interesting website - GP talking about home births, experience of midwives and breastfeedng etc

[mogwai]

Stumbled across this and I think it's very interesting.

It's basically a blog written by an NHS GP.

If you scroll down his pages, there are some very interesting discussions about homebirths and breastfeeding. The arguments stirred up are worth reading, but be prepared to get addicted!

nhsblogdoc.blogspot.com

gizmo - saw friend this pm, yes mw said about scan for her too.

our mw is 'attached' to a no of docs surgeries (burwell, bottisham and others i think) but isn't 'empolyrd' by the docs - but is part of the rosie team (east in this case). your notes may say something in the emergency no's to read.

my mw said about late scan around 28wks, hadnt mentioned it before.

for record, opted for homebirth as v quick first birth (2.5 hrs) and was worried about getting to rosie (25/30 mins away). in the event ds2 was 25 mins from waters and only 15 mins from 1st contraction, and so ended up an unassisted homebirth, with mw arriving about an hour later!

.....still feeding, lol

I agree with Dr Crippen. I was always very in favour of homebirths and had planned to have a homebirth myself. The midwives were very supportive, my GP was concerned in part because I have fibroids, was first child and I would be 41 at time of the birth. The fibroids did not show up on the hospital scans (incl. 20 week scan), I then I saw a private obstetrician (who is known to be willing to attend homebirths), he carried out a scan,fibroids had grown and were in awkward position, greatly reducing the risk of pph, his advice was absolutely no homebirth and managed third stage at place with full medical backup with drips on standby in case of pph (i.e. already rigged up etc, although his preference was to have the drip precautionary, but at the minimum to have a canula inserted during the second stage at the latest). I told the consultant midwife who did not take his advise (in form of report)serious at all and in her view I could proceed with planned homebirth. To cut it short, I had to fight to have a hospital birth with necessary preparations in place for third stage and only got this after having spoken to labour ward consultant (Not midwives, they did not want to hear), who agreed with private consultant. In the end I ended up with labour ward with drip to prevent pph. Two friends gave birth in birthing centre (in hospital) both had pph and had to be transferred to labour ward, they could have been at home as they had been classified low risk like myself. Whilst in hospital there was a cord prolapse in the birthing centre (water birth), woman was transferred to labour ward, but as far as I am aware it was too late ...

I think that it is easy to become too casual about the dangers of childbirth for both mother and baby, if I was to have another child I would most definitely not consider a homebirth, probably not even a birthing centre within a hospital, due to reluctance of (some) midwives to seek help from consultants if necessary. Also, all this stuff about epidurials and that women should pay, is again a sign that midwives do not necessarily act in the interest of women. Could it have to do that they want to protect their own interests given that you need an aneasthetist for an epidural? Don't get me wrong there are clearly some fantastic midwives as well, although I didn't come across them myself ...

It sounds like you made the right decision for someone in your situation, Conni. Interesting (and sad) that the cord prolapse baby in the waterbirth died despite being in hospital.

This ongoing low grade friction between midwifes and doctors is a real pain, IMO: what I do not want to be doing, in a pregnancy/birth situation, is having to mediate or choose between two sets of professionals with different opinions about how to treat me. Frankly it's a situation that undermines my trust in both groups. Although I should add the usual disclaimer in that I have met and been treated by very knowledgable, nice people from both camps.

Meanwhile, I've pulled my finger out and improved my understanding of my midwife services: I think they're part of the East team (based on the fact that it's the same team as I had when living in Mill Road, indubitably on the east side of Cambridge) so no doubt I should be having a conversation about late scans which I for one would find extremely reassuring.

SC: 3 months early! My GD . What a b**dy awful thing to happen. Still, she was worth all the shock and hassle, eh?

