How do you get the birth you want if you are high risk? Terrified of a repeat!

[BabyDubsEverywhere]

This may be a little long so I apologise in advance.

I really need some help to get my head straight about where to have my baby. DH is supportive of me and will go with what I want, but I find him placating rather than helpful in the actual decision making part of this.

This will be our fourth baby. I am only 10 weeks but I know if I decide to go for a home birth I will need to ‘start the fight’ as it were immediately. All my other babies were born in hospital and the first and third births were traumatic for me. Second was lovely in a way but the midwife was ineffective, she only popped in the room at the last minute and caught the baby as she came out, a minute later and she would have missed it anyway!
I am high risk because I am over weight and I have a mental illness. None of my other pregnancies have had any issues due to my weight, (I am a size 16-18) and I really can’t see how having, (and coping with) bipolar effects childbirth!
My last birth really haunts me. I was completely unsupported by the midwives. I was induced and I had a 45 minute labour start to finish with a back to back baby. I had the urge to push about 30 minutes in but the midwives belittled me and told me I was silly and needed to calm down as I would hurt myself/ the baby. I asked to be checked, they said I can’t be as far as I think. I bloody kne how far I was – I had done it twice before ffs! The pain of resisting the pushing with a back to back baby lying flat on my back with monitors all over me (because I am so fat!) was horrendous. They injected me with pethedine just as the doctor walked in. He went off at the midwives for giving it so close to birth – they said she has a while yet with a smirk to me! He came over check me, helped me to sit a little more upright and delivered the baby – who was white and floppy from the drugs they gave – in about a minute and a half! I felt/feel scared to be in their control again. The idea horrifies me tbh. I had haemorrhaged behind the baby due to their inefficiencies (– doctors words!) and needed a transfusion. Even then after the doctor popped out I was still bleeding he came back to check on me and the midwives hadn’t noticed I had gone pale and floppy – I was bleeding out! I honestly think I would have died without that doctors intervention!
I really want to be at home but I think as I am high risk they won’t allow it, in fact this is what they said the last three times. (I would be happy with a hospital birth if I could have a doctor rather than a midwife – but that’s unlikely isn’t it.) I think they will use the transfusion etc as a reason against homebirth too – but that was their fault as well!
I don’t know what to do – I can see me asking for a HB – they say “no BabyDubs – you are fat, silly girl!” and I cry and go along with it for the easy life… and then spend the rest of the pregnancy dreading it and the first year of the baby’s life regretting it again!

Oh man - its really long - and my spacing has disappeared - so sorry, if anyone can read this I really appreciate your views. tia.

I am sorry I don't have much experience on which to draw on, but wanted to offer some support. I had an induction with ds and now 15wks with dc2, I am hoping for a different birth (I.e less complicated) but awaiting an appointment with a consultant to discuss my risks which include hemorrhage and ds being born at 36 + 2.
I had a very pleasant chat with a birth afterthoughts midwife who went through my notes with me from first time round, it was quite reassuring to fill in the gaps (diamorphine had made me very sleepy) and although she couldn't answer every question I had was very encouraging about second birth. do you have some similar service in your area, prob best to call ante natal clinic at hospital or if you would feel more confident ask your gp for consultant led care (think if they are pushing you being high risk then you can probably put in a good argument!?)

Are you certain you'll be under consultant led care? Can you find out at booking in what the homebirth provision is like in your area? How far would you be if you needed to transfer?

I think in your shoes I'd prefer a homebirth (by a mile!) - it sounds like you labour quickly, and being at home can be particularly useful in those circumstances. If you need and agree to induction again, though, you will have to be in hospital and have continual monitoring. Induction increases the risk of PPH, so I don't think that alone is a good argument to be in hospital (ie, if you avoid induction you reduce the risk of PPH) - did you have a PPH after either of your other births? If induction seems likely, could you afford a doula? It might be really great to have one in those circs.

