospital to be monitored for hours (due to a very small amount of meconium in the waters and the fact that they didn't have the correct equipment to allow me to be monitored continuosly whilst in other positions) contradicting all the advice given during pregnancy re: position.

Even in hospital they still examine you internally, and monitor you. Four hourly for internals is not too bad and by that point you probably won't even care. Doppler monitor can be done in any position and is not invasive.

Having had a labour in hospital which ended in EMCS I know how quickly things can go downhill. From MIL spotting DD's heart rate dropping during contrractions (yes midwife didn't notice!) to EMCS was about half an hour. When they took me into theatre they told DH they had only 7 minutes to get DD out before she became oxygen deprived which really isn't very long. I am not trying to scare you or put you off by telling you this, I just want you to be aware of all the facts.

Had I had a normal birth with DD I would have considered homebirth second time around as it just seems more relaxed and personal than the hospital environment. If I did go for homebirth I would look into transfer time between hospital and home during busy times just in case.

I hope the midwife you get to attend you is more positive than the one you see and that you go on to have a successful homebirth.

One of community MWs was very clear in an antenatal class that she does not agree with homebirths. Even though it's her job to provide them. Her reasons:

• she does them on call after a day at work and it interferes with her life
• she does them on call with a day off next day and it ruins her day off
• if she is knackered after a day at work then has to attend a HB she can call for backup but doesn't like to do this
• the NHS have better things to spend their money on (?) than giving one to one care to a woman in labour

I will say that she asked the class where we were giving birth (all hospital births) before spouting off this rubbish. Basically she has taken a job as a community MW but doesn't like the on-call / HB aspect. If she were advising anyone about a HB, I'd imagine she uses similar language i.e. "allow", "let" etc rather than behave in an advisory capacity. Just something to consider.

wow - 7 minutes - that isn't long at all actually is it?! i thought it took longer for things to start being dangerous.

thanks spudulika re NICE for every 15 minutes monitoring info

i agree AIMS very good site

The homebirth.org.uk site others have linked to is very good.

Your midwife is talking bollocks. You do not have to be engaged, induced, examined or monitored at any particular time. The problem with timelines for 'normal' births is that no-one has told your body or your baby that they have a timetable to work to - so if things are not progressing exactly as planned, in hospital you may be more pressured to allow augmentation rather than perhaps a more wait-and-see approach at home.

It is not for her to ALLOW you to have a home birth. I'd have told her as much, reminded her that consent would be needed from me for each and every single procedure and would probably have put in a complaint to the SoM if a midwife had spoken to me that way.

I very nearly complained about one who put my back up by making it appear I had no choice in where I had my baby.

Can I also say that a first time labour isn't a trial run for subesequent births - having a successful hospital birth first time round doesn't meak you'll have a successful birth second time round.

Can I also say that a first time labour isn't a trial run for subesequent births

That is very true, i've had 4 and they have all been completely different.

So 1st time mums are about twice (IIRC) as likely to transfer in during labour - most likely for pain relief. That isn't a blue light emergency job. I found it quite scary that, for low risk women, planning a HB in and of itself halves your chance of an instrumental birth or CS (with no statistically significant change in outcomes). Somehow the MW didn't mention that (or any other) risk of hospital birth when we were talking about HB.

ZhenXiang - I'm really glad your Dd arrived safely and you feel you were in the best possible place. I'm not trying to comment on what happened to you in specific (I can't - I don't know the details and I'm not an expert). All I'd say is that I know a lot of people who, when they heard we were planning a HB, had similar stories - "our DC would have died if we hadn't been in hospital as it all went wrong very fast." In every one of those stories there was a common theme in that they'd had little care for much of their labour - when a problem was spotted it was significant and required instant action. After discussing it, they all agreed that with a MW in attendance and observing the labour more closely the big emergency situation may well not have occurred. To re-iterate, I'm not trying to comment on your birth specifically - it was just that you brought up a point that I thought was worth exploring in light of my own experience.

peanut - what I found very hard to establish was whether the very short time window till disaster was from when the problem started, or from when the problem was identified. From the research we did our conclusion was that a high proportion of the cases were the later. Are you safer in hospital, with all the facilities to solve problems but without the staff to avoid them, or at home, with no facilities but 1-to-1 care? I don't think there's a right answer for everyone - but to me at least the question was a lot less cut and dried than a lot of medical professionals would have me believe.