how to insist on a home birth??

[stella1w]

I was all set for a home birth until a 28 week scan (due to fall in the street) showed the baby was 95 percentile for abdomen circumference. Cue doctor muttering about shoulder dystocia and diabetes (though they refused to do the GTT at the time and later on said it was too late in the pg for it).
I am now 34 weeks and feel like I am being fobbed off by the midwives on the home birth issue eg. they are delaying me booking a home visit which is the first step eg at my booking appointment they ticked hospital instead of home birth despite my insistence.
A booklet by RCOG says 50 per cent of shoulder dystocia is with babies above 9.5 kg and 50 per cent below and that late scans are inaccurate (which is clear from various threads on this board).
However, it's very unclear to me if I have the right to insist on a home birth and if so, the best way to do it. Seems to me that each hospital has different policies and protocols (which also seems strange to me) and so much depends on the midwife you get. So far I have seen a different midwife every time and they kick off by not reading my notes and asking me how many weeks I am. Which doesn't inspire confidence. My care is also disjointed, with all antenatal being done at one clinic with totally separate midwives for delivery.
It's now too late for me to change hospital and I am furious they are stringing me along like this.
Advice on how to approach them would be great, particularly if anyway has any national policy/evidence I could use to bolster my wishes..
Thanks

"To quote a letter from a retired (female) GP, "the only safe homebirth is one with hindsight"

Why would you take the opinion on this issue of someone who's probably done fewer deliveries than a second year student midwife, over the official line of the Royal College of Obstetricians and Gynaecologists, who support the view that homebirth is safe for low risk women?

Seriously? Do you think GP's are an authority on the safety of birth in different settings?

"I love the notion that all those demanding home births are so happy to be taking up lots of resources ie lots of midwives which may put at risk babies born in hospitals"

The only responsibility women have in this matter is to themselves and their babies. If their local hospital is so short staffed that women are being put at risk then a low risk mother is actually reducing the risk to her baby by insisting on a homebirth, where she is GUARANTEED one to one care from an experienced midwife.

Last year 5 women died at my local maternity unit. Three of them in the space of two months. The investigations are still ongoing but the current view is that at least one of these deaths was avoidable and down to inadequate staffing levels on the labour ward. If I was having a baby locally now I wouldn't hesitate to have a homebirth - much safer than putting myself at risk of inadequate care on an understaffed hospital ward.

Here it is community midwives that do homebirths, not hospital midwives. So you aren't taking away valuable resources from hospitals. There is absolutely an issue about understaffed hospital wards, but homebirths are not to blame. In fact, taking low risk women out of the hospital environment means more time for those who are at high risk.

"means more time for those who are at high risk."

v. true. And the much lower rates of c/s in homebirth mums means that theatre space and obstetric care is freed up for high risk mothers having complex births.

for the 'its-all-about-the-baby-what-if-you-have-an-emergency-and-can't-get-to-hospital-in-time' histrionics.

please reference what the RCM has said time and time again:

a home birth for a low risk pregnancy is as safe as a hospital birth.

That is, despite all the expensive stuff that go 'ping' available there.

People who opt for a home birth are opting for a different set of risks than those who choose a hospital birth. they usually inform themselves more thoroughly about the choices they have made and are usually more prepared to take ownership of the choices they have made.

As for them being selfish and what about taking resources away from hospital births, ah well, 1 Homebirths are statistically cheaper by a long way

1. A home birth rota for midwives is different from the hospital shift rota (or should be anyway).
2. Provision of hospital births should not be at the expense of providing for home births
3. The lack of midwives in maternity is due to cuts in budget made by the hospital administration. Cuts which have been occuring even in the spend, spend spend years, not just since the new Gov't came to power. Fighting with women planning home births divides us. Our energy will be much better spent on demanding one midwife to one woman no matter where the birth occurs.

Well - that's a first for me. I've never had a post deleted on mumsnet before.

Time for a methinks.

wow.. I have just come back to this thread... update is that I declined further scans, went back to the midwife track, had a checkup on Sunday that showed all was fine and baby measuring normally. Booking a home visit is tricky because they won't try to find an appointment until your 36 week and will give no notice and may cancel if because they are busy delivering babies but so far the midwives seem unfazed by the 95 percentile AC.
I looked up shoulder dystocia on RCOG and it says scans are inaccurate and 50 per cent of babies with SD are under 4.5 kgs and 50 per cent over.
I am not tying up the resources of midwives because one would have to attend to me during delivery anyway - I am freeing up consultants. sonographers, and a hospital bed!
Much has been written about how a hospital birth can become over medicalised and lead to unnecessary complications.
If I had the money I would go for an IM to get the support and continuity I need. btw, at the last appt they realised they had forgotten to take my 28 week bloods! And I have to have those in case I am anemic and therefore not a candidate for HB. Would have been nice to have known this kind of stuff in advance. I asked on the phone what I should gather together for an HB and was told, not a lot, a torch and a bowl to be sick in!!

stella i hope you get the homebirth you want and that you are entitled to choose

pleased to hear latest scan was normal!