There was a lovely thread recently about giving birth with a high BMI, see here.
I've also seen some blogs about weight and natural childbirth, sorry I can't remember which exactly but worth a google.

Very best of luck, BabyDubs.

Thank you so much for your replies, its nice to think I'm not being a total loon about this. I will ask the midwife about running through the previous births, that could be helpful regardless of this birth anyway - I seem to spend an awful lot of time going over them in my head.

They put me down as consultant led again at my booking in app, because of my weight. I hate being in the hospital, I find it really stressful. My bipolar disorder comes into play here a too.

My first birth was also induction - and a comedy of errors! But had healthy baby and it was really only my mental health that suffered long term - but my god did it suffer!

I would in my heart love a homebirth - I have wanted one the last three times, this is my last baby - my last chance. I just don't know if I am strong enough to stand up to them.

Can I just say I have decided to have a home birth FULL STOP! ?
Can I refuse an induction in favour if a section instead?

I need to go read more threads I think. Thankyou again for your replies.

Do you have this in your area? It might be worth looking into.

I was so sorry to read your story - and really sad to hear you have felt so belittled. I was about the same dress size as you when I got pregnant, and 5 ft 5 and had had a previous fast prem birth. My consultant said I was fine to try for a hb with my second - and I did - and got one by the skin of my teeth on the last night I had negotiated staying at home (40+13). It was great and I feel very lucky about how things worked out.

I would say that even if you are able to try for a hb there are loads of reasons why they may need to transfer in eg too early, too late, any concerns about heart rate, meconium in the waters if they break early on, etc so you would need to be prepared for that. It sounds to me that wherever you have your baby you could do with a strong advocate and support and I wonder how you would feel about a doula? Doula uk have an access fund you may be eligible for if cost would be an issue. I also think it is really important you get that debrief from your past experiences. I really hope you get your home birth but even more than that i more I hope that wherever you have your baby this time you feel supported, empowered and in control. Good luck!

You certainly can say "I am having a home birth full stop, and I don't want to discuss it any more" - you would then have to use the "pleasant stuck record technique" and just repeat the same sentences over and over again, and not be drawn into a discussion unless it is how to facilitate your homebirth.
They can advise you against homebirth, but they can't refuse you one.
I used to find it helpful to say "thank you very much for your advice, but what I have decided to do is X. Who do I need to see to get this put in place?".
A reminder to hcps that they are not in a position to allow or refuse is always timely I feel .

'I am only 10 weeks but I know if I decide to go for a home birth I will need to ‘start the fight’ as it were immediately'

You mustn't fight. It is not in your interest nor the interest of your baby.

You don't even need to tell anyone about your plans for a homebirth until you are close to term if you don't want to. It is your right to give birth where you want and your right remains with you until delivery. If you want to, you can give birth in a hot air balloon commissioned in transition.

It isn't something you need permission for, nor something you even need to discuss if you don't want to (though I would advise a little bit of discussion post 30 weeks just so the midwives have some idea what to plan for).

I had mental health issues CAUSED by my first birth in a hospital, and a pph CAUSED by the way I was treated there. I had therefore become a high risk and was encouraged to have a hospital birth.

You just repeat. 'No thank you. I'm having a homebirth'. and for every other question 'Mmmmm'.

So, 'I'll book you in for a sweep on Monday'.
Me 'No Thank you'.
'You have to have one at some point'.
'Mmmm'
'How about Tuesday?'
'No thank you'.
'I think you need to see a consultant'
'No Thank you'.
'I have to recommend that you do'
'Mmmm'
Shall I book you an appointment?'
'No thank you.
'You can't have a homebirth without one'.
'Mmmm'
'So we'll see you in hospital on x date'
'No thank you'.

etc etc etc.

If you refuse and induction in favour of a c/s, they'll just wait until you give birth naturally, which rather begs the question about how 'essential' an induction might be.

