Want home birth but there "might not be staff"

[Kopparbergkate]

I'm expecting DC2 and am nearly 38 weeks now. Ever since my booking in, I've said that I wanted a home water birth with this baby. I didn't have a pleasant time (putting it mildly) having DD1, albeit in a different hospital, and I am really really keen to stay at home; though I have also said throughout that if anything changed and I became high risk, then I would go in.

Anyway, the community midwife I have had for all my appointments has seemed keen and assured me that there is no reason I can not stay at home.... That is, right up until my 37 week "home birth check" at home last week, when she said that, of course, there's only one home birth team in this area (its a big rural area) and if they're attending another woman, then when you phone for a midwife, you'll have to go in to hospital. I asked how often that happens and she said it happened at least every month.

I've never had an issue with the thought that I might need to transfer in labour or indeed that I might develop a complication in pregnancy that means home birth isn't an option but that's not the case. I'm in tears at the thought I might phone up expecting to ask for a midwife and get told to come in instead and it's really worrying me (i guess partly cus of what happened last time). I have a doula and she's given me a letter template from an AIMS book to send to the supervisor of midwives basically demanding a midwife be guaranteed.

Thing is, I feel really torn; I do really want them to guarantee me a midwife and they have had months of notice but I also don't want to come across as an entitled arse making a huge fuss when NHS resources are limited etc etc.

Wwyd?

patches: your approach seems to be that the health authority says: we won't provide a home birth service. Tough' and the woman just accepts it.

Further up thread you said If I'm in labour and I want an epidural but the anaesthetist is dealing with someone for a C-section should I demand they leave that woman and come and see to me? What if you were told at your booking appointment, "forget the idea of an epidural, we haven't the resources to provide pain relief on non-medical grounds so only those getting a CS can have one?" Would you be quite so happy to have your expectations managed in the same way? I rather suspect not.

nannyl you are wrong. The midwife has a duty of care, yes. But that may be to send an ambulance if there is no midwife available to attend. There 100% definitely is not a legal obligation for the trust to send a midwife.

I'm not saying its morally right by the way. I do support homebirth.

No patches I disagree with people frequently. I try not to actively upset or guilt trip vulnerable people though. This site is about opinions but it's also about support and the OP posted in 'childbirth' not AIBU after all.

LaVolcan I might not like it, but if the resources aren't there, then I'd have to live with it wouldn't I? That's life. I would also have had time to comes to terms with that which would help.

I know when I give birth I may not be able to access a birthing pool which I'd like to do. If someone is using it, I'll accept that. The ability to do that is made easier by the fact I've been told that at the outset.

I'm not saying it's right. I'm saying if the resources aren't there because the money has been put into something which will assist more people (or save someone else's life) and there is an alternative that is available then you use the alternative.

In this scenario I wouldn't be getting my birthing partner to demand they send someone, I'd be taking steps to get to hospital. The time it takes for them to find someone else (if there even is someone) and for them to get there might make all the difference to me or my baby.

As I've already said, I hope you get your HB OP.

I'll try not to post on this thread again as I just feel I'm going round in circles.

I suppose patches it depends how strongly you feel about the options. I agree that it's better to be told at the outset than to be strung along that something is a possibility when they have no intention of providing it.

I do question whether we should just meekly accept that the resources aren't there. Some of it comes down to deliberate choices being made, not necessarily the wisest ones. Sometimes it's worth fighting for changes to be made. If people hadn't fought for changes/improvements just before the war we probably wouldn't have an NHS now.

Jesus a woman feeling entitled to a midwife when she gives birth how totally unreasonable

Women can be utterly utterly vile.

I do remember being warned when I was planning my hb that it is standard procedure to put you off with the staffing objection at 37w, and not before.

It happened to me, and to everyone else I know who planned a hb.....

Most women aren't in a fit state to argue the point by then.

Viking it was never mentioned in mine. I was told that I might not get MWs from my own area (and I didnt) but they seemed to have on call teams in more than one area and rotated it.

i was told it was too early to even think about birth until 37 weeks last time....

and mine wasnt booked until i was nearly 38 weeks, but would have been home birthing from 37 weeks end of.... i had told my midwife my intentions at every appt from 5 weeks pg...

this time it was much easier.... on the homebirth sytem by my 8 week booking appt, though obv wont be "booked in" until 37 weeks..... and wont be getting in a car to go to hospital after 36+5....

i refuse to take the (significant) risk of an unassisted road side birth.... would rather birth unassisted at home

It is very frustrating that a pregnant women has to bear the stress of an NHS service that has failed to plan for the flexibility of service REQUIRED by govt policy!

i have personal experience of women making a determined stand to challenge the lack of service. Some colleagues felt personally attacked but I was pleased. It did lead to improvement that benefited other women. There is always the danger of sliding back though. Managers always prioritise what they can see, in the unit. Community services are invisible and always at risk of marginalisation. I encourage women to write to the head of service about their experiences, good and bad, so that they are known about and command attention.

A [positive article in today's Telegraph www.telegraph.co.uk/women/mother-tongue/9943365/Kate-Middleton-open-your-eyes-to-the-home-birth-revolution.html

The Queen did indeed have four home births, but I have also heard that they set up a 'palace hospital' inside Buckingham Palace, so maybe it wasn't quite as homebirth like as anyone else would have had?

I believe that Princess Anne also wanted home births, but was persuaded to go to hospital - but this was 1982 ish when home births were at an all time low.

Will Kate have a homebirth? I very much doubt it - I don't think the pendulum has swung back far enough.

BTW Why have we never heard of Betty Parsons? Why is it always Grantly Dick-Read? (I found his main book unitelligible, although I did inherit a book based on a series of lectures that he gave and that was much better.)

