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Childbirth

Share experiences and get support around labour, birth and recovery.

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Original poster

Too many homebirths, not enough midwives. What is the solution?

40 replies

mears · 27/01/2006 22:40

A real dilemma. The homebirth rate is going up in our area so midwives are doing endless oncall from 37 - 42 weeks for each woman. As a result, midwives' clinics are disrupted and 'regualr'users of the service are not seeing their own 'named midwife' on a regular basis.

Who has priority ?

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VeniVidiVickiQV · 27/01/2006 22:44

The Midwives.

Angeliz · 27/01/2006 22:44

That's a tough one Mears.
I was told i'd have to wait till i was 14 weeks to even see a Midwife today so am very dissapointed. The care here has dropped DRAMATICALLY over the last 5 years.
I really can't decide who has priority. A woman in labour i would suppose as she needs to be where she feels comfortable.

mummytosteven · 27/01/2006 22:45

the labouring woman.

VeniVidiVickiQV · 27/01/2006 22:46

That wasnt helpful was it! homebirths are i think, AFAIK, in my area anyway your community mw isnt the one who helps you give birth anyway if you go to a birthing unit or have to have a consultant led birth.

mummytosteven · 27/01/2006 22:47

do you mean that antenatal appointments are cancelled, or just that they are with a different "team member"?

TambaTheInnocentPrincess · 27/01/2006 22:47

It is more benificial to a woman in labour to have a midwife who isnt sleep deprived and exhausted... So I would say the midwives have priority.

lunavix · 27/01/2006 22:48

Aren't homebirths only 'available' if there is enough midwife cover?

paolosgirl · 27/01/2006 22:49

Mears - do you mean that women who are choosing to have their babies in hospital are not seeing their midwives as a result of so many of them (2 to a homebirth, I think?) doing oncall for homebirths?

VeniVidiVickiQV · 27/01/2006 22:49

OH ffs did my post make any sense to anyone?

WideWebWitch · 27/01/2006 22:53

Ultimately the solution is to pay midwives more, respect them more and attract more so there aren't shortages. but that's ideal world stuff. I think labouring women sd have priority over ante natal appts, surely their need is most urgent.

Frizbetheexpansionset · 27/01/2006 22:57

Hmmmm dilema there mears, I'm booked for homebirth in a few weeks, but my named midwife isn't doing my 37 week check, as she's already busy with other things! and I've also missed her at clinic on two occassions, as she's been attending other births! don't expect to get her at the birth either to be honest.....the answer I'd like to give you is that the NHS would make more midwifery places avaialble for people to train in, thus the amt of midwives would go up and you wouldn't be so pressurised......... I think if its made clear to you when you go to see the midwife on booking in, that you will be seeing a team of midwives, with your primary midwife being whoever, then its not as disapointing.......
On the otherhand from your point of view as a midwife, I hope your all getting decent payrises for your extra workload......
Tough one......

pooka · 27/01/2006 23:12

No answer really. Just need more midwives. My own experience was that I was booked for a home birth with my group practice. 6 midwives covering my whole doctor's surgery. Nice idea as meant that generally I saw each of the midwives at least once prior to delivery. However....went into labour on a Friday pm. Rang when really thought things had kicked off. Left message with the labour ward for the midwives to contact me. Rang again an hour later (or rather dh did - I couldn't talk and wanted G&A). To be told none of the group practice midwives were on call that night and noone could come out. If I thought things were advanced I would have to go in. Went in. Was 10cm dilated on arrival. All's well that ends well - had quick labour and then me and ds came home within about 3 hours (refused to stay in, he was fine, I was fine). And had my lovely midwives for all the post-natal stuff.
Who do I blame? No one person. I blame the lack of staffing in my health authority. and ds for arriving at a time when the lovely midwives were variously: on holiday, on study leave, off sick!

Levanna · 27/01/2006 23:36

Under the circumstances is having a 'named midwife' really feasible?

During my pregnancy I met most of the midwifes on the community team and so I would have met whichever came out to the birth prior to the birth IYSWIM.

This is IMO preferable to having to birth in hospital purely due to midwife shortage caused by named midwifes caught up in ante-natal care.

I do think continuation of care would be fantastic in an ideal world but don't see how it's possible, given midwife shortages and the undue stress caused to them by having to be in several places at once.

As things stand, lady in labour should take priority IMO, without a doubt.

pooka · 28/01/2006 09:31

Oh yes - lady in labour should definitely take priority!

Jasnem · 28/01/2006 09:45

The solution is more midwives...not as easy as it sounds, I know.