My birth plan stated that there were no circumstances where I would consent to an induction, not even a sweep. They didn't come rushing at me with the c/s consent form, despite going 12 days over.

A scan document was missing from my notes and I was already overdue. She asked me to call the hospital and try to get a copy and added 'It would be a shame to not be able to have a homebirth simply because of a missing piece of paper'.

I couldn't stop a laugh. As IF I would ever give up the homebirth for someone else's admin error.

There is no such thing as 'not allowed'. As others have said it is your right to choose and if you want a homebirth and go into labour they have to attend you at home.

There was another thread recently where a lady with a high BMI in the same position as you, pregnant with her third had a homebirth here. The birth announcement is on page 4.

Even if you go with hospital you can refuse continous monitoring (I did for my high risk VBAC attempt with last birth). You can refuse sweeps and induction and opt for expectant monitoring if overdue. You can also see if your hospital do one to one midwifery care so that you see the same midwife for antenatal appointments and the birth. That way you can find a midwife who you trust. You can also refuse consultant led care. It might be worth you speaking to the Supervisor of Midwives once you are clear about what you want, to make sure that they sign your birth plan. That way you can just say speak to the SOM and look at my birth plan anytime anyone tries to pressure you.

Good luck x

btw, I'm way fatter than you and they never even brought it up.

They brought up other things but not my weight.

As a fellow sister midwife and mother whos had 2 traumatic births i can't apologise enough for ur experience. Which has sadly lost ur faith in midwives care. I can safely say that we're not all like that. I feel the best thing for u is asking for an app with ur consultant to speak things over. Maybe a bit of reassurance from some midwives and a consultant would ease ur mind. Midwifery led care is better for a more natural outcome, medical led tends to have more interventions. I dont mean to be nosy but what caused u to have a post partum haemorrhage (pph)? Theres no reason why u shouldnt have the birth u want xx. Zoe xx

Congratulations on your pregnancy BabyDubs !

I would second much of what has been posted here (Starlight , I'm quickly turning into your biggest fan - hopefully not in a scary way ).

Some useful phrases that I've come across from other wise MNers:
-They are NOT ALLOWED to tell you what you're NOT ALLOWED to do.
-It's their policy. And it binds them. Not you.

There is a lot about birth rights at the moment, particularly on MN - there's a guide on here somewhere...

And there's a UK charity recently launched, which has some really useful info on your rights during pregnancy and birth - and how to use them. Birthrights. I think the issue of informed consent is crucial. It is the doctor's MW's duty to give the patient enough information (about the risks and benefits of whichever course of action) for you to make the choice about how you would like to proceed. Patient led care. Unfortunately, in my (limited) experience, I suspect that hospitals are unnecessarily pushing patients into the high risk category, in order to get them where they want them (on beds, strapped up to the monitor).

The great advantage of HB is that they cannot force you out of your own home. I think Starlight 's suggestions for the path of resistance are great. Staying off their radar for as long as possible is a good idea. But if your HB team are good, and offer 121 care, it could be that if you were assigned a dedicated MW from early on, she could become your advocate??

Good luck!

Thankyou all for the replies, I have a semi update.

I Had to have a meeting with my community midwife to talk over my health issues. She came to my house, and we went through the forms for my previous births and health problems. When it got to my Bipolar and Psychosis I was trying to explain the effect all the long appointments and hospital visits/stays have on my psyche in general... she but it down on the forms as 'a bit of depression and sees things' !!! it felt a little belittling tbh :(

I am hoping I have more luck with the consultant in a few weeks. I really don't want endless appointments this time just because I am fat and mental.

Starlight I may have to print off your posts and make the no thankyou, hmmm trick my new mantra... I have the confidence now - I don't know about when the time comes...