Lol - I think that's the first time I've had my mental competence called into question (by anyone apart from myself :o)!

I think most points of have already been answered. One that maybe hasn't is this one of camilla's:
Actually unbelievable.You have been told that you are at risk of shoulder dystocia. Do you understand how serious that can be?It can leave your child with permanent damage! Maybe the doctor was 'muttering' about shoulder dystocia because he knows that too, given that he is the professional here - unlike the posters here!
Yes. Its possible. Its also possible that, as a consultant, he hasn't seen a "normal" birth in the last 15 years and so is giving an opinion skewed by his experience. That's the generous version. Its also possible that he share's camilla's view that all homebirths are intrinsically unsafe and its his duty to persuade all women daft enough to consider it into hospital by mentioning issues that can occur in any birth, in any location without discussing how the individual woman in front of him is at any higher risk than Jane Smith up the hall and without discussing what the consequences of that issue may be in a home or hospital environment.

I don't think I've ever seen a post on MN where a woman has been told "yes - completely ignore all medical advice and have a HB regardless because you're entitled to it". I've seen a LOT of posts saying "Ask more questions. Find out why they think its not a good idea. If you still want to go ahead once you understand your personal risks and they won't support you, these steps will help you achieve a HB."

Sorry if this embarrasses you, MintPurple - but I really wish more MWs (and consultants, for that matter) had your attitude. You seem to actually follow through and enable women to make an informed choice regarding the births of their children, where so many MW's seem to merely give the concept lip service. IMO, one of the reasons why women wanting a HB become so defensive and militant (although I hate to use the word) is because so often we are treated as though we need to be spoon fed the little bits of information our poor feeble brains can cope with so that we come to the "right" decision (according to the HCP doing the spoon feeding). Too often we're put in a position of not being allowed to ask questions, to have an opinion - we're not given the courtesy of having a discussion between parties that have a shared interest even if they don't have equal knowledge. If we, as women (and our partners) are not extended that courtesy then all to often it leads to a break down of trust. And then you're into the whole them vs us scenario, and it spirals on down :(

Big x-post - glad you feel happy with your informed choice Stella, and wishing you a relaxed birth in the comfort of your own home :) (If you want a more detailed list to work to, have a look here. If you feel strongly about an IM you loose nothing by calling a couple. Many will do payment plans and/or take payment in kind - I think ours was after a decorator or kitchen fitter, and had her freezer stocked by a client instead of cash. You may not get anywhere, but if you ask it might be more possible than you currently think.)

ps - you know you can choose to stay at home even if your HB levels do come back below your PCT's cut off, don't you (at the risk of starting the whole merry-go-round off again :o)?

sorry.. what are HB levels???

HB = haemoglobin. Its the first pass measure of the concentration of iron in your blood and therefore how anaemic you might be.

There is an argument that low HB if that HB level was measured in isolation is not terribly meaningful. There's a lot more detail here, but hopefully your levels will be plenty high and you won't need to worry about it :)

thanks.. I was muddling it up with Home Birth..

stella, I want to apologise to you for my angry post. I think I took the thread in a different direction than you meant it to go. I'm glad you have thought things through and I hope your homebirth works out for you.

Also, I did not mean to imply that hospitals are teh evilz. I think they are wonderful when you need them and, as a transplanted American, I think the NHS is brilliant. That being said, my reasons for wanting to have my baby at home were varied. I did manage it, and my midwife only did hb so I wasn't taking up any other resources. I honestly believe that, for me, the familiar environment made my birth easier (I didn't even need stitches) and thus I was better with my baby who is currently snoozing next to me.

MintPurple, I am curious. Which is the McRoberts maneuver? Also, I agree with Tangle. You sound lovely.

mumwithdice -did not see your post as angry (although clearly the person who called me ignorant and selfish was angry!!)

Just to update - had home visit at just before 36 weeks. Midwife agreed baby was not too big and scans could be wrong. Spent an hour and a half going over things, very supportive. I am not anemic and everything looks fine.. so thanks for all the support, hopefully I'll give birth at home!

:o

So pleased you got a pragmatic MW and your plans can go ahead - fingers crossed your LO co-operates from now on

stella1w, I had to have a scan at a little over 37 weeks because my mw had measured me too loosely with a tape measure. Scanner had a bit of trouble because my baby was engaged already and very low. As it happened, my baby was perfectly fine for size so we went and talked to my mw who gave us the homebirth talk. That was on a Thursday. DD was born that Saturday at home. Think she was ready to have a look at the world.

Hope all goes well for you!