Help me argue for homebirth (just in case)

[pettyprudence]

I had a very successful homebirth with DC1 - textbook length of labour and delivered a 50th centile baby with no tearing etc.... on my due date! My BMI was high (32 at start of of pg and put on about 3-4 stone) and bp was a bit high towards the end. Always measured slightly ahead for dates. My mw never had any concerns.

So I just got back from MW appointment an hour ago- I am 38+6. I saw homebirth MW and 36 weeks and she had no concerns. My mw now is concerned that I have put on too much weight (nearly 3 stone) and I am measuring big for dates (fundal height was 38-39cm which I thought was normal but looking at the graph in my notes this does put me high?). My bp is a nice level and my bmi at start of pg was lower this time (29) as I lost a fair amount of weight before being pg again. I would estimate that I am about 10kg lighter now than I was at the same point last pg.

MW has left me a voicemail to say she has booked me an appointment with consultant at the hospital ante-natal clinic tomorrow morning due to her concerns about my weight gain and babies size. I know that they can't REFUSE me a homebirth and I really have no concerns about me or baby but I feel iffy about having to put up a fight for a homebirth :(

I would never want to put me or baby at risk but I REALLY don't want to give birth in hospital (a big teaching hospital with MLU and CLU). I do not believe I would have the best birth outcome there. I live about a 10 minute drive from the hospital so do not feel that I am too far away in the event of an emergency. Plus I believe that the hb team (so long as my current mw isn't on call!) would monitor me much better than in hospital and would not take any risks with me or baby.

Not sure what I need - a hand to hold? A kick up the arse? I have the hb team leaders mobile number but don't know what to say to her even if I call now. Thinking I should wait until after my appointment tomorrow?

I just feel a bit thrown and out of sorts as this is not what I was expecting :(

I wouldn't be remotely concerned about that fundal height at all, your weight gain seems relatively high but given similar happened last time and in actual fact you weighed more I would just listen to what they say and if you feel they are just putting obstacles in your way then repeat firmly 'Thank you for your time but I would still like a homebirth'.

If you don't want the appointment, you can decline to go. In your position I would probably phone the HB MW and talk it over.

And, since you said "help me to argue": www.homebirth.org.uk/youcant.htm
Good luck!

Comparisons to your weight last time would be a good one they can't refute numbers like that.
You could refuse to attend the consultant appointment, too. Just "No thank you and I'll see you for my previously scheduled MW appointment next week."

I think I am just in a bit of shock! I have considered declining the appointment tomorrow. On the one hand I am thinking the consultant can scan me and see that baby is probably about average, maybe a bit bit but nothing to get in a tizz about. On the other hand I know that scans to determine weight can also be notoriously inaccurate too! But even if baby is big, my friend has delivered 2 10lb babies at home with no problem (I know that's purely anecdotal) but I don't think that size of mum or baby should be a huge concern. Not sure where all the weight as gone either as my size 12-14 maternity wear is still fitting me fine!

Thanks for the link puddock - already going through the concerns raised by the mw on the site! I have never had confidence in her - hope she's not on call when I go in to labour!

So you have been seeing 2 MW's? The home-birth one and another one.

I've always worked on the basis of asking the right people the right question to get the answer that you want. In all likely hood the consultant is going to tell you that you would be safer giving birth in hospital, you will probably come away a bit stressed and (unless you change your mind and do decide on a hospital birth, which seems unlikely from what you have said) as though you have wasted a few hours (...on the last day of half term depending where you are and what age your DC1 is).

I would say thanks but no thanks, you know what the consultant will say anyway. I would call up your HB MW and double check with her for reassurance and then say that you have been booked in with the consultant over concerns over your BMI. The HB MW is the one who will probably be at the delivery anyway, she won't be able to contradict the other MW but she could offer some reassurance.

IME the HB midwives are really calm and very able to let woman trust their own bodies, some MW's just don't agree with HB's and any advice they give is given on that basis.

My usually community mw is on the homebirth team - all the community mw's are here, but the co-ordinator of the hb team came out to see me at 36w and to get me signed up on all the paperwork. While she was there she carried out my 36w check up, save me doubling up on appointments, and she was happy.