Midwife you have nothing to apologise for, I have also met some lovely midwives, I seem to have drew the short straw a couple of times, but yes it has resulted in a loss of faith when it comes to a hospital setting - funnily enough I have total faith in a midwife for a home birth - perhaps its a confidence thing of being on my own turf? I am not too sure about the PPH. The doctor that delivered my DS said that the bleed had been caused because the baby had been ready for the 20 minutes that I said I wanted to push for, (but the midwives were telling me to calm down, not to be silly as he couldn't be ready yet and I was going to hurt myself and him so was fighting the urge for 20 minutes) He didn't say anything else, and this was said seconds after he was born - he wasn't happy with the midwives and made that clear. It was quite uncomfortable tbh - blissful birth and first meeting with my baby!!

When I told the midwife that came to discuss my previous births this and that the birth left me emotionally fucked she shrugged it off and said it must have been because he was back to back.. so I am still non the wiser.

I really need to make that meeting and go over my previous births.

Sorry this has become another epic post, thank you for all of your help with this it is very much appreciated.

Thank you for that babywitch I will have a good read through the birth rights thing - I feel more confident the more I read, it will help my DH too as he needs to be a much stronger advocate this time (not that he is particularly weak - but risks thrown in your face about the health and wellbeing of your baby is scary - and damn right un balanced at times too!)

At the minute I think I will meet with the consultant and see what he says - and if I don't like it I am not going to make anther appointment. Then I am moving on to the SOP and going from there. My eldest is 6 and I still have nightmares about his birth - I cant face another 6 years of that for the next one too!

Thank you again

BabyDubs involving and empowering your DH - inspired! Giving him some mantras of his own might help.

My DH is not weak either, but when faced with authoritarian doctors, and feeling responsible for your vulnerable birthing wife (ALL women are vulnerable at this point - not just the fat mental ones ), they must find it utterly overwhelming.

A friend of mine did a doula course, and when the subject of pressure of induction came up, the instructor recommended the path of apparent least resistance 'Hmm..mmm.' Let them book your induction... And then don't turn up (or in your case appointment with the consultant). (I know for us upstanding citizens, this would represent an unholy waste of NHS resources which mustn't be condoned. But sometimes you need to save your energy and sanity).

BabyDubs did the midwife write her comments about your mental health issues in your notes? Write your own comments about what your actually said in your notes and sign it.

I am on another forum (Yahoo VBAC) they are having a discussion about hospital notes and rights at the moment, even though you are not attempting VBAC you may get some good advice on there.

I have copied and paste this from one of the posts on there as an example:

"Just a thought following our recent discussions about what is being recorded in hospital notes/green book. I don't see anything stopping you from putting your own notes in your green book at/after a consultation or even just when at home. Date and sign the entry and put your name and signature at the back. So you can say explicitly, "following careful consideration of this advice I have decided that I do not want ..." Or "I have asked for the evidence in support of this recommendation and not received it. Accordingly I intend to continue with my plans for ..." The next consultant/midwife will be forced to write after your entry and therefore cannot as easily ignore it/might feel more inclined to take you seriously. Likewise with any letters you address to your hospital, there is nothing stopping you sending one/handing one to the consultant/Mw at your appointment and she will Have to place it with your notes."

You could also look into a doula, trainee ones are cheaper than fully trained. Have a look at Doula UK. If you write in your notes that they can advocate for you then they can speak up for you on your behalf if your husband is finding it difficult.

I'm not surprised you want a homebirth after what you had to go through at the hospital.

You have the final say. If you want a homebirth then you can have one. I know it's hard to stand up for yourself sometimes, but you should never feel belittled by a professional during your pregnancy. Why not phone and ask about what the midwife put down in your notes, and say that you are not happy with it? It might be good practice for being assertive later on down the line.

Congratulations on your pregnancy. I really hope this time the birth is everything you want and deserve it to be.

You know they are YOUR notes, and you get to keep them.

You can add things to them, and if you like, even cross things out.

I did. I changed my due date on them because the scan date was bollocks.

Honestly.

At one point a midwife said to me 'unfortunately we have to go by the scan date', to which I replied 'fortunately I don't'.