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?

Nannyl what are you comparing home birth costs with? Is it purely against a straightforward hospital delivery with no interventions? Or all hospital births including elective sections? What about the women who plan home births but are transferred due to complications? I suspect if compared to an equivalent hospital birth cost differences would be minimal.

op it does seem unfair that you weren't warned about the possibility of this earlier and I understand why you are upset. Chances are you will get a homebirth but bear in mind there is a shortage of midwives nationally, so if loads of women go into labour at the same time there might not be anyone available to do a home birth. It does take up more resources to have a midwife doing a homebirth as in hospital a midwife could safely monitor more than one woman in the early stages of labour

Good luck with your delivery

I'd like a home birth, but would also like continual care from the same Mw. I've had two hospital births, 1 with an epidural, second in water without anything inc no gas and air. Thus me now wanting to be at home, where the water birth is guaranteed. Where can I find an independent midwife for the Solihull area? Does anyone know?

Oh, and personally I'm a big believer in giving birth in the manner you want and the NHS should support it. As with all professions there are some great mw's who completely support and those who just don't know any better.

Good luck to all

Masiejoe - when you reference the NHS being sued how much of the figure that they pay out every year is attached to homebirths that began and concluded at home? Have you thought to find out?

Perhaps there is a much wider issue here too: the head of the RCOM basically pleaded with the government to do something because maternity services are at crisis point. My two local hospitals are only staffed and designed for 8000 births a year...they currently do 11000. Last year one woman had to wait in the waiting room and actually gave mirth on the waiting room floor - the baby died. Another laboured for hours in a corridor....our units are regularly shutting because they don't have the space. Midwives are being encouraged by their line managers to put women off as much as possible from coming into hospital when they are in labour based on highly questionable assessment practises such as how their voices sound on the phone....and are dealing with up to 5 women labouring at a time. This is not safe. It's bloody dangerous.

Stories such as this one www.telegraph.co.uk/health/women_shealth/8261784/Meltdown-on-our-maternity-wards.html are becoming less of an urban myth and more of a frightening reality.

And then we have superbugs - last time I was at my local hospital they proudly had plastered on their walls their statistical information of days free from MRSA - 53 days - oh now I feel so much BETTER about being in hospital.

I'd much rather stay at home, make my demands, and take my chances.

thinking - a midwife safely monitoring more than one labouring woman at a time (adding into that that the midwife, according to reports from midwives struggling in today's NHS failures, probably hasn't eaten or even maybe had a drink in hours) is safe? Could you please tell me where you found this information? Best practise reports that 'safe' means one to one care.

Trust - there just isnt the money for 1-1 care. We need to be realistic about what the NHS can and cannot afford.

Of course patients should have access to the best drugs regardless of cost, they shouldnt wait more than 1 week for an operation, they should be able to get a GP's appointment the day they call and be given the choice of morning or afternoon. All just dreams..

I'm aware of that, Masiejoe - but that isn't an excuse....there's a lot of evidence to suggest that management of services is being handled badly, money is being mismanaged etc etc etc. We are the services users and nothing is going to change if we don't make a nice big fuss. What incentive is there for the government and NHS managers to make changes if we all just sit there with a nice big collective bowl of apathy?

And if the NHS provided a better service perhaps they wouldn't be paying out so much in compensation every year...now that's a shed load of money they could be saving (not even going into the human cost of the muck-ups)

Too right it isnt an excuse. But there is money for the endless rounds of drunks on a saturday night.

That there should be one to one care and that this should be a right is something I would have thought any woman who has ever given birth would be willing to stand up for. It amazes me that people come on with the boo hoo nhs crap. Of course there are limits but this is basic.

Thinking The Birthplace Study 2011 compared like with like - low risk homebirths (including women who planned to birth at home but then gave birth in hospital), low risk women in MLUs and low risk women in CLUs.

