advice for getting the homebirth i want when "decision" wont be made until 36+5

[nannyl]

At the moment in 28+5.
Im having an uncomplicated (first) pregnancy, and I always see my (lovely wonderful) community midwife on a Friday so Im always X+5.

Anyway i have known since before i was pregnant that I intend to have a home birth. Now im pregnant and have researched it even further i know the decision is right for me.
Its what i want, what i have a right to have, and MY choice.

I also know that midwifes / NHS like to think its their choice, but the reality is its mine.

I have been talking about having a home-birth since my 9 week booking appt. My midwife has always maintained that they dont make the decision until my 36week apt (which i will have at 36+5)
(I have not yet bothered to have the "its MY choice" discussion cause i dont see the point... at 9 weeks anything could have happened and even now i could have a premature baby and have to go to hospital)

The midwife has always said they dont decide until 36 weeks as there is lots of paper work, and no point doing it, if there are last minute complications, which i understand.

However if my baby is breech (today she was head down but of course can move) I will STILL be wanting and insisting on a home birth. (Im sure that wont go down well!)
Also in the event that my BMI is slightly above the limit of 35 (I doubt it will be, im only a size 12) I will still be choosing a home birth.
Or if there are any other minor risk factors which matter to NHS (but not to me) I will still be choosing a home birth against their advice.

It strikes me that on the Friday, less than 48 hours before i become term on the Sunday, i could have to start my battle for my right to a homebirth. (and this doesnt give me much time to fight my corner if necessary)
Also when Im so close, i want it to be all sorted and not wondering at 36+4 if i will be allowed to give birth at home!

Does anyone have any ideas?

Also if baby is breech, and NHS really have a strop id happily go for an IM, but it doesnt give me much time to find one, if i only call them, when i could go into labour at any moment, and they will have bookings / plans etc.

Id rather use the NHS (and have met 2 lovely community midwives out of the 5 that might attend already) though, and on the positive side, because i live so far from the hospital home births are very much supported in this area, much more so than in many other areas.

I have already been admitted to my hospital (I have no choice regards to hospitals, there are no others close enough) with HG, and (unless in an ambulence for an emergancy) i do not plan to go their willingly, at all, ever. It was awful (another thread lol)

Of course if there are complications during the birth i'll have no choice, but to go in, which is fine, and if baby is transverse (or if placenta was in wrong place; its not) I accept that a homebirth is positively stupid, and id be admitted for a CS, but otherwise i intend to at least try to give birth at home, as is my right.

Has anyone else had the decision made SO late in pregnancy?
I am normally super organised with everything (i have my birth pool, towels, waterproof sheets etc all ready ) and I find it stressful that its my decision and im not allowed to make it until just a matter of hours before becoming "term".

Also i know the midwives here like to deliver home birth stuff so its ready. Well if i dont get 'booked for a home birth' until Friday at 36+5 will they really get the stuff here before Monday? 37+1?

(and yes i know as its my 1st im highly likely to go overdue anyway, but i still want to be all ready!)

Any advice welcome!

[nannyl]

pinky....

at 31+5 its now been agreed..... so long as everything continues to be fine
My midwife probably got bored discussing it with me at every appt!... and my next midwife appt, (all being well of course) will be the last that is at the surgary, the rest will be at home.

Paperwork will be done during week 36, and i'll collect the homebirth kit myself, from the midwife led unit at 36+6....

Baby just needs to behave herself for 5 more weeks, and arrive by 10 weeks time!

[pinkytheshrinky]

Firstly you need to calm down a bit - it is early days. And no, they will not deliver a homebirth kit to your home before 37 weeks - that is prefectly ok as if you go into labout before then you should go in anyway. What they mean by waiting until you are 36 weeks to book it is they will not put you on the rota until then - how on earth do you expect to plan that far ahead????

Look, they do this all the time, they know you have a right to a homebirth and they also know that the majority of transfers in from homebirths are for first timers... this will probably not be the case for you but it is a fact.

My genuine advice to you is try to be a bit more flexible, you do not know what is going to happen, your baby being breech right now is absolutely no indicator for how it will lie nearer the time.

I say all this as someone who has had one preterm birth rather unexpectedly in hospital and three straightforward homebirths after that. When I have another baby with all being well and good I will have it at home too. Please try not to be too hard and fast about everything, please be flexible because having to climb off your high horse whilst in labour is a long fall.

[UkeHunt]

Great news, pleased for you.

[Bue]

That's awesome news, nannyl.