Gizmo (smile) loved your description of your husband, certainly lightened what could a fairly heavy thread, first delivery was millenium night and my DH was drunk as a skunk so was being sick most of the time...thankyou for the compliment ..i am not tough at all and still cry at thought of my Dh being told DD2 would probably die, ( he can't talk about it either )I do know that labour suite panic to baby out in my case was 2 mins 30 secs..luckily obs consultant already in theatre doing something else at time and a very game anaesthetist who pretty much gave me a general anasthetic in the corridor...I agree the friction between midwifes and docs is appalling and very bad for patients. I think sometimes each is jockeying for position as " most important" and midwifes do see their position as being undermined by increasingly high tech births, but last word of caution..midwifes often state that childbirth has only recently been medicalised but don't forget 50 yrs ago when home birth was more common ( and further back) the mortality rates for mothers and babies was considerably higher. I did n't put thisin originally but I had too ahve a hysterectomy during second delivery (sad) and a midwife 2 dasy later said " you know if you want to have a third you can still try for a normal delivery or even a home birth" pretty unforgivable comment and I have never had much faith in them since then...

Mummydoc, sorry to hear about your experience, presumably the midwife didn't read your notes.

This was a major gripe of mine during ante natal and post natal care last time I was pregnant.

I have little faith in anyone supposedly in charge of my medical well-being who clearly hasn't bothered to read the notes their team have spent months compiling on me.

They see me as supercilious, I see them as unprofessional bordering on incompetent. Stalemate !

Ah, just realised I've dropped a major clanger.

SC, I'm so sorry. I got my pregnancies mixed up

Really, really sorry.....

gizmo, dont worry, it was 16 years ago, i did go on to have dd1 after that though

btw you are allowed to get mixed up..you are pregnant! it comes with the territory!

From what I overheard the nurses saying, if the woman had been in the labourward it would have survived because they would have spotted it in time , mind you they don't do waterbirths in the labourward. However the woman was in the midwife led birthing centre of the hospital and by the time they bleeped the cardiac arrest team - incl. the paed who was treating my daughter at the time, the woman was being rushed to the labour ward, but too late for baby. When I had my tour previously of the birthing centre the consultant midwife told me this was home from home environment and no doctors were allowed in birthing centre except when invited by midwives, that explained why she was so reluctant to follow the advice of the independent consultant I saw wrt treatment of possible/probable pph. In the end I gave birth on labourward, not birthing centre with drips etc but at least did not have pph.

Also I think that figures from birthing centres are very unreliable, for example when pph or death, the women will have been transferred to labourward and hence will show in labourward statistics, hence birthing centre looks 'safer' than it really is.

I do agree that conflict between professionals is helpful to no-one. As well as having different interprofessional disagreements, there are disagreements within the professional group itself.

That said I stand by my comment that GPs do not have enough knowledge of maternity care. There has been a huge change in how care has been delivered over the years. GPs got paid for seeing pregnant women, however in reality it is often the midwife who delivers the care with the GP receiving the payment. There has been a huge reorganisation of payment of GPs, and only those who continue receiving training in maternity care will be able to continue to provide it. I am really pleased about that as it will ensure women are not receiving outdates advice and care.

I do get disheartened when it comes across that midwives do not value medical input. The bottom line is that midwives are the experts in NORMAL pregnancy which is what the greatest number of pregnancies are. Where problems arise, the midwife works in partnership with the obstetric team to ensure women get the best care.

I am surprised about the midwives' attitude about fibroids conni - fibroids are not 'normal' and the risk of PPH is known. Infact I posted this info recently when a mumsnetter was seeking a homebirth and wondered whether fibroids made a difference.

Mummydoc - your experience is appalling and there is no excuse for that.

Back to the subject of homebirth - no birth is risk free, whether it is in hospital or at home, birth centre or obstetric unit. The balance is weighing up the risks.

For a normal, low risk pregnancy there is no reason not to use a birth centre or have a homebirth. Risk assessment is a continual process and where there is a change from the normal, care should be transferred to the appropriate obstetric unit. Birth centres publish their transfer rates along with their delivery statistics.

Unfortunately there is still a tendency to intervene in normal pregnancies for no good reason. The classic intervention is induction of labour too soon either because the woman is 'fed up' or it needs to be done earlier than necessary to fit into the consultants day on labour ward.

Appropriate intervention from medical staff is vital and welcomed by most midwives. There are some midwives who are just as guilty as some medical staff regarding unnecessary intervention.

Sorry to waffle on, but it is a shame that it comes across that no-one speaks to or respects each other. In the main there is good communication between obstetricians and midwives.