Homebirths, for low risk women (the only type studied) worked out cheaper. By quite a way.

maisiejoe123 Fri 22-Mar-13 12:52:33
Trust - there just isnt the money for 1-1 care. We need to be realistic about what the NHS can and cannot afford.

Actually the converse is true. Poorer care and outcomes is associated with not having one to one care. The problem is that compensation resulting from cockups and complications doesn't come from maternity budgets. Its passed on to separate budgets instead. Maternity accounts for a staggering percentage of claims and payouts for negligence.

The truth is we can not afford not to start proving one to one care. The sooner that we get out heads around the fact that all these pots of money are not disconnected but are in fact part of the same thing, the better. Sadly the NHS has decided to structure itself in completely the opposite direction, which ultimately is damaging patient care and is more expensive than dealing with problems at their root cause in the most cost effective way rather than being obsessed with initial price tags which often work out to far more expensive further down the line.

Realistically, a lot of the country has community midwive shortages, it's not hospital midwives who come out to home births, so if they have a current shortage where you live now OP (only need one member of staff to leave and not be able to replace them and you have a shortage), they really might not have a the staff when back when you first asked, they did have the staff.

Plus, even if there are 3-4 teams, realistically you still could find there wasn't the staff to cover it if it just so happened that several woman in your area go in to labour on the same day. (I live near the biggest maternity unit in the county, yet there are occasions when they get overwelmed and have to send woman in labour to the next hospital).

Red - exactly. As my grandmother used to say - an ounce of prevention. It just seems madness to throw money away on a malpractice suit that could have been prevented had proper services been supplied and then for the pen-pushers to throw their hands up in the air and say they have no money and then cut service budgets even further because their cock-ups pay out budget took another hit....

On another note....women are pregnant for 9 months with a general expectation they wil go into labour somewhere between week 37 and 42 in general...most of those women give their intentions to their MW's for home birthing around say, 15 weeks before the 37 week birth. Of these women who intend to home birth a percentage (don't know how many) will automatically drop out of the homebirth system due to complications arising - so logically, if the NHS is getting lots and lots of notice of intentions to homebirth then why can't this be planned for accordingly? Bank staff?

Because you can't hire bank staff for sometime within a 5 week period. Trusts can make provision for x amounts of homebirths at 1 time. If more women labour at that time, there is not the staff to cover that, and it is therefore not safe for them to continue to offer that service at that time. I don't understand where people expect the staff to appear from, given that most often it is the middle of the nights when this situation arises, and so there aren't spare midwives roaming around.

Dontmind - does the lack of being able to replace midwives come down to lack of qualified staff, or cuts leading to posts being frozen? It didn't really sound as though it was a sudden lack of staff in OPs district: it sounded more like a lack of planning because having to go to hospital was described as happening 'at least once a month', and not, 'it happened last month or 'it happened a couple of months ago, but last month was OK.'

There is no shortage of women wanting to study midwifery, so there shouldn't be a long term shortage but they need posts to go into once qualified. Then serving midwives need to be retained. To me, many of these problems seem to come down to a lack of will to try to address the issues.

Staff shortages in London are probably a different problem, due to the shocking cost of housing there.

I agree Izzy. There is a view on this thread that if you insist someone will come. Not necessarily. On a very simple level - I have a phone and a mobile. When I am speaking on the mobile for how ever long I cannot answer the landline however urgent the other person thinks it is.

Maybe some people think there is a cupboard full of people who can be pulled out on the off chance there is spate of home births....

No business is run like that.

And I agree with some posters who say that it is organisational management that is to blame. Also there is a culture in the NHS to protect their own, if as a nurse you see something wrong, God forbid you report it..

TBH - I opted out. I cannot singly sort out the NHS and dont have the time so I use private medical insurance and have only rarely ie 3 times in the last 10 years used the NHS.

But izzy and maisiejoe, some areas do offer fully staffed homebirth services, so they manage it. I agree it would be a different problem if a whole lot of women suddenly decided at 39 weeks that they weren't going to go to hospital, but in OPs case she has been telling them that she would like a home birth since her booking appointment.

