No home birth!

[Witchofthenorth]

So, had my midwife yesterday, currently 17 weeks prg and due on 31 st of December and am planning a home birth ( dc number 4). apparently at that time of year I would be extremely lucky to have midwives available ( which I do understand btw, time of year and all that).
I kind of feel quite despondent about it now......my midwife unit is just a small one, for the unit to be fully staffed, they only require 5 midwives and she did say that legally they were not allowed to refuse, but to prepare myself for the fact that it will be highly unlikely that there will be no staff to attend.
There is only one independant midwife round these parts and I cannot afford the fees :(. I always said that I wasn't really one of these mums who would stamp her feet and demand a home birth, and that if I had to go to hospital then I would, but, I kinda want to stamp my feet and demand a home birth!
Anyways, should I resign myself to the fact that I am going to have to remove myself from a comfortable environment where I know I will be in more control and manage pain better while labouring, get in the car and go to hospital?
Sorry it's a long post, I guess I just need to vent a bit.....didn't think it would upset me so much :(

I can see why it's upsetting - but she's not saying definately not, is she? She seems to be saying maybe not, depending on staffing; you might get lucky. And whatever happens you'll get your baby at the end - try to switch your perspective around to "as long as baby and I are safe and well it doesn't matter where he/she's born".

Were your other DCs straightforward labours? With my DC4 I left it till I really couldn't cope without G&A before I went in, and so was in for the bare minimum of time, and home again 4 hours after birth - could you plan to do that?

Well you are in the right place to get help stamping your feet

personally I don't think you need to fight just yet. Also bearing in mind you could be delivering either before Xmas or in the new year you might just be lucky anyway.

I think there are peak times, eg I am due sept so am hoping I get my call into the hospital to bag the pool before someone else.

I also think it right that she warn you but remember it won't just be staffing it's also the weather.

Oh I know I know, I am normally such a logical person and I totally see her point, there is the issue of the weather too, none of the midwives actually live in the town I live in, all live in outlying villages which all have ridiculous roads in winter ( bloody selfish if you ask me ). I am also acutely aware of how hormonal I am this time round. And you are of course right, as long as baby is fine does it matter really? In the grand scheme of things?
hassled I was being diplomatic, it was a conversation about there not being a midwife to attend, she was just trying to let me down gently and I am clutching at straws slightly. Other than being without waters for a time with number 1 and 3 I have had straight forward births with all of them, number two I left and till the last possible moment to go and honestly would have quite happily had her in the bath :)
I need to pull myself together.....but you know what its like when you have decided on something?!? It also doesn't help I suppose when the only one to really support this decision was DH , everyone else family wise thought I was being a touch irresponsible....it brings out that stubborn childish side of you, you know?
sigh I am sure my rational, hormone free self will return soon :)

Oh, that's a disappointment, Witch. I'm paying through the nose for a private homebirth (it's the only way where I am, there's no public homebirth available and my fucking private health insurance won't contribute) so I do understand how important it can be.

So were the other three all hospital births?

Hi tortoise, yes all three were, although number two was nearly an unplanned home birth. I hated being in hospital with 1 and 3 It was awful, I was made to feel like crap, I was surrounded by babies who were all going through diazepam withdrawal, apart from one or two mums who were pretty much in and out! Both 1 and 3 were extended stays due to jaundice with number 1 and suspected group b strep with number 3.
With dc 3 they classed me as a capable mother, which is fine as I am :) but they took it as far as completely ignoring me for all weigh ins, blood pressure etc. Eventually I took baby through to midwives room to ask for her to be weighed so I could organise going home ( extremely judgey of me I know but believe me when I say the ward was full of junkies!) then got serious lectures for taking baby out of cot! ( I know there are health and safety issues) it just was not a very pleasant experience, although I am aware others have had a much worse time than me. There are plenty more, but I think I may make you lose the will to live if I list them all :o bearing in mind though, this was the hospital in the city and not the MU in the town, it is a completely different set up there.
I am sure I will get over it.......I have told DH to prepare himself though for childbirth :o ( just kidding!)

Wow, my posts are soooooo long! Sorry must try to stop waffling!