I think because people generally like to be in control of what's happening to them, it can be really hard to wait til 36 weeks to have the HB conversation. But once you get there, it's highly unlikely you will be denied if you're a good candidate. They could handle it better however, by saying "we'll make the decision after 36 weeks, but if you're still low risk then it shouldn't be a problem".

Please let us know how it goes!

[brettgirl2]

Thats really good news :-)

[nannyl]

UPDATE

thought id add, been to midwife today at 31+5

Have been discussing home birth (its no longer too early to think about) and baby is in the right position etc.

So long as baby not born early etc, (or other major complications between now and then) I have full NHS support for the home water birth i plan...
and my (lovely wonderful) midwife, who i have seen throughout my whole pregnancy will do her best to be there personally .

Such a relief.... it is now officially official that i want and plan a homebirth
One more appt with midwife at her clinic then the rest of my care here in my own home.

[Tangle]

That's true WidwoWadman - but it doesn't necessarily follow that the infant mortality rate is high because the Netherlands support homebirth. The author of this article seems to think that HB isn't the problem but more a lack of communication between MWs and consultants resulting in a poor identification of women with increased risk factors, combined with some social problems making some demographic groups much more likely to have poor outcomes regardless of birth place (for various reasons, including smoking, diet and lack of antenatal care).

[spudulika]

And the response to that study:

"Too early to question effectiveness of Dutch maternity care system
Ank De Jonge, senior midwife researcher Ben Willem Mol, Birgit Y Van der Goes, Jan G Nijhuis, Joris A Van der Post, Simone E Buitendijk
Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical C

With interest we read the study from Evers et al. on perinatal mortality and morbidity in the Utrecht region, one of the 12 provinces in the Netherlands. This is the first study ever to show a higher mortality rate among births that started in primary care compared with secondary care. We have concerns about the methods used.

First, although the title suggests that this is a prospective cohort study, the entire population at risk has been defined retrospectively and was based on postal codes of the catchment area of one university hospital. All intrapartum and neonatal deaths were included from hospitals and midwifery practices within this area, but potentially not all births. Midwives in practices at the periphery of the catchment area will also care for many women in neighbouring regions. These births have not been included in the study, unless the baby died. This will artificially inflate mortality rates in midwifery practices.

Second, the study was conducted in only one region in the Netherlands. The intrapartum and neonatal mortality rate was twice as high as in recent national studies among women in primary care at the onset of labour (1.39 versus 0.65 and 0.52 per 1000)1;2. Although classification bias and underreporting may have played a role in these retrospective studies, it is unlikely that half of all deaths would have been missed. In another prospective study of perinatal mortality cases only 3.5% additional cases were found as compared to national registration data 3.

Strikingly, in Evers' study 67% of all babies that died during labour were born in primary care. This means that either the midwife noticed fetal distress too late to refer a woman because the birth was imminent or a deceased baby was born so fast that the midwife arrived too late to a woman's home. It is very surprising that these situations were much more common than referral before birth. In Amelink's national study, only 5% of intrapartum deaths were among births that took place in primary care 1. This discrepancy suggests that the study sample may be rather different from the national population.

Given the limitations of the study, the conclusion that labour starting in primary care carries a higher risk of delivery related perinatal death compared to labour starting in secondary care is premature from a scientific point of view. The authors correctly state that "their findings are unexpected and deserve further evaluation". Previous audit studies did not find that features of the Dutch maternity care system were related to preventable perinatal deaths 3;4. The results of Evers' study call for an urgent review of all mortality cases in the audit study announced by the authors. In addition, perinatal outcomes in other regions need to be examined. Ideally, a large national prospective cohort study should be conducted. The suggestion that "the obstetric care system in the Netherlands possibly contributes to the high perinatal mortality rate" can not be made based on these data alone.

(1) Amelink-Verburg MP, Verloove-Vanhorick SP, Hakkenberg RM, Veldhuijzen IM, Bennebroek GJ, Buitendijk SE. Evaluation of 280,000 cases in Dutch midwifery practices: a descriptive study. BJOG 2008; 115(5):570- 578.

(2) De Jonge A, Van der Goes BY, Ravelli AC, Amelink-Verburg MP, Mol BW, Nijhuis JG et al. Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. BJOG 2009; 116(9):1177-1184.

(3) Wolleswinkel-van den Bosch JH, Vredevoogd CB, Borkent-Polet M, van EJ, Fetter WP, Lagro-Janssen TL et al. Substandard factors in perinatal care in The Netherlands: a regional audit of perinatal deaths. Acta Obstet Gynecol Scand 2002; 81(1):17-24.