My usual mw has just called me to say they just want to be extra careful to make sure everything is hunky dory and no surprises for a hb . My mw has said she is on call next Mon/Tues so baby is under strict instructions from me NOT to appear then as I can totally picture her advising a hospital transfer for the slightest niggle. Hope my mw from dc1 is on call when I do go in to labour!

I agree that a consultant is never going to say "homebirth, what a great idea" even if I had a perfect bmi, weight gain and fundal height! I have for the time being agreed to go to the appointment and if they do flag up any issues then I will speak to the hb team (they are desperate to up the numbers here and have even been recruiting women in early labour at the mlu who have been sent home for not being dilated enough!). My best friend is going to try and pop by my appointment as she works in the hospital and she will have her questioning medical head on, to challenge and question if needs be. I might be getting in a tizz about nothing and they just sign everything off fine tomorrow but its just thrown me out of sorts this afternoon. My nesting has been abandoned!

We have some fab pro normal/homebirth condultants on our team. 2 of their wives had a HB and one of the female ones started out at home but transferred in yet still raves about the experience. Don't write the consultant off just yet, you never know

You're right - I am not being fair on the consultants! I think to be honest, the scan will show baby is normal size. Its my size that will be an issue. I was a size 14, almost down to a 12 before pg but quite high bmi (29) but I was below the cut off at that point. Not going to lie, I have eaten what I like, when I like whilst pg and other than run around after a toddler (ds is nearly 3), oh and renovate a house (personally up and down those ladders!) I have done no exercise. I put on a similar amount with ds but by 3 months post-partum I was lighter than pre-pg so I hand't really given weight gain much thought this time. After having time to think clearly, I am feeling a lot more confident about the appointment and thinking that there shouldn't be too much discussion. fx.

I can't see how your weight is a problem to be honest. I had a BMI of 28 before pregnancy and have put on 2 stone (but I am short, 5'1") and have been congratulated on my great weight gain! My first baby was 75th centile and I had a growth scan this pregnancy (for reduced movements, rather than because they were worried about size) and this baby looks 75th centile too. And there have been no issues at all raised about having a homebirth.

Fundal measurements aren't an exact science anyway, and surely 38+6 and a height of 39cm is bang on? Especially as dating scans are only accurate within a week.

its becoming more and more confusing as to why I am being referred? I can only assume that its due to lack of mw experience/confidence. most of the mw's here do 6 month community/mlu rotations but I guess hb rates are so low she might not have much experience. really must make sure I don't go in to labour next mon/tues sh when she is in call .
according to the chart in my notes measuring 39cm at 39w puts baby on approx 90th centile! must be a unique chart to my lha!

I'm in a big city and I think homebirth must be quite popular here. I am with a different community midwife team this time to my first birth but both times they have been really positive/excited about homebirths.

I am in a city too but when I had ds, the last hb for anyone had been 2 weeks before! when I go into labour I am going to request my previous mw in the hope she is on call. she only does community mw and was utterly fab during ds delivery. I tried to get her again but I had moved house to another part of the city so had to switch surgeries.

Just a quick update - consultant was lovely. Possibly the most cheerful man I have ever met. He was very confused as to why I was there but measured baby (bang on average) and said even with my weight gain pushing my bmi over the "acceptable" home birth limit he still felt I was in a lower risk category than a first timer with a good bmi so was happy to sign me off. Not a completely wasted trip though as they did pick up on a possible uti, which my mw missed yesterday (despite me mentioning it!) so at least I can have some anti-b's and only need to wee when baby squishes my bladder!

Fingers crossed my mw isn't on call when I go in to labour!

do they perhaps think you may have excess water? It can lead to cord prolapse, I think.

When I had to see consultant with dd2 due to irritable uterus he seemed to think that hb was a perfectly normal choice btw.

x-posted good news then

Glad to hear you got a sensible consultant, there are some about!

Quick update - Baby arrived last friday on her due date and...... my mw was right - 91st centile - 8lb 12oz!