Home birth - would appreciate some advice/back up

[NotFromConcentrate]

Hi there.

I was hoping to draw on the knowledge and experiences of other mums if that's ok - especially mums who've had/are having a home birth.

I was due to have my HB visit this month (currently 26+5) but have had varying levels of support from the midwifery team and now the lead MW wants me in for a "chat" before she "decides IF" we're having a HB visit.

What I need to do is put together reasons for wanting HB (I can do that) and also a birth plan which covers al eventualities including admission and even C-Section. I'd also like to really arm myself with HB statistics too.

Quick background: this is DC3. DC1 I had PET & then eclampsia and was induced, delivering a baby with no respiratory effort and an extremely low heart rate (he's now fine). DC2 was induced due to PROM but had 2 hour labour and very straight forward delivery. I feel like they're almost holding DC1's birth against me and ignoring the fact that I've since had a healthy pregnancy.

I had various bad experiences in hospital, mainly relating to prosecutes being carried out without consent or things not being done as they should. Also, my local hospital has the lowest natural birth rate in Scotland, the highest instrumental delivery rate and are in the top 3 for C Sections and induced labours. I'm determined to avoid

(pressed Send too early!) provided my pregnancy remains uncomplicated and I remain well.

Any advice please?

Right, well first thing I would say is maybe to give the head midwife the benefit of the doubt -unless and until she has proved herself obstructive. I know you feel she's putting hurdles in your way, but I'd go in all smiley, positive and upbeat unless and until you need to fight, then you can stick it to her blind her with how well informed you are.

On the face of it, a chat may not be a bad idea. It's still very early to book a homebirth. My area doesn't do HB visits until about 36 weeks because so many complications could arise later where the risk profile would change and they may want to talk further with you. Maybe she means the 'if' as "I want to make sure you know all the facts and still want to do it" and not "it's my decision' (which, unless Scotland is different, it obviously isn't).

Homebirth.org here has some great information.

Good luck.

Do you have a local homebirth support group? Sometimes they are run in conjunction with the local NCT group - it may be worth seeking out local support.

Consider speaking to your local supervisor of midwives - this kind of thing is exactly what they are there for. Look here.

Thanks. I know I'm going in on the defensive, but only because I'm so sick of the negativity from the midwives, and all the talk of getting "permission" from the consultant, which really winds me up... I'm not under consultant care, I'm midwife led.

I've been looking at the homebirth.org website an did consider myself really well informed, but my confidence in myself is becoming slightly eroded by how obstructive some of the midwives have been.

I know it's quite early, but what really annoys me is that I've always been very clear that I will not opt for a home birth if the circumstances are not appropriate; I'm not determined to have this baby at home regardless of how safe or otherwise it is. I just feel like they won't even acknowledge that it's a possibility and that they think if they just smile and nod then the novelty will wear off an I can have a nice medicalised delivery

Thanks Fessa, I hadn't thought to look for a local group. I'll do that this week.

I reckon I could get them to agree to an unnecessary section more easily than a home birth!

How far do you live from the hospital?

luminescence I live (literally) a two minute drive from the hospital. Had I lived much further away, I don't think I'd have even considered a home birth.

They book us at 30 weeks here because the off duty is made up 6 weeks in advance, and the midwives go on call at 37 weeks. It's easier for them to cancel on-call at short notice than to cover it a week before IYSWIM

But why risk it - your waters broke early with DC2, so you would have been monitored anyway.

Could you imagine if you did lose this child. You're experienced with labour and with the hospital and if they're doing something you're not happy with way things are going you have the knowledge and experience to ask WHY and if there are any other options.

There's more risk to having my baby in hospital than at home IMHO, provided things remain as they are with both of us. I'm not out to take unnecessary risks with my baby's life or my own, and have researched my options at length.

My waters broke with DC2 at 40+6 so not pre-term, just pre-labour. Had I been given the information I needed to make an informed decision perhaps i would have given birth without induction.

I'm happy with my decision to have my baby at home

Good for you

I'll just remind you that it's not up to the MW if you can have a HB. It's YOUR call, not hers. And you don't have to give your reasons for wanting one, so please dont feel obliged to. Just state your intention, in writing to the Head of Midwifery, saying this is what you plan and that you expect to be supported in your choice.