(4) Bais JM, Eskes M, Bonsel GJ. [The determinants of the high Dutch perinatal mortality in a complete regional cohort, 1990-1994]. Ned Tijdschr Geneeskd 2004; 148(38):1873-1878.

Competing interests: None declared

[WidowWadman]

www.bmj.com/content/337/bmj.a3118.extract

[WidowWadman]

The perinatal mortality rate in the Netherlands is pretty abysmal though.

Neonatal mortality looks at children up to a year, while perinatal mortality refers to third trimester up to 1st month of life, so gives a better insight.

[EggyAllenPoe]

the invective directed at the op seems to come from know-nothings.

the Netherlands neonatal mortality was one of the best in europe - better than both France and the Uk. 30% Hb IIRC.

[barleycorn]

Babyonboard that was a nasty comment about bleeding to death.
On the subject of PPH the wife of one of dp's colleagues had a PPH in hospital, with a junior doctor in the room who just fannied about for ages while she turned the colour of the sheet. She was really sick, and in ICU for ages, partly because of the delay in doing anything about it ie giving her fluids and arranging for theatre.

Working in the emergency services, I do like to think that a paramedic would have had the situation under control more quickly, and ime coming into hospital in a blue light ambulance focuses the mind of HCPs and results in quicker, life-saving action being taken a lot more than being 'safely' on a ward.

[HyenaInPetticoats]

Babyonboard, on this thread you've made one of the nastiest comments I've read on Mumsnet. NannyL is clearly feeling robust enough not to be too upset (well done, NannyL), but regardless of your views about homebirth, telling a heavily pregnant woman that you hope she bleeds to death is inexcusable. You should be ashamed.

And what about doctors (like my sister) and nurses and midwives who choose to have homebirths? Are they also deluded and spoilt and ignorant? Or perhaps just guided by ALL THE EVIDENCE.

[spudulika]

Great post Tangle.

Personally I always find it a bit worrying when I hear parents say 'I'm just going to put myself in the hands of the doctors and midwives and let them tell me what's best for me'. I tend to assume they know nothing at all about the reality of maternity care.

[Tangle]

nomorehotbaths - you are completely correct. Over 350,000 women die each year in pregnancy, childbirth and the postnatal period and 99% of them are in developing countries where those women, as you yourself have stated, have NO access to antenatal or intrapartum care.

To use the these statistics to try and support an argument that a planned HB in the UK for a woman who has had regular antenatal appointments, would be attended by a trained MW and would have (relatively - c/w a woman in central Africa, for example) quick access to a fully equipped hospital is some combination of disingenuous and nonsensical, and is certainly inflamatory. Research has shown that for low risk women in the UK planned home birth is at least as safe as planned hospital birth, which is why the RCOG and RCM support homebirth for low risk women. The situation of women in developing countries does nothing to change those statistics, and nor does it demonstrate that all medical intervention is beneficial.

You are also completely correct that if you, as a patient, wish to make decisions then you have to be prepared to accept the responsibility for the consequences of those decisions. Personally, that's exactly what I want to do. I will be living with the consequences, whatever happens and whoever decided - I'd rather I got to choose the risk/benefit profile I'm going to be subjected to as my interpretation of the "best" course of action may be different to the next woman's (or Dr's or MW's). As a mentally competent adult I have the right to choose which care I will accept and which care I will decline, I expect to be given the data to allow me to make an informed choice - and I then expect to be supported in that choice.

The biggest threat to women being supported in this way is other women who are not prepared to accept any responsibility and try to sue HCP's as soon as things don't go as they expect. I don't blame HCP's for practicing defensively and proactively in this environment - but I hate the impact on women who are still capable and willing to do their own research, make their own decisions and take responsibility for those decisions. And I fear for the future of maternity care in the UK.

[spudulika]

"You tell that to the 350,000 - yes, 350,000 - women who die in childbirth every year because they do not have access to medical care in childbirth. Childbirth IS a dangerous process at times for mother and baby and to deny that is naive and ignorant."

What is the relevance of this to the OP? Birth is dangerous in countries where women are impoverished and have no access to midwifery and medical care in pregnancy and childbirth. That is not the situation here in the UK and hasn't been for decades, including the 1950's when most women had their babies at home.



"ignore the bits you don't like about a HB being unsafe in certain circumstances. Just as long as you get the birth you want, eh?"

