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]

Thanks susie

I really like the 2 community midwives who i have met so far... out of the 5 it might be. I really like them and would be delighted if one or both of them attended.

[OnlyWantsOne]

I've read the OP..

oh my, diva springs to mind

[Tangle]

babyonboard
"Before hospital births and medical intervention there were a lot more childbirth related deaths and women still die during childbirth."
Just for clarity, this point is completely incorrect. When hospital births started to become common place the maternal death rate went up. Quite a lot. Mainly due to childbed fever. Spread between corpses and postpartum women - as the Dr's (who were meant to make things safer) didn't bother to wash their hands between looking at one and looking at the other.

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

[Tangle]

More generally, it strikes me that its not what the MWs are doing so much as the terminology they are using that causes a number of women angst. It would cause no extra to work for them to put on the notes "intended homebirth" and acknowledge that HB is the plan unless circumstances change - they don't need to DO anything, just agree that on the basis of the way this pregnancy has progressed to this point this woman is not planning to go into hospital and their is no medical reason to advise that they should do so.

Why would that make any more work than getting women upset by telling them that someone else will decide at 8 months whether or not they're allowed a HB, as seems to be the status quo in many areas?

[fotheringhay]

Totally agree with that. Would do no harm at all to put "intended homebirth", and might put the woman's mind at ease.

[OnlyWantsOne]

What about MWa that put intended home birth then the mother isn't able to have one - and is left disappointed etc

[Tangle]

As has been stated, there is always the possibility for things to change during pregnancy and birth - and deciding that "this is the way things are going to go" is setting yourself up for distress and disappointment, I completely agree. But not all women write a birth plan and intend it to be a plan of the way the birth will be - for many women its more a way of considering different possibilities and what they think they would prefer to happen should that circumstance come to pass. I think the average woman who chooses a HB will have given that decision a lot more consideration than the average woman who chooses a hospital birth - and so they're more likely to be very aware of the fact that not all births go according to plan.

Many MLU will allow you to book direct with them in the first trimester, assuming there are no pre-existing conditions that would automatically make a woman more high high risk. Why should HB be any different? In either instance plans may need to be reconsidered if additional risk factors develop during pregnancy - and that's something that can be discussed very early on.

To me its about MWs in specific (in this instance) and HCP's in general listening to women and respecting that this is a decision that they are entitled to make for themselves. Telling a woman, such as myself, who knows that she cannot legally be forced into hospital against her will that "we'll decide if you can have a HB at 36 weeks" is insulting and paternalistic and causes unnecessary stress throughout the pregnancy. Saying "we'll put that down for you - we don't do the paperwork till 36 weeks as things can crop up that would make it inadvisable to have a HB, but if nothing changes the paperwork will be a formality" would make me, for one, feel as though I was being listened to and supported as an individual - leading to a much better relationship with my MW as I'd find it much easier to trust them to listen to me and support me as an individual if complications DID arise.

[TTTonTour]

nannyl Sorry you are getting such crappy responses here - can't see why you wouldn't want to try a homebirth, and can't understand why people what to stick the boot in and be so rude.

The issues you're considering however, like breech and high BMI, aren't very likely. What's more likely to happen is some sort of "complication" in labour, hence the high transfer rates. Some of those might be necessary transfers - others will reflect poorly researched NHS protocols - such as your waters have been broken "too long" or you've been pushing "too long" etc etc. Believe me, you won't be in a good place to argue....

You say you would consider an IM (btw, agree with the other poster who thought you would struggle to find an IM willing to take on a breech...) so assuming you can afford it, why not get one anyway? An IM will give you a lot of the things you're looking for now - like a guaranteed HB, and you will also have a chance to build a relationship - which will give you a better chance of a good labour - and she won't be bound by your NHS protocols, that are more likely to send you to hospital anyway....

Just a thought - I know it is an added expense - but worth every penny ime.

[umf]

Tangle I totally agree with you. I found the "well, we'll see about that at 36 weeks" approach stressful, because I was concerned that the MWs were prevaricating because they were unsupportive of hb/knew they had staffing problems. I think it may even have been a deliberate test of my resolution to have an hb. All of which is underhand and not the kind of openness you need in dealing with your MWs.

Incidentally, when my grandmothers had their children in the 1950s and 1960s, they were only allowed to go into hospital for the first ones. After that it was hb. In those days the misogynists whinged about these lazy, wasteful women who wanted to use up NHS resources and have their hands held by doctors. New times, new songs, same people who can't believe that mothers are able to make informed choices.

But for the OP - it really will be fine. Just stay politely firm.

[lukewarmmama]

Tangle - very well put, totally agree.

I also agree that an IM, if you've got the spare cash, is worth looking into. As well as the benefits of knowing who will be caring for you, and the outstanding postnatal care (you won't be thinking about that at this point, but its just as, if not more, valuable ime - dealing with recovery/stitches/infections/establishing breastfeeding and all the million things you'll need support with), its great knowing someone is 'on your side' if you feel a bit them&us about it all, as you seem to (I did anyway!).

Or a doula is a lot cheaper if you want the value of an experienced supporter and advocate without the medical care?

[NoodieRoodie]

Well I obviously live in a really different area to everyone else as I had a home visit and filled in all the HB paperwork yesterday and I'm only 23 weeks.

The MW has known since my booking in appt (8wks) that this is what I wanted and so far seems totally non plussed by this idea, even though this is my first.

During yesterdays chat that were a few things that annoyed me a bit, along the lines of "you wont be allowed if ......xyz" but we did discuss several things and I think that we've got the measure of each other (in a good way).

As far as I can see short of a medical emergency I won't be going to hospital but I'm not stupid and wont insist on staying at home if the MW thinks that there's a serious risk.

One thing that I have decided is that like all things in life you have to pick your battles and when to fight them, so until we get closer to the time and I see what's happening there's no need to stress too much about what may not happen!

[TTTonTour]

Just wanted to echo lukewarmmamas advice about the postnatal care. You'll probably (understandably) focused on the birth - but as a first time mum, the post-natal support from an IM is just immense. A NHS mw just won't spend 3 hours dealing with your bf-ing issues... I know they should, but they won't!

Also, just an observation - you say you like the com mw's you've met, but you sound embattled. Not a good place for a calm, gentle home birth!

Good luck with it all - hope you get the birth you want!

[babyonbord]

Well unfortunatly in this country hospital births are the general norm, it is actually illegal to plan to give birth without a qualified midwife present, you could or more likely anyone who knew could be prosecuted should you attempt that 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, (unless you can afford private care and even then they may not agree if you are considered high risk.)
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. 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 well there's always room in the darwin awards for you.

[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.

[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.

[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]

"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.

[ScroobiousPip]

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

Awesome.

Great posts owl and spud.

[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

[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.

[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.

[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

[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.

[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]

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.