Anyone know what my "rights" are wrt to home birth if I go beyond 40+14?

[floozieinthejacuzzi]

I'm 40+13 (officially, but 40+8 by my dates), today (second pregnancy) so I won't have any midwife on call cover after tomorrow. I'm due to have a midwife appt at some point today to have another sweep done (had one on Mon, no joy), and I just know that she is going to tell me that cover won't be extended beyond the 40+14.

Am I still entitled to have midwife cover for a homebirth if I chose to go beyond the recommended dates?

Has anyone else been in a similar situation? and what have you done?

The thing is I don't believe the nhs due date is correct. Had long discussion on Tues with consultant about it, as they recommend induction at 40+12, which I declined. They say edd is 12th, I say 17th (I was charting bbt when we were ttc, so I know exactly when I ovulated. Scan date suggests I conceived before I even ovulated). But they won't budge from the official due date (even though my evidence is factual - v annoying!), which puts my home birth plans in jeopardy unless I go into labour this minute (which unfortunately doesn't seem like it's going to happen).

Also, does anyone know if I go post-dates and I cannot have the home birth whether the MLU would take me when I finally go into labour or is it straight to the CLU because I'd be past 40+14 (officially) at that stage?

I really want to avoid CLU as that is where I had to go when DD was born, and had the usual constant monitoring (meconium in waters), lying on bed for 10 hrs, augmentation, episiotomy etc etc- obviously not what I was hoping for. I can't understand what's taking this baby so long. I wish he/she would just hurry up and get here, and save me all this stress! DD was born at 40+4. I thought subsequent pregnancies should be shorter!

Anyway back to the original dilemma re home birth "entitlements" post dates, any advice gratefully received!

You need to go to homebirth.org.uk to verify your position.

afaik, the NHS is entitled to provide you with health professional support whenever & wherever you go into labour.

However, they could only turn up with paramedics, not MWs.

My tale may be salient:
Local policy was to induce at 40+10. I conveniently ducked out of 34 wk appointment to book my 40+10 induction date (I think I rang to cancel it & firmly told them that any appointments were my choice), I also avoided seeing MW at 41 weeks (naughty, I know, I just didn't want the stress, I simply didn't book it).

I went into labour spontaneously at 40+10, baby born early hours next morning (home birth). It was me who pointed out to the MWs that I was already past 40+10. I had literally slipped thru the system. Wasn't that hard to do at all, in retrospect. MWs commented that the baby didn't look at all overdue.

But be mindful, of course, you have to live with the responsibility of outcome. I had made up my mind to agree to induction at 40+18.

You have the right to a homebirth regardless, even if you are going against medical advice.
The midwives have a duty to attend you, they cannot refuse to go to a labouring woman.
I would get in touch with your Supervisor of Midwives and explain firmly that you intend to give birth at home, and will expect a midwife to attend.
Take a look at this www.homebirth.org.uk/overdue.htm

My dates were diff from the hospital's dates and 2 sweeps failed to shift DD so I sympathise!

Remember that appts are voluntary - you can decline treatment at them. The hospital may well want to book you but you could agree to the induction but only on 40+14 by your dates? That way you've got an appt booked so it'll encourage your baby to move under sods law? you could also suggest daily monitoring in the interim?

I had an active birth in a CLU, it is possible - just make sure your birth plan is very clearly worded! e.g. "I charted while trying to conceive and by my dates my edd is x - I wil consider hospital policy only in line with my dates", "I want a home birth but would transfer to hospital if baby shows signs of distress" etc.

is there a birth choices group at your hospital?

Good luck and I hope you get the birth you want

You could ask for scans to monitor the effectiveness of the placenta. Doctors and midwives get scared because sometimes the placenta fails when a baby is very overdue and that results in a stillbirth. You can ask for expectant management, where they will do daily checks of the baby's heart beat and a scan to check that everything is fine.

If you have mec in the waters you may be transferred anyway...

Midwife at hospital antenatal class told us that you can't be "made" come to hospital and they will have to send someone out but I think that might be very, very stressful.

I hope you go into labour yourself ASAP x

ok

I had a homebirth (at 40+3) but had no intention of going to hospital at 40+14

for a start i knew for a fact that my dates were wrong... (I charted / OPK's / CBFM etc etc) and according to the hospital DD was concieved before i ovulated.

I asked my midwife about what would happen after 40+14 and i would not be induced then... she was all very calm about it... she said essentially, so long as i was happy for monitoring (which would have been in hospital) and all was fine, they would still be happy to attend a homebirth

(clearly if any monitoring revealed a problem i would have consented to induction or whatever was necessary, but essentially, so long as monitoring showed things were ok, i would have a "normal" home birth)

I was of the opinion that i was NOT going to go to hospital unless there was a medical reason to go, and i didnt consider the date to be a reason....

Thanks for all your replies. As it turns out, I had a different community midwife for my sweep yesterday and she told me that they will stay on call for as long as I want them to, which was a relief to hear. I thought that on hearing that, feeling a bit more relaxed, and having a sweep might've started something last night but no, still waiting!...