Actually we don't know very much about the outcomes for anything other than low risk mothers birthing at home - because the research doesn't exist. There are many situations where the health issues are very murky, and some where they are more clear cut. A mother with pre-eclampsia for example, needs a lot of monitoring. Protocols for caring for women with high BMI on the other hand, or gestational diabetes, or a VBAC mum, will differ from area to area. Some midwife led units are happy to care for these mothers, some are not. It might be that a fit, healthy woman with a high BMI will labour very efficiently and well at home. The same mother who in hospital might end up with a c/s for failure to progress, who then is at extremely high risk for DVT and wound complications. The risks and benefits have to be assessed on an individual basis - which is why blindly and thick-headedly adhering to protocol is sometimes not a good idea and won't end up with the best birth outcome possible, which is good for the mum, good for the baby, and good for the NHS.


"I agree with the poster who said that if you go against medical advice and something goes wrong, you must take responsibility. That's not nasty and disgusting, it's true."

NICE guidelines on caesarean section state that as a group, women giving birth with the support of a doula/female birth partner, have significantly lower rates of c/s than women giving birth with just their partners present. If a woman chooses not to have doula support, and opts to give birth in a CLU where she knows she's unlikely to get one to one care, then ends up with an emergency c/s for failure to progress and fetal distress, should we wag our finger at her and say - "Well - you were told how to reduce the risk of this happening to you, but you CHOSE to ignore the advice. You have no one to blame but yourself!' Would that be compassionate or fair? I don't think so. We don't always follow recommendations made by medical professionals, because those medical recommendations are not always appropriate for our particular unique personal circumstances.

[nannyl]

Thanks

and no morehotbaths..... of course people WITHOUT medical care die during child birth (as well as plenty of people who DO have medical care) Giving birth is one of the most dangerous things we as humans do!

And thank god im lucky enough to live in this country where i am lucky enough to have medical care.

But a large proportion of people who die during childbirth die because the cant birth their baby.... the placenta may be on the way.... in which case death is positively likely... so all those with that problem and no medical care ARE highly likely to die... and they do....
Given that I have medical care, and for me at the moment, those complications arnt applicable to me (and if they were id be 1st to get myself booked for a planned cesarian).
Anyone can also heamorage after and die.... which is why i will have 2 midwives with me, to hopefully keep me alive until i get to hospital, should that happen

At home i HAVE medical care, and tbh i am likely to have even more midwife attention than if i am in hospital.

There are many circumstances where vaginal births are not safe.
The fact is our NHS can be very specific with its criteria for a home birth... if you weigh 1kg more than X, or a test is out by a tiny amount you can be instantly declared not low risk enough for them to advise a home birth....

JUST because you dont quite fit in with what in the scheme of things isnt actually that important.

and perhaps you didnt notice but baby on board said "if something goes wrong let it be on your head, ie you didn't want to go into hospital in the first place so that's where you can stay and if you bleed to death well there's always room in the darwin awards for you." and IMO that is pretty nasty and discusting comment to make

[UkeHunt]

bloody hell babyonboard

clearly you are vehemently against homebirth and you have made some vicious and spiteful comments to the OP who, btw, and the clue's in her name, has been a nanny for long time and knows more than the odd bit of anecdotal evidence of the safety of homebirths. Unlike you.

I know sod all about homebirths tbh, I don't know why I opened this thread.

but I can't not comment when a woman who has some concerns about the birth of her child is attacked by someone neither helpful or kind

It's almost as if you have nothing better to do, babyonboard, than criticise women who make decisions that are not in line with your own.


....just read nomorehotbaths's post
sheesh - in what way is attacking someone anonymously, helpful? You might disagree with the OP, but how about doing it in a manner that is intelligent and neutral, rather than ranting and critical and rude?

Shocking, some of the replies on here.


Good luck with getting the birth you want, nannyl.

[nomorehotbaths]

Tangle -
The assumption that hospitals and doctors make childbirth safer and always have done is a dangerous and incorrect one.

You tell that to the 350,000 - yes, 350,000 - women who die in childbirth every year because they do not have access to medical care in childbirth. Childbirth IS a dangerous process at times for mother and baby and to deny that is naive and ignorant.

OP, you continue doing what you are doing and listen to the advice that supports your spoilt demanding attitude - just you ignore the bits you don't like about a HB being unsafe in certain circumstances. Just as long as you get the birth you want, eh? Go against the medical advice if it doesn't suit you, what do they know anyway? You as a first time mum with no experience of labour and bits and pieces you've read online know far better.

I agree with the poster who said that if you go against medical advice and something goes wrong, you must take responsibility. That's not nasty and disgusting, it's true.

You sound extraordinarily self centred and narrow minded - and dangerously ignorant about childbirth. What a silly woman you are.