I am currently low risk pregnancy, high risk birth due to previous PPH and plan a homebirth this time. Get on the yahoo homebirth group if you've not already done so - VERY helpful!

I had a beautiful HB with DD2. I just told the MW that's what I wanted and they couldn't have been more helpful.
The yahoo group are great as is Angel horne's web site.

www.homebirth.org.uk Angela Horn

Just to add in case others come across this thread (OP, I realise you already know this) Karoleann - the recent, extremely comprehensive, study showed that, for low risk mothers (excluding first timers, for whom there was a small increase in risk), homebirth is just as safe as being in hospital. This is by the measure of deaths and other serious problems with the baby (although that includes things like broken bones, I believe, which could obviously heal without long term consequences, so we are not just talking about deaths and life altering complications). Saying 'what if you lost the child' is just irrelevant - because the research is showing that simply being near all that technology and doctors, etc at the start of labour does not appear to be what makes a difference to the outcome in that regard. And once you add in other factors (like maternal complications from interventions), the picture looks stronger again for homebirth if you are someone who is comfortable with it and wants to do it.

Only the OP and her midwives can discuss whether she is considered low risk this time. I honestly wouldn't have a clue. But even if she wasn't, I don't think scaring people with ideas of losing babies is particularly helpful.

To add to seconds post for those finding this in the future, planned first time low risk homebirthers who transfer to hospital during labour for any reason have a MUCH smaller chance of having intervention than women of low risk who planned a hospital birth.

So even if you plan to have your baby in the very safe confines of your home and go to hospital part way through, you're reducing your chance of a CS, forceps, ventouse, syntocinon and episiotomy - and fewer interventions means smaller chance of birth injury, retained placenta or PPH.

Thank you for those (more helpful!) replies.

I have been absolutely resolute in my decision, and I suppose what's frustrating me is that I feel like I'm not being taken seriously. Infeel like they've adopted the "oh she's one of those types" and they think they can patronise their way round it.

In a way, I think is quite like to give my reasons (although I appreciate the assurance that I don't have to, should I prefer not to) so that Ivan demonstrate that while the thought of birthing in my own home is appealing, that's actually secondary to my main aim of avoiding a hospital delivery and all the failings that cane with mine. So really it's the very people desperate to change my mind who have made my mind up!

I'm off to have a look for the Yahoo group now :)

i've had 3 home births. i never needed permission but i was low risk with all of them. i just told my mw i was planning a homebirth and that was that. i got a visit with dc3 but not the others - they just turned up when i was in established labour. in fact they missed dc3's arrival because it was so quick, i was confident and to be honest i didn't really want them there as i had already done it twice by myself. i did hypnobirthing which really helped my confidence.

my waters broke with dc1, just a trickle, and mw gave me a v.thorough stretch and sweep to help things get going. baby arrived 6hrs later.

just be confident and ignore their silliness. community mw's who attend homebirths will not have the same attitude. i had one mw when my regular one was on holiday who gave me the eye roll and "of course...blah blah... risks...better in hospital" speech but i just smiled and nodded (as you do with all unwanted 'advice'!).

We book in at 36 weeks here. As I understand it the community midwives do not have the authority to book a homebirth unless you are a low risk pregnancy and birth.

Therefore the procedure is that it has to be booked in by the supervisor of midwives/ consultant if there is raised risk. Therefore if you look at it differently it should be to do with making sure you have as much information as possible.

I think the use of language some midwives use is unhelpful because the above seems reasonable to me! I think that homebirth is considered fairly mainstream around here though, which is seemingly not the case everywhere.

I definitely don't need permission, I think the midwives would like me to think I do, if that makes sense. If they think
I'm going to see the consultant, they can think again.