I think that you will just have to wait and see, no one could promise a home delivery on New Year's Eve with the prospect of dreadful weather. There is nothing to say that the baby will come on the right day and the weather may be mild.

i can sympathise. I planned a homebirth with number one. When i rang up to tell them i was in early labour they asked would i come in if they are busy. I said no. Tbh i was taken back and the word was out before i even thought about it. Glad it did though as i had a really long labour and think this would have been worse in hospital...though we ended up going in for delivery anyway. Ha!

ment to say i would still insist that they note your intention to have a hb. And see what happens. If it really looks like no one can get to you and it's getting on they can blue light you in. Be aware of weather. The odds of going in to labour on new years eve are slim surely... Good luck!

Thanks everyone for reading my rant :) much appreciated! I doubt I will go on new years eve so hopefully it can still happen. I will carry on with the home birth plan for sure :) and see what happens at the time, as I said to mw yesterday ( whilst in one of my more rational moments) , just because I have had three uneventful labours doesn't mean this on e will def be like that and I may have to travel into city to deliver ( shudder ). I guess I just, perhaps naively, assumed there wouldn't be an issue so was quite taken aback when told there probably will be.
Thank you all, going to work now and will check in later :)

Speak to another midwife to get their view. I've been in your position and there was a huge difference in attitude. Where we are there are teams, and I've never had one of 'my' team deliver any of mine (4 births, 1 in hospital, 3 at home). I had to change hospitals for DC3 as I was told half-way through "we'll see if you can have one" - then I found out they had put a ban on them so were stringing me along. if it's important and it matters to you sometimes you need to dig your heels in.

Wishing you lots of luck.

I still think you should INSIST on planning a home-birth (as is your right and the safest place for you and your low risk baby).... you may very well go a bit over OR deliver 3 weeks earlier than due ... and it might not be holiday season anyway.

You have a RIGHT to a homebirth.... if its what you want, and midwives have a duty to attend to a woman in labour.... This right does not change at Xmas, bank holidays or at any other time.

I have been stressing about homebirth too as i was never far enough along to "think about birth"..... Ummm i can assure you i was, even at my booking appt (even long before i was ever pg!) but at my 31week appt it was finally taken seriously.... Im now 32 weeks.

But of course anything can happen.... baby may move transverse.... i may develope GD (hope i dont, no signs that i will etc but you never know) I may go into labour early.... my placenta could have been in the wrong place.... and all these things might affect you too.

I took the attitude of just saying nothing and not making a fuss at the 3 weekly intervals that i brought up home-birth, cause didnt wanna upset the relationship with my wonderful midwife, but was over the moon when i was finally far enough along to think about it... she had always mainatained they wouldnt think about it until 36 weeks which was stressing me too but in the end it went on my notes at 31+5

Hope all goes well and you get the birth you want

I'm always in two minds when it comes to bad weather - in lots of ways I think the absolute last thing I want is to be stuck in snow whilst in labour, so I'd almost rather take the risk of being at home alone than trying to get to hospital and failing!

Have you actually talked to the IM near you? Most prioritise supporting women over making money, so if you think that might be the right solution for you (even if its just would she be prepared to come out if the NHS say they can't) you loose nothing by talking to her - many IMs will happily arrange payment plans and/or barter (I know one of mine was hoping for a decorator, and in the meantime got her freezer stocked). It may come to nothing, but if you don't ask you'll never know.

I'm also torn on the issue of how much can women INSIST on being attended at home - in principle, yes. And I do think that the more women kick up a fuss the easier it will become for PCTs to demonstrate that there is a demand and so the service should be supported. But whether there is a duty of care for a MW to attend you is a grey area (whilst there is a duty of care there is also an argument that it can be fulfilled by sending an ambulance). There's also the issue that if a lot of CMW's with HB experience are on leave and/or unable to get out of their villages and the labour ward is busy they may find a MW to send, but it may not be one that is experienced in this area. Again, not ideal - but if there really are no experienced MWs available then however much you demand one there's not a lot they can do. I'm not saying I think this a good situation - but we are where we are and I also wouldn't want to be at home with an inexperienced MW...