I understand that as I am so post-dates now (even by my date) that there is an increased risk of meconium unfortunately, but I'd still like to try for the home birth and transfer if necessary.

I've decided I'll give it til 40+14 by my dates and then go for induction if need be. In the meantime I'm having extra monitoring/hospital scans. DH would rather I went for induction at +12 (as that's normal hospital policy) but I want to wait the full 42 weeks as long as baby is healthy. Could do without the extra pressure, but hopefully baby will come before then so it won't be an issue! Fingers crossed..

good luck floozie

if you lived in my postcode you dont get offeren induction until 40+14 anyway
(unless medically necessary ofcourse)

Past 40 plus 14, the chances of meconium become very high, it's statistically much safer to be in hospital.

You cannot be forced into hospital or into being induced. They will have to send someone to see you when you call hospital/999 but they don't have to send a midwife.

They will make you very aware of risks though as they start to go up more steeply after 42 weeks.

You can ask for monitoring.

Or you could book a private midwife (will be costly obv)

Good luck and fingers crossed for you popping ASAP!

I had a home birth planned but ended up really really over due and was induced so really hoping you get your home birth!

Apologies for long post- this is my bug bear!

Glad to hear your mw has reassured you they will remain on call. Stick to your dates like a broken record and follow policy when it is backed by sound evidence is my advice.

Induction based on estimated due dates (estimated by inaccurate scans we take as gospel) causes far more iatrogenic harm to mothers and babies than a flexible approach with monitoring past 42 weeks.

The vast majority of babies are born by then (if their dates are accurate) and there is evidence that as babies trigger labour themselves those who are truly very postdates have not done so because they have other underlying issues.

Which is of course tragic but does not justify what I personally feel is the assault of induction on mothers and babies who simply are not ready to birth/be born. Babies lay down glycogen stores in their liver to manage labour - no wonder induction so often results in distress and subsequent 'emergencies'.

On an anecdotal note - I know several mothers who knew for sure their scan dates were wrong by a week but couldn't budge the system on it - and they had had IVF fgs! Can you get any more sure??

And apparently 40+10 is too long in one postcode but 40+14 fine in another...I'd Like to see evidence of harm caused to those in the latter compared to those in the former... But what I do know is those with the former policy generally have significantly higher rates of CS, instrumental delivery and admission to SCBU....

So yes, stick to your guns IMO!

You have a right to stay home. You have a right to NHS care there.

I had hired private midwives for my twins. Had I been in the NHS they apparently in our area always induce twins at 38 weeks. We waited as the babies were fine until I went nito labour naturally which was amazingly at 40 weeks on exactly the due day which is actually quite late for twins and I feel they were such happy nice babies because they stayed in until they wanted to and had a least another 2 weeks of growing bigger before coming out.

Can't help regarding home birth but my care trust won't allow a birth at the MLU after 40+12 whether that's standard around the country I don't know. I really didn't want to have dd at the main consultant lead unit but being 17 days late and it literally going tits up from the start it's a good job I did.

Either way I hope u get the birth u want

mellibobs midwife units have rules which mean you "are not allowed" to go there and they dont have to admit you. (though silly that you post code is 40+12 and mine is 40+14)

however, having a baby at home is different... unless you are sectioned under mental health you do not have to go to hospital; all you have to do is call a midwife (when you believe you are in labour) and a midwife is legally obliged to attend the birth.

floozie if you still haven't gone into labour, I ended up not getting my homebirth as went more than 14 days over and agreed to be induced.

My top tips if you end up going in, you can refuse continuous monitoring - I only had it for the 45 mins directly after they insterted the pessaries rest of the time I sat on the birthing ball with entonex in one hand and the tens machine in the other - made a huge huge difference, once labour had established it was very quick probably 5 mins from 3cm dilated to delivered - official labour was 1 min!

Hope all goes well regardless of where you end up delivering.

nannyl what happens if they have no midwives avaible as I was warned that if there werent' any available to come out then I would have to go in, which to me seems reasonable - when it's busy in our maternity unit you often end up with one midwife flitting between a few rooms unfortunately

you stand your ground

you do not have to go to hospital....

I had said I would be having a homebirth since my 1st appt at 5 weeks pg... i gave them 8m notice IMO.
NHS staffing issues are the problem of the NHS, not my problem... and if you stand your ground, (based on other peoples experiances, not my own) a midwife will be found and will appear...

"when it's busy in our maternity unit you often end up with one midwife flitting between a few rooms "

that is the very reason why i chose a home birth..... 2 midwives all to myself... 100% attention from both
(though DD arrived so quick only 1 midwife was here for the birth, the other arrived a few mins later)

Hmmm not sure that would happen around here, they are pro home birth but chronically short staff at times - not sure I'd personally fancy and unassisted homebirth if they didn't make it on time and the thought of not having gas & air - eek!!

Yes nannyl that's one of the many reasons I booked for homebirth too, sadly spontaneous labour never happened for any of mine and I decided to go in and be induced, to be honest my actual labours were so quick not sure if a midwife would have ever made it to my house...

I have birth to dd with one midwife. While I was pushing she was also trying to direct the other midwife to my house!