Princess Margaret was born at Glamis Castle

That's an interesting read. Queen Victoria's labours are noteworthy too because Prince Albert attended all of them and stayed with her throughout. She gave birth in the same 'shift' every time and had continuity of midwife and nurse as well as posh obstetrician. When relations were giving birth she tended to send the same staff or receommended persons to them as well.
Prince Philip was also born at home - on the dining room table in his parent's Greek villa. His mother, Queen Victoria's great-grandchild, was born in Windsor Castle with the old Queen in attendance. As the birthing mother's own mother was dead, Queen Victoria filled in to keep an eye on the situation.

I suppose when the Queen and Princess Margaret had the births in the early sixties it was still a time when homebirths were not uncommon. By the time Princess Anne started having children, the Peel Report of 1970 had come along and the anti-home birth propaganda, (for want of a better word), was in full swing.

The queen had the same midwife for each birth. They kept in touch for years afterwards. some letters were published a few years ago.There was an obstetrician but he stayed in the background.

I actually agree with a lot of what Patches has said. Demanding this that and the other when you are in labour will be horrible and you wont be thinking clearly.

And what if the nearest midwife is 2 hours away or someone has already gone into labour before you and having their homebirth. Some of the replies seem to indicate that the NHS will magic up someone - they wont.

If there is no one available there is no one and you will then need to choose whether you go into hospital.

No one is telling you you wont have any care at all, just that it might not be at home.

And btw, I am sure you will get your home birth!

No one is telling you you wont have any care at all, just that it might not be at home.

Unfortunately maisiejoe, even that statement isn't necessarily true. You might not get over the threshold of the hospital because they have closed because they are too busy, and so you have to go to another nearby. Even if you make it, there is a very good chance that you won't get one to one midwifery. It's debatable whether that can really be called care.

Where I live they will send a mw out from the hospital which they did for me. Before anyone slates me for taking a mw away from another woman, I would have been doing that anyway if I had gone into hospital!

Just remembered something one of the Community MWs said to me at some point in the weeks before I gave birth: they are always much busier when it's a full moon.

Have just checked the day I went into labour against the lunar calendar (bearing in mind I was told no HB as they were too busy)

No idea if anyone else has any thoughts on this, but may be worth bearing in mind if you are worried about the availability of community MWs.

The difficulty is, is that in order to be cost effective they can't always have a midwife on duty doing nothing just in case more women than expected go into labor at the same time, so at some point there is going to be the situation where more women wanting home births are in labor than midwifes able to cover. You have the right to refuse to go into hospital when you do go into labor, but most women won't do this in case something happens. But my guess is that the best thing you can do is tell them when you do go into labor early and see what the situation is (it maybe the case that it doesn't happen to you or because you're in labor someone else is told to go into hospital). Maybe the answer is to tell them early when you're in labor (that way you have plenty of time should they tell you that they're having problems).
The reason that it's cheaper to have a home birth is that you don't usually end up in hospital (with electricity, heating, cleaners, food, overnight stay, more nurses, midwives, doctors) although you would assume this would be available anyway and therefore paid for, as more people opt for home birth then less beds and therefore hospitals need to be provided.
We were warned that as the hospital we're down for is very popular (people who miss out on a space there apparently still turn up in labor and get in as the hospital can't turn them away if they're in active labor), we've been warned that if we're unlucky then we could find ourselves transferred to another hospital. There's not much I can do if this happens, all I can do is hope it doesn't and let my OH deal with it if it does (make a fuss or go along with what they say) that's his job, mine is to keep calm and get to the other side whatever happens.
Guessing that the average labor is approximately 8 hours long and a month has approximately 730 hours, then they can do approximately 91 home births per month without being double booked so you've got a good chance that they won't be double booked.

Princess Margaret was born at Glamis Castle

Queen Elizabeth was a home c-section :o As was Princess Margaret I believe.

although I suspect neither were performed on the dining room table

Agreed LaVolan. Yes, the local hospital might be 'full'.

I also dont understand how home births are cheaper and more efficient. There is travelling time to the person's house and often the hours and hours once in labour giving one to one care. You wouldnt get that in a hospital. MW's look after a group of women and dont have travelling time.

But I really dont agree with people who say stand your ground (when in labour!) and 'someone' will come. There really might not be anyone or perhaps the MW team have unexpected sickness, the nearest mw might be 2 hours away having been called away to cover another area - the NHS isnt being sued for millions of pounds for nothing.

If I was the OP I would try and relax about this. The chances are that it will be fine. Of course if she is really really determined to have a home birth to guarantee one she might well need to consider paying for a independent MW.

I know - very very late in the day

Couldn't it be argued that it might actually be technically illegal to refuse to consent to your preference for a home birth under European Law now?

Ternovszky v. Hungary used Article 8 of the Human Rights Act:
1. Everyone has the right to respect for his private ... life...
2. There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.?

Now given its widely documented that homebirth is both cheaper and potentially safer/healthier for women expecting their second child I think the NHS might have trouble with the exceptions listed there.

Might be wrong, but it poses an interesting question.

yes red toothbrush

there has been so much press about that...

pretty sure it concludes that under EU law we are entitled to homebirths....

i fail to see why anyone should be forced to go to hospital and increase the risk of death (mum and baby) infection, major heamorage, intervention, while reducing babies likely apgar score, and breastfeeding sucess....
What a bit of luck we dont have to do this.

I cant think of any worse place to spend labour than sitting in the car, for an hour or more..... so i wont. end of.
should i need to go to hospital i will do so WITH a midwife in an ambulence.

I wish they hadnt closed the labour ward in my local hospital...

my choice is stay at home, or risk unassisted road side delivery, not that unlikely as last time i only had 12 mins before realising this was real actual labour and my baby landing on the sofa...