Can the hospital dictate my birth choices?

[babsie007]

Hi I am 22 weeks pregnant at the moment and I have so many questions! This is my first baby and we are expecting a baby girl (very exciting!), and I am really looking forward to the birth. I am looking to have as natural and as active a birth as possible. I will be having my baby in Sunderland Royal Hospital and ideally I would like a water birth.

I have a high BMi (42 on booking) so can this be denied by the hospital because of the risk?

My midwife hasn't discussed any birth options with me yet - when will this happen? And how much choice do I have?

i have some worries during labour:

-I won't be able to labour at home for as long as I wish.
-the hospital will have me laying in a bed and linked up to all sorts of machines during labour as I am medium risk (bmi)
-I will be pressured into having an epidural
-will be decline a water birth or just told the birth pool is in use

Can anyone help me with some advice or share any stories? Thanks!!!

Hi, congratulations on your baby girl. There's so much to think about that I think it's totally normal for you to have concerns but sounds like you really need to discuss these with your midwife. My friend was able to get a copy of the hospitals policies as she had a bit of an unsupportive midwife the first time round and she fo

Found this quite empowering. X

The most important thing is not hat sort of birth you want but what sort of birth is safest for you and your baby. That may well be a mid wife lead delivery, but I would take an open minded approach and look at all the options. I also think it is unlikely that you will be forced to have an epidural.

you can choose to say no eg no to hospital at all, no to induction, no to continuous monitoring
but you cant make them say yes eg to a water birth
having said that, with discussion and maybe involving the supervisor of midwives you might be able to persuade them to do some things you want and they are reluctant to do

If the birth pool is already in use, then you obviously won't be able to use it. One of the hospitals local to me allows you to bring your own birthing pool with you.

Yes, what Merci says. You cannot be forced to agree to anything you don't want - e.g. epidural, induction.

You can, however, be told no to things you are asking the hospital to do. For example, some hospitals have policies on BMI for water birth linked to being able to safely remove a woman from the pool if there was a problem. Likewise, if the pool is in use and there is only one, not much you can do!

hi they can decline you say a water birth they can only advise you on what they think is safe but you do not have to listen it is your legal right to decide what you want no matter what anyone thinks each hospital has a diff policy so def ask i had a high bmi in my second pregnancy it was 34 or 35 i think cant remember exactly but def close to that the hospital gave me the GTT test and extra scans how ever even know when delivery day came i was not forced to go into hospital at the first sign of things i stayed home till my contractions got to 3 mins apart and i was allowed to move around as i wished no extra monitoring just general checks and all went well

A BMI of over 40 would make you high risk for most hospitals so the chances of them agreeing to midwife led care and a water birth are slim I'd say. The reality is that the chances if intervention and complications are much higher the greater your BMI. The worry of a water birth would be that if something did happen that they would struggle to get you out of the pool.

As for being stuck on a bed/epidural etc, these things are all within your control but you may well be advised that it would be in your best interests. If you do need continuously monitored there's no reason why you have to stay on the bed though, you won't be able to dance round the room but nothing to say you can't stand/sit on a ball beside the bed. Or it could be fine, you have no issues and they're happy to monitor intermittently.

My BMI is much higher than yours. First baby, I had to be induced early for medical reasons completely unrelated to my weight. The hospital never mentioned my weight as an issue in how I gave birth.
Second baby, I went into labour at home, went to the hospital, got sent home, went back again, popped out the baby. This was in spite of my high BMI and being having issues with my blood pressure in the last month of my pregnancy. Neither of these experiences were in the MW-led unit as I was high risk - but I only saw MWs even though I'm sure a consultant was lurking around somewhere.

IME the hospital were aware of my BMI, but through out labour they responded to how I was coping. They didn't try and dictate anything, just responded to the needs of the baby and me.

I think I have been googling too much!

With this being my first birth experience, I have been worried about what to expect. Although I am not apprehensive about labour itself - I am looking forward to that part and I am confident in my ability to birth this baby naturally. I appreciate this may change closer to the time if there are any complications in my pregnancy. I too have extra scans booked in due to my bmi so they can check the baby size as measuring my stomach won't be accurate.

I have an appointment with my midwife middle of October so I will have to speak to her and put my mind at ease. I haven't found her to be very good so far but guess I should give her the opportunity to help me before I dismiss her efforts.

I should also add that my pregnancy to date has been very healthy with no complications and my worry is that because of my bmi, they will automatically assume that the delivery will be difficult. I just don't want to be generalised and want to ensure that I am dealt with based on my own pregnancy.

I had a completely low-risk pregnancy. Textbook was how my midwife described me. I was set ona waterbirth.

But then I had to be induced immediately and the waterbirth went out the window. I was on the consultant-led ward and had intermittent monitoring.

My point is that they can and do say no to things; often well within reason. It's good to have a list of things you'd like, but you need to be realistic that some things won't be available to you, or might be, but then that changes. Good luck

You still have a while to go so don't worry yet. I went mid wife led both pregnancies, but neither time did the mid wife confirm if I would be allowed to use the MLU until about 37 weeks. You have to be full term. I almost didn't get to use it second time due to my iron levels and had to really stuff the iron tablets in! I ended up with a totally unplanned water birth.