She mentioned that she was in a rural area, although she doesn't say which. I looked at the BirthChoiceUK stats for a couple of areas for 2011 and just chose the two areas at opposite ends of the country - both rural, both quite impoverished.

Cornwall:North Cornwall 8% of home births out of 958, Penwith 8% out of 646
Northumberland: Blyth Vale 0.6% out of 953, Wansbeck 0.7% out of 708.
The number of births in both areas is very similar. I know I picked out the extreme examples but the number of homebirths in the Northern Region are below the national average while those in the Southwestern Region are above the average.

What is the Southwestern region doing to facilitate homebirths that the northern region isn't?

Private medical insurance frequently does not include maternity coverage. Nor does it include pre-existing condition. So private medical insurance is about as helpful as a chocolate teapot half the time. And the situation is even more complicated in the UK, due to the fact that certain things - like maternity - can't be provided in private facilites so only use NHS facilities anyway. So you could choose to go private for birth, find that you have complication and end up in an NHS ward which is unstaffed and still have no guarentee of a private room as there aren't the facilities... blah, blah, blah anyway.

So maisie, what you say about opting out is bollocks because in effect you can not opt out. Not fully. And not in a hell of a lot of cases.

This is just part of my daily struggle. Its easier to organise, and get resources for, a proper home birth service if more women ask for it. In my area, only about 1.5% request home birth. Of these, 1 in 4 don't actually labour at home for various reasons. We have a good service on a shoestring with committed, pro-HB midwives but its hard and very vulnerable to just one person going sick. Its a cinderella service that is invisible to management unless a drastic problem occurs.

Its very hard to justify resources to staff a good reliable service when 98.5% ask for something different.

Red, I beg to differ. I have used private insurance a few times for various issues over the years and had my last child at the Portland which DOESNT use NHS facilities so you are incorrect in saying that maternity isnt covered privately. I saved up and paid myself and you clearly have not used private insurance. It gives you choices and I have opted out. I use a private GP having used the NHS which was complete rubbish.....

And my private insurance covers for existing conditions. Block big company policies often do.

Mayhew - you make a good point if nearly 99% use/ask for a different service why would you fund the 1%....

Home birth wouldnt be for me, for some it is a great option and perhaps people who really really want it need to consider paying for it to guarantee rather than demanding that 'someone' turn up. There might not be anyone....

Well the Portland is very helpful for those of you who live in London and the surrounding areas...

...However would you like to point me in the direction of similar facilities outside London. Most specifically the NW of England. You know the other 75% of the UK population.

Good luck with that one, since the Portland is the ONLY private facility with Consultant Led Care in the country. All other private wings are in NHS hospitals which are also in London

@lavolcan, I imagine what they are doing differently is promoting homebirth, encouraging women to consider homebirth as an option, as opposed to reluctantly providing a service if a woman requests it. And I agree that each trust should provide adequate midwives to cover a homebirth service, and promote it as a service.

I think there is a big difference between a trust never providing enough midwives to cover homebirths, which is an unacceptable service, and a trust that does provide an adequate homebirth staffing. However ultimately, with the best staffing levels, they can only accommodate a certain amount of births at the same time, and can not facilitate women in addition to that.

It is exactly the same in hospitals. Labour wards can and do close, when there is not the staff (or rooms) for additional women.

Knowing women are planning to have a homebirth, doesn't mean you can plan staffing levels, you can just average it out. for example, if u only have 5 women planning a homebirth due in may, if they all labour on the same night, you won't have the staff for all of them, unless a trust was to employ 10 midwives to remain on call for the entire month, just in case! It just isn't possible.

London has a huge population so granted there isnt a Portland in the middle of nowhere where there are few people. Of course there wouldnt be. But you are incorrect in saying that private insurance isnt useful. It is VERY useful... And would there be a demand in the NW? If not then business wise (and private hospitals are businesses) then they wont be there.

Ask someone who has used the facility as opposed to making sweeping generalisations about it.