Suspension of Home birth service

[sheliabug]

I know that this will divide everyone options hugely, however all I want is constructive advice.

I have always wanted a home and never planned to go to hospital, however I had twins first and the choice was taken out of my hands, and thank god it was, as the delivery suite was amazing and saved my second twins life.

On becoming pregnant with my third child, I knew that this time around I would be at home. However, at my 9 week appointment I got told that the homebirth service for my NHS trust had been suspended. I have been fighting ever since to get a home birth and so far to no avail. I have written to my local MP, and the health secretary, and national papers. It has been broadcast in the papers and again this has made no difference.

I thought I had finally come to terms with the idea that I would be allowed it and at 32 weeks I really need to get my head around it. However, I haven't and feel completely devastated that this has happened.

I just wondered if anything like this had happened to anyone else and if anyone else managed to achieve the achievable, and if so how. I know time is running out but I think there might just be a glimmer of hope on the horizon.

Oh that's horrible news.

I'm afraid I can't give you any practical advice except have you been onto the homebirth.org.uk website or found a local HB group where you live who may be able to give you advice?

Try the section on HB in the UK.

Another option could be to get an independent MW?

Get in touch with AIMS for advice.

As an alternative view, why has the service been suspended?

I know it's not "your problem", but reports of midwife shortages are all over the papers. Have they pulled home births at the moment as they simply don't have enough midwives to cover this? I don't for a second think this is right (although would personally be terrified of trying a home birth) but, if it can't safely be done, surely the only option is to safely labour women in hospital/mlu?

Oh, of course, if it's just stopped, then that is shit. Sorry.

:( this happened near me a few years back. they simply did not have the staff to cover it unfortunately.
i'm really split on how it should be dealt with tbh. i can't see an easy solution.

i think in your position i'd seriously be looking into the possibility of an independent midwife in order to ensure the best possible chance of a homebirth

I've never understood about the staffing thing because with each of my 3 births I've had one MW who has stayed with me just attending to me. Is this not normal practice?

depends how busy the dept is i guess, and how many staff they have?
with my first baby i had a midwife who only came in every 20 mins or so because she was also seeing several other women

But OP would like advice as to how to achieve her HB, presumably on the NHS, not hear a load of apologies as to why they haven't managed to sort something out despite having 23 weeks to do so.

It's prob better they don't offer it if they can't staff home births safley or tell you there is no one who can attend when your in labour.

I spoke to one of the home birth team the other day and they said they were having issues with staffing which meant thee on call home birth midwives were getting called in to cover the birth centre so were not attending the home births! This has scared me slightly as my first birth was under an hours and was really hoping I would be able to get a midwife to attend quickly if needed!

lavolcan, yes, ideally someone would have a solution. But. The NHS is finite, it's facile to suggest this isn't the case. It would be important to know why services have been stopped in order to offer surgestions. Having said that, it looks like the op has tried all the obvious routes.

Yes, the NHS is finite, but they have made choices as to how they staff it. This AIMS article summed up the issues for me. The author's conclusions were particularly sound, IMO.

We will continue to have second rate services as long as we just roll over and accept things. It's a good job those forerunners of the NHS were prepared to work to make things better, and didn't just accept the status quo.

Am sorry to hear of your predicament OP. It sounds like unfortunately your only option is an IM... if it is an option. If not then your best strategy is how to manage your disappointment. Could you try to remember that the mws pulled off the homebirth team may well be doing lifesaving work in the unit... Like they did with your dt2. I'm coming at this from the angle of never managing a birth where one party didnt require life support so never got skin to skin, babies plonked on tummy - couldnt hold one baby at all for 11 days and I never even saw her at delivery as she had to be rushed off to be ventilated. She was in hospital for 81 days and there were plenty of times mws were drafted in to ensure there was sufficient staffing at nicu and hdu level where the babies were so sick they require 1:1 care for a full 13 hour shift. Nhs resources are v chastened right now and unfortunately mothers are having to give up on the births they wanted to ensure the wellbeing of others' children. Those of us at the sharp end of the deal are v grateful.