Anyway, I really hope that you have a better birth this time round - wherever it happens :) (Oh - and I'm also due late December and considering HB, so facing all the same issues!)

Sorry but I'd stamp my feet and insist on the night.

Maybe if more women did this then more midwives would be employed, and midwife services wouldn't continue to be seen as the poor relation. And more homebirths would happen, and perhaps rates of intervention and longer hospital stays would go down...

I'd tell your midwife that when you go into labour you will be staying at home, and ask what their procedure would be.

Stamp your feet! I know I would in your position.

Smile sweetly, with heals firmly dug in and carry on planing a HB.

Im with Tangle, on the snow thing.....

its is almost impossible for us to get into or out of our road when its snowy and icey..... we live on the edge of the peaks, and even when most roads are driveable, it is often not possible to make it here to our road.

Im due in September so it shouldnt be an issue, BUT if it was icey or snowey, then BIL would be on call in his 4X4 and i would make my way to the midwife unit.... i would not expect a midwife in a normal car to make it here.... and should there be a problem, ambulences might struggle too.

witchofthenorth I guess I sit more alongside nannyl in that if you are planning a homebirth this should be supported regardless of the time of year.

To put my perspective in context I think most MN-ers would feel it wasn't acceptable for maternity units to be wildly understaffed over Christmas bearing in mind as many babies arrive then as at other times. You'd still expect to have access to a pool or an epidural and would fine the suggestion that 'we haven't got the staff for that as it's a holiday' unacceptable.

Suggesting this is the case with homebirth puts it in the category of a luxury- something nice to have but not very important. This isn't the case (though of course if you feel like that for you, then you might not want to pursue it further). Homebirth is an important choice for many and it is your right to expect it to be delivered (outside of emergency weather conditions) as you would expect any other element of your maternity care to be delivered whether it is Christmas or not.

Last year I had a client due on 1st Jan (I'm a doula). It was in London and there wasn't a hint of a suggestion that the timing might make things difficult. Same with my client due mid-December (who could well have been 'overdue' and delivered at Christmas) who was in a different part of London. While the hospitals were bigger the team itself was only 6 midwives and they had clearly devised a system to ensure homebirths were covered over Christmas, just as they would have a system for hospital births.

If you were my client and felt you homebirth was an important part of this pregnancy/birth for you I'd suggest asking to have a meeting with the Supervisor of Midwives at the hospital. It may well turn out that the midwife you saw was speaking out of line with hospital policy or it may be that they simply need to be informed that homebirth is important to you, you don't intend to go in to hospital simply because they haven't made provision for adequate staffing over the Christmas break and are aware of your rights. This doesn't need to be a confrontational conversation but probably worth following it up with something in writing.

I realise this isn't a popular view on this thread, but until trusts are committed to delivering a homebirth service properly these issues will carry on causing people anxiety at a time when they need to feel supported and they won't deliver them properly if we don't push them to. I've seen positive changes made in my local area recently based on service-user input so it is possible.

And I say this as the daughter of a doctor who used to spend Christmas morning in fancy dress helping him do his ward-round!

I'd write to the SOM stating your intention to birth at home. Just so she has fair warning to sort out any staffing issues

I had the speech about only 1 midwife on call, no one living near etc but ended up with two - both living somewhere nearby that my CMW had swore was unpopulated by MW. But I also had a promise from the SOM she'd come out herself if no one else was available.

I don't understand how providing an ambulance is the same as providing a midwife. A woman has the right to choose the birth location which she feels is best for herself and her baby. The midwifery service has a duty of care to provide a midwife. Surely a none labouring woman (the midwife) out in the snow is preferable to a labouring one. Well to me anyway. The midwife does not even have to use her own transport if the conditions are treacherous. The NHS will have a duty of care to her and to you to provide her with 4x4 transport (and driver).

I say speak calmly and dig your heels in. Or rather, write a letter to the HOM outlining your intention to birth at home and that their staffing issues is not your problem when you are in active labour. That you have given them ample notice to plan their rota around your birth date. Suggest to them that if they do not have enough staff to cover your home birth over this time period that they can engage the service of an IM on your behalf.

Were a woman who had planned to go into hospital but found herself unable to attend hospital also be left without midwifery care, given a similar set of circumstances?