No one can force you to have an epidural. For one thing, you have to sit REALLY still for them to get it in, which no one can physically make you do, especially while you're in the throes of labour!

The most important thing is to remember that you're going to have a baby, not a birth experience. Things may happen that you wouldn't necessarily choose but they may be required to deliver your baby safely.

The best thing to do is to research all the different options for giving birth, pain relief, interventions etc. Think about what your preferences would be both if things are going well or not to plan, and whether anything in particular is totally unacceptable to you. Eg I was adamant I didn't want pethidine so when the pain became unbearable to me I went straight to an epidural.

Thank you for all of your comments. I guess I need to stop worrying about all the "what ifs" and have a discussion with my mw in the first instance.

I have read that many horror stories online - one woman was advised by her consultant to have an epidural as she would likely need one to give birth due to a high BMi - hence my panic.

I know that weight can sometimes cause complications in pregnancy and birth but I want to keep it as natural a pregnancy as possible, and be as active as possible during my labour.

Fingers crossed for me!!

I gave birth at SRH too! When I was there they had no water birth facilities but I believe they have a pool now. I would still imagine you would be lucky to get it.
During the actual labour I was very impressed with how much they allowed me to dictate the pace and decide what I wanted. I ended up with an epidural but that was very much my choice.
My biggest regret was allowing them to induce me at 11 days overdue because if my high bmi. 3 days in hospital, induction that wouldn't take and waters force broken despite 0cm dilation. I would not be induced again unless in an emergency.

Why would you need an epidural if you have a high bmi?

The only possible reason I can think of for recommending an epidural would be if a woman had high blood pressure associated with her high BMI - epidurals can lower blood pressure. However I think it is seen as a useful bonus on top of the pain relief, not a fix for the blood pressure on it's own.

But it's a bit early in the day for the Op to be worrying about that yet.

The usual reason given for an epidural with a high BMI is to get it in early in case of intervention (which is more likely but probably at least aprtly down to restrictions on mobility, hospital policies, etc) as they are hard to site with the spine being more padded but a GA is even riskier with a high BMI.

I am confident in my ability to birth this baby naturally

With the greatest of respect, none of us know how labour is going to progress. The aim is to have a healthy baby, the means of achieving that don't actually matter in the great scheme of things.

I know when you are pregnant with your first, all you can think of is the ideal birth and how you are going to do it such and such a way - but you need to research all options and make sure that you know what would happen in the event of needing an epidural, or forceps, or a section or whatever, so that in the heat of the moment you know what your choices are.

The aim is to have a healthy baby, the means of achieving that don't actually matter in the great scheme of things.

Sorry, that's not the whole story - the mother's welfare is important too. The means of achieving the outcome is important. A birth which leaves you traumatised is bad for your mental health, and that matters.

It's still some way to go for the OP, but there is no harm at all in her researching her options. As for staying at home, it should be her choice as to when she goes in. As for the birth pool - it's their equipment, so if they say no, you can't use it, then you can't.

Remember also that what the HCPs say is advice, even if they say 'you've got to do, this, this, that or the other'. Unfortunately, sometimes the advice is more to do with hospital protocols than what's best for your own health or that of the baby.

Thanks Flora, that makes sense.

LaVolcan - the surest route to mental health issues stemming from a birth is to be blinkered and narrow in your thinking about having a 'perfect' birth. I speak from experience, and I stand by what I said that the means is unimportant in the end.

Babies007, I hope you get the birth that you are hoping for.

However it is worth spending a small amount of time considering that no matter how confident you are that you can labour and birth your baby naturally, sometimes in a small percent of cases it doesn't go that way. Not because the women involved were not confident, or that they weren't active - just because sometimes nature conspires to be bloody awkward. My ds had a large head and then decided to flex his neck and be a brow-presentation. This meant it was physically impossible for his head to get through my pelvis. An emergency c section was the only option. 30hrs of active labour had had no effect other than to squash his head into an odd shape.

So please do consider all the possible outcomes, and don't put any pressure on yourself to "succeed" in a natural delivery. If you do then it is too easy to feel that anything else is a "failure" when it isn't. You have very little control over what nature will do at the end of the day.

The thing is, if you are doing hypnobirthing or breathing techniques or some method of drug free pain relief, the success of this relies on your faith in the method. So if your mind starts to listen to anyone who with best intentions offers you the epidural or says to keep an open mind....well the whole point of hypnobirthing is to As you say have confidence that your body can do this natural process. So it is really hard to balance that with staying open to an alternative IF there is a real emergency.
My advice from experience is to stick to your guns, do what you want and to keep reiterating what that is on every shift change because with the best will in the world the staff may not have time to explain all this to each other in the middle of the night etc.
they cannot force you to do something such as have epidural, be induced etc but that doesn't mean they won't try.
If possible make sure you have a birthing partner who is well briefed on what you want too.
Best of luck and even if it doesn't go exactly to plan as mine didn't you can adapt quickly if you relax and feel in control and still have a peaceful safe delivery.