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

[mears]

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 ?

equipment! I'll shut up!

Ahem, I think birth is a unique experience that we all want to be wonderful, and as near to our wishes as possible, I really like the idea of people choosing whether to give birth at home or at hospital, but after seeing so many cases where labours had gone wrong because the maternity unit was at some point overcrowded and/or under staffed, I would say that I would preffer 3 midwives attending 6 woman at hospital rather than 2 midwifes attending six because somebody had to go out to attend a one-2-one birth. But I may have get it all wrong, as I don't know if the nidwives from the maternity unit are also the ones that attend the home births.

...Obviously, the ideal solution would to hire more midwives but... getting the money to do it it's a complete different animal!

In my area they aren't Chandra. The community M/W's, though based at the hospital, are a seperate team from the hospital M/W's.
i.e. a hospital M/W wouldn't be called out of a hospital birth to attend a homebirth; if there weren't any M/W's on the community team available to attend then no-one would, though I haven't heard of it happening here.

The community team is quite large and they also run the local family planning clinics.

May not be the same everywhere though?

Mears wrote: "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."

Yes, I know that would happen as a last resort. What I am saying is that if there are, for example, two labouring women booked for a homebirth and only one midwife available, they are likely to ask both to come into hospital - I will be the one refusing rather than complying. And in the area that I'm in I AM confident a midwife would be found and sent. Of course, I could be even more awkward ( and yes, possibly stupid ) and refuse, or ask my husband to refuse the paramedics access to my house. . .(playing devil's advocate here) - Nobody can force me into hospital, and so then. . if I have refused to go into hospital and they have neglected to provide me with midwifery care, where does that stand on the legitimacy side of things?

I'm not saying this is what I would do, I'm just raising the question. I would, however, feel incredibly angry and let down if my homebirth was jeapardised for the sake of staff shortages.

Not sure if I've worded that very well - too early on a Sunday morning!

What I am basically saying is that if a woman is legally entitled to birth in her own home, and midwives are legally obliged to provide that service, then surely failing to attend ( for whatever reason ) is failing that legal obligation?

I fully understand that it is not as black and white as that and the system is understaffed and underfunded, but failure of a legal right and a legal obligation is the bottom line, isn't it?

Re cost morningpaper, This doc from the Royal COllege of Midwives points out that a study has shown that home birth costs less than hospital birth. I have heard that avg cost of home birth is £400; straightforward vaginal birth in hospital £800 and c-section £1600 (all approx - I rounded figs when I heard them as this was an easy formula to remmeber by doubling!).

Hospital births include cost of premises plus labour plus heat, light, power and frequently reuire intervention (less than 50% of births are' normal' i.e. require no interference in most hospitals.

The paper points out though that if home births increase, there will still be the fixed costs to the trusts of the maternity wards and other hospital facilties (although presumably long term these could be converted to use by other patients).

RosiePosie - legally a maternity service needs to be provided. If a woman is in labour at home, and there is no oncall midwife available, then the woman is advised that the maternity service is provided in the hospital. If she refuses to go in, then ultimately that is her choice.

It is a very difficult situation. There are no reas in Scotland providing an oncall service 24 hours a day, 7 days a week. One of the reasons for that is safety of the lone worker. It is unacceptable for midwives to have to go to areas that they do not know and people they have never met. Now if they were provided a driver like on call GPs that might be a different story, however they are not.

So the reality is, that is a woman goes into labour, and there is no oncall midwife available for her, ie they are at another homebirth, the option is to go into hospital or stay at home.

The answer would be more midwives, but unfortunately that is not an option. As I said, we do not have a shortage. We just have a real problem when there are more homebirths booked than midwives available.
Solutions are being sought at the moment because the midwives definitely don't like this situation either. Equally, they do not like the amount of oncall that is required. Midwives have homes and families too.

Mears, if there are more homebirths than midwives available, that is a shortage, isn't it? Your trust hasn't provided enough midwives to meet the needs of its patients and should recruit more. It's the head of midwifery and trust chief exec (and PCT) who are responsible for providing appropriate healthcare.

The idea that you'll get more care from midwives in hospital - or more midwives per patient - is laughable in the part of London where I gave birth. On the allegedly midwife-led birth centre there was ONE midwive to six women in the delivery suite. She couldn't transfer me to the hospital birth centre (just across the floor) as there was only one midwife there too! This is one of the biggest, most high profile trusts in the country, St Thomas's. Absolutely appalling. Community midwives told me Tommy's has a reputation for being 'lucky' because they haven't managed to kill anyone yet despite their lack of staff.

The problem Edam is when there is a cluster of potential homebirths. You can go for months on end with none, so at those times there are enough midwives. It is trying to deal with the peaks really. No woman has had to come in yet because there hasn't been a midwife available. Potentially it could happen though.

Mears good point re. midwives having a life too.

I know that the costs local to me were looked at and home births were more expensive in terms of numbers of midwifes working on call and overtime, which was very high.

EVERY part of the NHS is lacking in resources. That's the nature of the beast. There ain't no point complaining because every single department and unit wants MORE MORE MORE. And it isn't going to happen.

The overall cost of homebirth is cheaper when you take in overheads of hospital and equipment etc. The problem is that midwife in community costs more than midwife in the hospital and that is the costs managers look at instead of whole picture.

H all very interesting i've had one hospital birth (awful) and two home births the last one being a water birth. With both home births i didn't now the midwifes as you just get whos on call. I experianced no problems all the midwifes where very supportive and at no point did i feel under pressure to change to hospital birth. On my last birth one midwife hadn't done a home birth or water birth so she said she was glad of the experiance, saying that both 2nd and 3rd births where quick so the midwifes only there for a couple of hours, don't know what would happen if you had a long labour.

How is this organised in the netherlands were most mums have homebirths?

Mears, isn't it possible for your health board to organise temp. staff to cover the rush? Contract in an independent midwife or something?