Re your point about sending an ambulance, arguably there is no absolute legal right to a homebirth ishchel. What is clear is that (unless she is sectioned under mental health laws) a woman cannot be forced to attend hospital and there's a duty of care from the trust to the women. Arguably they can discharge this duty by sending an ambulance to transfer her to hospital and, if she refuses, that is her choice as a competent adult. There's a good discussion of the law here. For that reason, I sometimes feel a bit uncomfortable when people on here say as an absolute that there is a right to have a midwife sent out.

Like so much in life, it's not that simple either. Most hospitals and units would not want to risk a problem happening, so if you make it clear that you won't come to hospital (even if they send an ambulance, if they start suggesting that) they are likely to muster a bank midwife/call someone in. There are also (unsurprisingly) a lack of rest cases on either sending an ambulance or refusing to provide a home birth service.

In a lot of areas the homebirth midwives are not the labour ward midwives, so a full ward is not per se relevant to sending someone out. Also, most midwives and managers in the area do want more resources, so only by standing your ground is it evident that these are required (rather than homebirth being a luxury add on, as Squiggley talked about) and I think a lot of professionals respect this long term.

Stand your ground. If they suggest that they will send you an ambulance, thell them that you would like them to inform you of that proposition in writing. I bet that makes them back pedal very fast. And I'd be cheeky enough to put your version of that conversation in writing and sharing a copy with everyone and his dog. Just to leave a papertrail, iyswim.

I didn't say that a woman had an absolute right to a home birth. I said that were they to send an ambulance was a different thing from them sending a midwife and that their duty of care was to provide a woman with a midwife not an ambulance. But that is just stroppy me who has battled down this road before.

"In a lot of areas the homebirth midwives are not the labour ward midwives, so a full ward is not per se relevant to sending someone out."

If a trust does not have HB midwives then they are in breach of the RCM's own guidelines. You have given them enough time to plan their rota and to have enough midwives trained up for the HB provision. The RCM is keen to know about trusts who do not have a satisfactory HB provision and is good at jiggying them up into that direction.

Ishchel - I think maybe we are talking at cross purposes. I am very supportive of homebirth and totally agree that the OP should hold her ground. I just think it can be unhelpful if people believe that there is a law which specifically says "all women have the right to have a midwife sent out to them for a homebirth" (which sometimes things people are told could be misread as meaning) because the law is less clear than that. I think one is in a better position to argue the case if you understand the points of ambiguity.

Re homebirth midwives, I think you've misunderstood my point. The OP was told at her meeting that the availability of a midwife for her homebirth was in some way linked to the staffing of the MLU. It may be the case that they are the same people in her area, but I was just making the point that a full ward was not in the least bit relevant in many areas. What was relevant to staffing of my homebirth was whether the midwife on call for homebirths (i.e. one of the community midwives who do not generally do many shifts on the ward) was attending another homebirth at that moment (they are pretty good, but warned that if both on call midwives were busy they had to get someone out, and that could take a bit of time as they had to ring round asking people).

"What was relevant to staffing of my homebirth was whether the midwife on call for homebirths (i.e. one of the community midwives who do not generally do many shifts on the ward) was attending another homebirth at that moment (they are pretty good, but warned that if both on call midwives were busy they had to get someone out, and that could take a bit of time as they had to ring round asking people)."

This is highly relevant. As babies rarely arrive on their due date (5%) it is not a simple matter of scheduling staff to cover someones EDD - which in reality could be anything between 37 and 42 weeks. Consequently many trusts operate an on call system which realistically can cope with 2 homebirths at the same time, if you were unfortunate to coincide with other homebirths which midwives were already attending then there might be no staff available for HB.

The midwife does not even have to use her own transport if the conditions are treacherous. The NHS will have a duty of care to her and to you to provide her with 4x4 transport (and driver).

If only, CMWs here have Yaris's . In last years awful weather the Trust had to rely on volunteers with 4x4s (many of which were used to get staff in outlying villages to work) so no guarantee of this in order to get to a HB, also Trust has duty of care to MW to not put them at undue risk (ie travelling on what were here treacherous roads).