Caseload midwives are full :-(

[Badgerina]

So I'm expecting number 2 in September and am planning a Home birth. I've been told that the caseload midwives in my area are "full", so I can't get my care through them. This means going with the hospital team and probably not knowing the midwife who comes to our house when baby decides to arrive.

I'm wondering if anyone has knowledge or experience of making a fuss, stamping your feet and/or writing letters in order to get the model of care you want. I truly feel that caseload midwifery is the best model for me. Feeling comfortable with a midwife that I've gotten to know over the course of pregnancy is going to effect the way I feel during labour, which in turn could effect the outcome.

Yes I've considered a doula, but I want caseload MW care!

May I suggest that you join the Yahoo Homebirth group, and also have a look on the AIMS website. You may get some helpful advice there.

However as someone who is planning a homebirth myself, I live in an area where there's no caseload midwifery, you get whoever is on duty on the night when you go into labour and to me, that doesn't seem like a problem.

Even with a caseload midwife, you could be unlucky enough for her to be ill or on holiday or something when you go into labour anyway.

This model isn't an option in our area - you get who you get basically. I believe you could request a change if you're not happy at the time? An independent midwife or doula is your only alternative I think, if you aren't happy with that.

Hmmmm, you've sort of confirmed what I thought. One good thing is that the hospital mw team are generally pro home birth so that helps. I think I just dread getting nearer the edd and being told "you can't have a hb cos we're too busy around your due date". I will start looking at doulas I think!

I would have had my community midwife if I'd gone into labour during the day, but whoever was on call if it was at night. As it happened, my midwife was on holiday the day I went into labour and I got the two duty midwives, one of whom I had met once. TBH I thought it would matter, but on the day they could have sent me anyone and I wouldn't have cared! Both the midwives I had were lovaly (I had a fast labour so basically had them both the whole time) and 'my' midwife came round first thing the next morning.

Don't forget as well that it may be that some of the women the caseload team have at the moment are later assigned to the hospital for various reasons (they become high risk etc) which will then free up space, it won't hurt to ask at antenatal appointments if there is space later on for you to be bumped across, which still allows you time to build up a rapport with that team of midwives instead.

Don't forget, you can't be told you can't have a homebirth, that's a different kettle of fish altogether!

Ditto the AIMS website. It talks you through the myth that you 'can't' have a homebirth cos they are busy. Yes you can, and they have a duty of care to send someone.

i have had 4 hb's and only got my assigned mw once!

tbh, all that really matters is the outcome, and at the time you will more than grateful for anyone to help you!

1st hb my midwife was already deliuvering someone else
2nd i was too quick and no one arrived in time, and 2 mw's turned up afterwards
3rd time my mw was on holiday
4th time it was my mw but dd2 arrived as she was walking up the stairs! she was most annoyed as she had missed my last one too!

I'm not sure that stamping your feet is going to get you crowbarred into the caseload MW, because if they're full, they're full. You could write some pointed letters saying that this is unfair, that if the local health authority are going to operate caseload midwifery (yay) then it's important that this is available to everyone who wants a HB. I suppose, by definition, that caseload midwifery can take only so many and no more, so they need more MWs on caseload. (I presume the MWs would be happy about that, because it seems to be one of the most popular ways of working.)

In the meantime, if you don't get put onto caseload, consider an independent MW (around £3500 for full care) or a doula (a lot less) if you really, really think that continuity is going to be vital for you. On the other hand, your local HA has to provide you with a MW for a hb if you insist, and getting one from the local hospital might work out very well for you!

If it helps any, I hired an independent MW for DS2 and nearly didn't get her, because there'd been an unexpectedly earlier birth on her 'list' the previous day. Doulas and Ind MWs purposely don't book themselves so many clients that clashes become likely, but shit can still happen! I have a friend who recently gave birth and hired a birth companion. She didn't have her the whole time though, because the birth companion was also a MW and had two other births to attend on the same day! Ind MWs and doulas (I think) work together to cover one another, but you have to remember you still may not get the MW you've built up a relationship with.

Hope your pregnancy goes well and that you do get the care you need.

In my area you only get a caseload midwife if you're deemed to have special needs. So at my home birth I just got the community midwives who were on duty that night.

I agree with the PP who said that in labour you don't really care who is there. Even though I didn't get on with one of my midwives, don't think it made any difference to the overall birth experience cos I was away with the fairies!

I did have the midwives who had done my antenatal appointments for all of my postnatal visits, which was when I really appreciated the relationship.

Thanks for these replies everyone - they've really helped me get some perspective on it. I actually agree with those who have said that when it comes to being in the throes of labour, it doesn't matter if you "know" who attends. It has reminded me how certain I was about not having a student midwife present during DS's birth, however, when it came to it I couldn't care less (and was actually glad of the extra support and presence).

Part of me still thinks I should get the model of care I want (as should all women), but I'm much less worried. On with the doula search - anyone got any recommendations? We're in S. London.