[nannyl]

Baby on board you DO speak a load of rubbish (again)

so really when the midwives say it's up to them it is up to them

So wrong. You could be pregnant with transverse triplets and choose to homebirth if you want. The midwives are legally obliged to support mum WHERE EVER she chooses to give birth. It is illegal for midwives to refuse to provide care....
you can ONLY be made to go to hospital if sectioned under mental health. There are no other situations when you can be legally forced to go to hospital..... if you want to risk likely death at home, if your placenta is in the wrong place, its up to you, a chance you are a legally entitles to make

Also it does seem a bit selfish to want a homebirth, if something goes wrong you will require an ambulance, what if someone else requires that ambulance and has to wait because you were too pig headed to listen to medical advice.

HOW it selfish? It costs the NHS much more to have a lady give birth in a hospital or midwife unit then at home.... if every low risk mother chose to have a home birth the NHS would have a lot more money to spend on ambulences and medical care for those who needed it.
Giving birth is NATURAL, and does not normally requite medical intervention at all. Our bodies can almost always do it.
Perhaps ambulences shouldnt attend drunk drivers, people who have attempted suicided, those who climb a ladder to fix their gutters and fall (cause they didnt ask anyone to hold it steady) ....after all its their fault they are are injured , in need of medical care right?

Maybe fire engines shouldnt attend fires due to unattended chip pans or candles? again people not listening to advice
Perhaps the coast guard / life boats should not attempt to rescue people when the weather is bad as inadvisable to go out on the water in the first place
Not to mention mountain rescue who go and rescue people who are lost when fog is forecast and they are ill prepared to be out walking



I would say the nhs should let you have your homebirth but if something goes wrong let it be on your head, ie you didn't want to go into hospital in the first place so that's where you can stay and if you bleed to death

Thank God the NHS disagree.

What a horrible nasty and discusting comment to make

If i bleed heavily i will be EXPECTING to recieve blood to help me, & Im pretty certain ill get it..... yes probably selfish too.... after all ive only donated 30pints of my own blood to the system..... why oh why should i expect any back?

I suggest if you dont like the system that we have in this country then go and live somewhere else!!!!

Babyonboard you clearly have no clue so perhaps you could avoid commenting..... quite frankly i dont want, need or care about your barbaric opinions

[ScroobiousPip]

'These are shit arguments, and so is yours.'

Awesome.

Great posts owl and spud.

[spudulika]

"Also it does seem a bit selfish to want a homebirth, if something goes wrong you will require an ambulance, what if someone else requires that ambulance and has to wait because you were too pig headed to listen to medical advice"

What about the argument that it's selfish for low risk women to go into hospital, where they are twice as likely to have an avoidable c/s than if they'd stayed at home, thus blocking up the operating theatres, which are needed by women with serious health conditions who need medical help to give birth?

Or women having epidurals for pain relief, thus monopolising the services of a anaesthetist who may also be providing cover for ICU?

These are shit arguments, and so is yours. Women have a responsibility only to themselves and their babies in labour - to try and get through as best they can.

[owlbooty]

Wow. Babyonbord in the Netherlands the homebirth rate is about 1/4 and their rate of maternal and neonatal death is no worse than the UK (indeed, it may well be better) - I'm sure they'll be delighted to know you think they're all idiots who deserve to be wiped out.

Toddle off now, why don't you?

OP good luck with your home birth. It sounds like you've done the research which is all any of us can do; there will always be factors that might require a transfer in but with a 6/10 success rate for first time home births I also reckon it's well worth aiming for. Having met many, many women who have had wonderful home births (including many first timers) I hope that your experience is a lovely one. :)

[spudulika]

" it is actually illegal to plan to give birth without a qualified midwife present"

No it's not. It's illegal for an unqualified person to plan to CARE for a woman in labour in the absence of a midwife. It's not illegal to plan an unassisted birth or to have one.

"so really when the midwives say it's up to them it is up to them, if they say you are having a hospital birth that's what you will have to have"

No - you are simply wrong.

[spudulika]

"This time round at 35 weeks I was diagnosed with Gestational Diabetes that pretty much rules out homebirth"

No - not always. I had a homebirth after a diagnosis of GD in my second pregnancy, and planned another one with a subsequent baby (transferred in during labour with that one for failure to progress). There's actually very little that categorically rules out a homebirth. A mum in my area had twins at home last year - cared for by the community team. I also know of someone with type 1 diabetes who had a homebirth plus a mum who had her 6th at home - HBAC with a 10lb+ baby. With the community team. Not saying it's common, but it does happen if a mum wants it enough.