And trust me I totally get your disappointment. Dd was supposed to be a healing water vbac after I nearly bled to death w ds. They dont do those if your baby decides to arrive three months early.

Poppet45 - while it is good to know that the NHS can cope with catastrophes and that your DD is well, you are effectively telling someone that if her circumstances don't lead her or her baby to be a high risk, she either goes privately or accepts what you refer to as 'disappointment' but others would say a second rate service, or in plain English a less safe standard of care.

That may be fine, that may be what we are all happy with, but should it be done without discussion? This goes back to the article I highlighted - do we say that we only the baby's welfare matters; do we say only a woman's physical health matters, and that her emotional needs are ignored? This is not just a home birth issue, this is a 'does one size fit all?' issue; an attitude, 'this is the service we are giving you, if you don't like it - tough.' When, in practice, even with limited resources, if the will was there, a way round these issues could be found.

If it's either or? And if staffing is the issue (which may not be the case) it will be. Then yes. Baby and mum safety trumps the holistic experience within the NHS.

SinkyMalinks: then by this token then they should be promoting home birth/MLUs much more vigourously, because as the Place of Birth survey showed, for multiparous women these were as safe for the baby and safer for the women - fewer interventions, fewer tears, better chances of establishing breastfeeding, were some of the benefits I recall.

With all due respect I can't think of another area of publically funded life; tax returns, benefits claims, other areas of NHS care, where we aspire to individually tailored holistic service. Public funds can just about cover one size fits all, and if you want a with frills service above that then you can pay extra for it. I didn't actually say that my daughter was alright now and after three further hospitalisations and over 60 hospital outpatient appointments (there goes the home birth budget) I can tell you care is excellent but definitely not holistic and tailored in paediatrics generally. Also while HBs may be safer for the individual if it means understaffed acute services overall then they reduce safety for the group. Anyway I shall stop hijacking the OPs thread I just wanted to offer some differing ways of thinking about her bad news which might help her make peace with it.

I am sorry to hear about your daughter Poppet45.

I still think that the OP has a valid concern and I don't think it's about holistic care, or nice to have extras.

There are obstetricians out there who think that the present 'CLU for the majority approach' is not using the existing resources effectively; leading to their expertise being spread too thinly instead of being concentrated on the cases who truly need their help.

But then, what do you do with the majority - continue with the present system of having one midwife between 4 women and keeping your fingers crossed that none of those women have a problem?

There is a debate to be had about whether the scarce resources are being used effectively, which doesn't appear to be happening at present.

"and if you want a with frills service above that then you can pay extra for it."

I look at it this way - it's not about having 'all the frills' - it's about wanting the model of care which offers the best chance of a mother coming through birth in good health with a well baby. In the case of someone expecting their second baby, like the OP, opting for an out of hospital birth is the surest route to this outcome, especially in a situation where the local hospital is not offering one to one care to women on its CLU.

Quite, Minifingers - I wish this message could be got across to more people, including those who commission services.

So I think OP is right to make a fuss.

Minifingers Tue 01-Apr-14 11:10:35
"and if you want a with frills service above that then you can pay extra for it."

I look at it this way - it's not about having 'all the frills' - it's about wanting the model of care which offers the best chance of a mother coming through birth in good health with a well baby. In the case of someone expecting their second baby, like the OP, opting for an out of hospital birth is the surest route to this outcome, especially in a situation where the local hospital is not offering one to one care to women on its CLU.

Why do people think that basic care and having a choice equals "all the frills"? Why do they use this as justification for poor management of resources? Why do we have a situation where claims in maternity account for such a significant percentage of all claims and insurance is so high for maternity that care is cut, thus making the problem worse in a vicious cycle?