I am definitely low risk; high risk mums are consultant-led, and those in the middle tend to see a consultant and midwife at booking, with a view to MW led care with the option of consultant intervention

I must admit I dont understand why you would be so anti seeing a consultant. Seeing a consultant does not raise your risk level. I had a consultant appointment but am still low risk (threatened pre term labour). He didnt try and talk me out of having a home birth, in fact he was a fairly relaxed chappy generally!!!

brettgirl2 it is the mother who has the 'authority' to book the homebirth, no-one else. I am high risk for birth apparently but have declined consultant care and haven't seen one at any point as I don't think it appropriate or necessary in my case, and am only meeting the Supervisor of Midwives to discuss my particular case and risks out of courtesy and so she can let her CMWs of my specific situation and care plan - I am under no obligation to do so and if I find them unsupportive (which they've not been so far) then I will only have contact with my Community Midwives.

A midwife may have to inform the SoM or consultant of a high risk woman intending to have a homebirth but neither of them can choose to authorise it or not

I chose not to see a consultant as they won't tell me anything I don't already know as I've spent nearly 2 years looking at my specific risks rather than the more general risks the consultant looks at. I won't change my mind and agree to deliver in the CLU - why waste an NHS appt and make DH take half a day off work as a teacher for something that changes nothing?!

I really am not trying to be contraversial in any way. Of course you know more than a consultant and of course you have the legal right but I was referring to the hospital admin system. The OP was asking for back up - if it was me I would go the normal route and assume if there was no real issue then the consultant would provide it in the lowest stress way. That to me is worth 30 minutes of my time. Each to his own as they say!!!!

It just seems to me that people assume that a consultant will be obstructive - they wont necessarily.

I just think it is easier to follow their procedures before making things into issues.

The only authority needed for a home birth is yours. When the midwife gives you her (many times practiced) guilt tripping chat, counter with the fact that if they choose to ignore your request and end up sending a midwife to your home at last minute notice, then THEY are creating the risk as they wont necessarily have a HB kit with them/might end up short two midwives. As long as you do listen to facts, and expect the midwife to show you unbiased evidence, dont just accept verbal facts and figures, and weigh up for yourself how any potential risk may be dealt with, really the choice is yours. No health professional has any right to patronise/ridicule/nag you...and would be most unprofessional to do so.
I was so sick of the 'permission' card in my last pregnancy...this time i have armed myself with facts and legal rights (and a damned good midwife) and am not having any nonsense...lets hope we both have positive birth experiences in march.

I know the consultant quite well, I've worked with him previously.

The reason I do not wish to go to an unnecessary appointment is because it's just that - unnecessary. Had I required the input of a consultant from a clinical point of view, I'd have been referred. I haven't, because I don't. Perhaps I'm not doing myself any favours, but I refuse to pander to this pantomime they seem determined to play out whereby I have to jump through several hoops and practically beg to be 'allowed' the birth of my choosing. Call it bloody mindednes, but its how I feel. All this unnecessary intervention is exactly what I'm trying to avoid.

I am going through something similar, and have been made to feel by my hospital that I need permission. Two consultants have basically told me 'no' and said 'sorry to be the bearer of bad news'. I said, isn't it correct that it is my choice where I have the baby? - neither of them would give me a straight answer. They consider me to be at risk because I am having my first baby at 40 and coinceived her through IVF (there is some very shaky evidence that IVF increases the risk of still births which I have looked into and found to be dodgy at best). The consultant seemed personally put out when I said that I would like to think about it and showed no signs of going along blindly with what she said. On my next appointment I said I would like to go ahead with the homebirth and was told again - oh sorry, you are high risk. I took no notice of her and asked when the home birthing team would contact me. At this point she knew I was not budging. she said she would ask the team to contact me but warned me that the midwife would not be willing or happy to allow me a home birth. She then wrote AT RISK OF STILLBIRTH all over my blue notes (my risk, even if the IVF study is to be believed, is approximately 1%). when the midwife came to my house a week later she said how fantastic it was that I had chosen a home birth, said my age was no problem at all, had never heard of anything about IVF pregnancies being any different to any others, and pointed out that if the baby is stillborn, it would be too late to do anything regardless of whether I was at home or in the hospital! Having looked at all the options and evidence I am going to go ahead. I am a 5 or 10 minute drive from the hospital and have my bag packed ready :) just in case. I say dig your heels in. As long as you have done your research and know what you are doing, the most important thing is that you are comfortable with where you are. You will find the home birthing midwives very supportive of your decision, I can guarantee it. Good luck!