I planned a homebirth with my second, having seen all the team, but not a having a "named "midwife.
When I started int he morning, the on call m/w was already at another birth, and they suggested I go in and get checked, then go home when the next one came on duty at 9. When I got in, I was almost fully dilated, and so had to stay.
I ended up with fairly serious complications and had a c section, so I am very grateful for staff shortages! ( I live 1/2 hour away from hospital, and baby would not have survived if I had been at home)

Original poster

mears · 28/01/2006 12:33

Thanks for the responses. In my area we actually are not supposed to be short staffed. However, I think the problem is the staffing ratios are old and a case has to be made to advertise more jobs. New working practices are being shoe-horned into old staffing quota. Won't happen overnight though and in the meantime midwives are torn trying to provide care.

Women are not denied clinics and visits - they are not getting to see their 'own' midwife.

In my first post I meant which woman's needs takes priority. Nice to see many of you thinking about the midwives' needs

OP posts:

RosiePosie · 28/01/2006 17:56

I'm afraid I'm one of these awkward sods who would refuse to go into hospital on the grounds of staff shortages. As far as I'm concerned, I have given them plenty of notice of my planned homebirth and it is up to them to provide the service. I know, it's not always as simple as that, and I'm sure a lot of areas have staffing problems, but - as a labouring woman I reserve the right to be as selfish as I like! I'm fairly confident that if I tell them I'm staying put they will find someone to come out to me.

expatinscotland · 28/01/2006 18:01

Here in Edinburgh, we're seen by any one of the midwives on the community team, not necessarily a named one.

Seems to work fine.

Original poster

mears · 28/01/2006 18:14

RosiePosie - if a woman has an 'unplanned' homebirth there are no midwives on call for her so paramadics would be sent to bring woman to hospital.

When a community midwife cannot be provided because they are already out at homebirth, then the same thing would apply. If there is no available midwife on call, woman needs to go to service in hospital I am afraid.

OP posts:

pooka · 28/01/2006 19:56

I chose to go in because wanted/needed g&a. None at home and no midwife to provide it at home. Also didn't want to be in the position of labouring with just dh and dd or paramedics. Wanted someone who knew what they were doing.

Mears - my group practice midwives were fabulous and I found that having 6, and getting to meet all 6 during the course of the pregnancy, was fine. It didn't occur to me to think that I should only be seeing one of them. They were all lovely, they all sung from the same hymnsheet, but all had different funny stories to tell.

That they weren't able to deliver ds was not their fault - it was a combination of miniature baby boom round here combined with the health authority failing to increase the number of midwives to cope with population increase. I bumped into one of my m/ws the other day. She said that the labour ward at local hospital had had to close for incoming patients because insufficient midwives. I asked whether the labouring women were being sent on the Queen Mary's (20 mins drive away) and she said that they were full too. The nearest hospital accepting women was Redhill, which is a good 45 mins drive.

morningpaper · 28/01/2006 20:09

This might sound terrible but I don't think that the NHS is compatible with the kind of 'birth choices' that women want. I think the NHS should provide the CHEAPEST and SAFEST healthcare for all. For labouring women, that is a hospital (generally agreed to be cheapest). I think that where staff shortages cause problems, women should not be given the option of a homebirth, or should have to pay for a private midwife. The NHS was set up to provide healthcare for all, not choices for all. It's not BUPA. If you want more choices, fine, but you should pay for them yourself by booking a private service.

I'm sure my view will be v. popular.

SoupDragon · 28/01/2006 20:18

But a hospital isn't always cheaper given that a homebirth is statistically safer for both mother and child in a normal pregnancy.

sweetkitty · 28/01/2006 22:41

hi mears as you know I had a homebirth 3 days ago, I live in Lanarkshire, my MW told me there was only 10 homebirths here last year. In fact I was the forst homebirth she had attended since she was a student (she must have been about 50 I reckon). Anyway I feel a bit of a celebrity up here as all the MWs have been talking about me/dying to be the one to deliver me, they said it was v exciting!

I was only "allowed" to have a homebirth from 39-42 weeks as that is all they will be on-call for. I can only say that the MW care I have received has been excellent both the antenatal and labour care. I had a team of 2 MWs and a few others of the on-call team even popped in to introduce themselves etc so the chances are I would know who was delivering me. As it happens it was one of the team of 3 who delivered me and another MW I hadn't met before. To have someone deliver you that you already knew was great and really really made a difference.

In answer to your question it is nice to see "your" MW when you have antenatal visits but I don't think it's necessary for every visit. But I do think if you are having a homebirth it's nice to have one of your MWs present.

Levanna · 29/01/2006 01:24

mp, I don't believe 'choice' should be available to only those who can afford it.

I don't see how hospital births are necessarily cheaper. Maybe in terms of staff wages they are?

Given the spiral of intervention I would imagine quite a lot of hospital births can be quite expensive given the quantity of drugs used, operations carried out, quantity of days in hospital, aftercare necessary, etc? On the staff aspect, the nurses, porters, midwifes, paediatricians, obstetricians, cleaning staff, cooks ~ per birth, surely can't be less expensive than community midwifes?

I'm prepared to stand corrected though!

Levanna · 29/01/2006 01:25

...electricity, food, formula

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