Why is 'getting the appropriate care for the appropriate patient' seen as a luxury? Yes this IS practiced throughout the NHS in other areas of medicine. Why do some people get referred for medication, whilst others with the same complaint might get counselling? Or why might someone be given surgery as the first option, whilst another might have that presented as a last option? In theory, the patient could potentially decline a) and be well within their rights to get b) instead.

Why is maternity thought of so differently and why are we continually just told to 'suck it up'.

Until we challenge this nonsense, it will continue. The insanity and frustration of this particular case is that homebirths have been shown to be actually CHEAPER than both MLU births and CLU births. Its an economic decision made by idiots who clearly have no idea of how to save money long term. Its all about short term funding and budgets being restricted to individual departments rather than acknowledging that costs can be spread between areas.

So why support this ridiculousness by saying that resources are finite? Yes they are, but why exactly are they so stretched? Its not just down to austerity or a rising birth rate. All you are actually doing is allowing the commissioners who clearly don't understand the complexities of the problem and quite frankly simply aren't up to the job, to remain unaccountable for their decisions.

I don't get it. Why don't women like the OP get the support they deserve?
How is it constructive and helpful to go on about bollocks finance?

(PS 'Paying extra' for 'frills' isn't an option either under the current system, so making that suggestion is about as useful as a chocolate teapot and is one used by ignorant people who really don't understand the system at all. People who frankly don't want to understand the system, because if they did then they might be forced to face up to the fact that it is not fit for purpose. Its the ultimate head in sand tactic. Maternity in the UK is very distinct in that the options for going private are significantly less available than any other area of healthcare. Its none existent in many areas. The truth is that if paying extra was an option, then many women probably would jump at it, even if they couldn't really afford rather than be forced to go with the current system. The lack of even this choice, means that we are even more restricted. To my mind, if going private isn't allowed or available, then it is the duty of the current system to ensure that there is full range of services available to ensure public freedom as providing it is in the public interest).

I am shocked and sorry you have been told this, I had my third child 6 months ago as a planned home birth (first two labour were very very quick), I was actively encouraged to give birth at home, I wobbled half way through my pregnancy and was unsure if I was doing the right thing, the midwives in charge of my care really pushed for it (which I glad they did as all went well, and didn't have to make that awful 10 mile journey to the hospital while in active labour) They actually told me (as I think RedToothbrush said it is far cheaper for the NHS if a lady gives birth at home, your not using up hospital beds, less chance of intervention etc.
It sounds like they have made their mind up though and you do sound like you have done sommuhnto try and get your home birth, I do feel for you x

Oh for goodness sakes. Hyperbole much? I would say maternity is one of the most patient focussed healthcare fields there is. I can't think of another field where 'patients' come in with the equivalent of a birth plan. Women already receive basic care AND lots of choice while labouring. Want to labour in water? Fine. Reflexology or essential oils, get offered that too, despite them receiving pretty much zero NICE backing. Active birth? You got it. Tens, gas and air, diamorphine, or lie back on a bed with all the best drugs on offer, that too. Elective section, you pick. Delayed cord clamping, vitamin K orally or by injection. But the NHS cannot magic up midwives to be in two places at once. Which is why they tend to focus the medical professionals in one place and the patients come to them. It gives the hospital the most flexibility. That's how it works in oncology, paediatrics, a&e, geronotology, pretty much any department I can think of. Show me a cancer patient where the chemo comes to them? On the NHS it just doesn't. I would far rather that one on one midwife care is with a v sick neonate rather than a perfectly healthy, labouring well woman on her second or third child, who frankly doesn't need to tie up such a valuable resource for 12 hours or so. My births were pretty sucky. My daughter was born to silence, other than my xh sobbing on my shoulder and the squeak of the paeds theatre clogs as she ran my asphyxiating child out of the room to get her intubated. I will always have that as the defining moment of her delivery. And who knows, between brain bleeds and suspected CP it may be the defining moment of hr life too. And she was my good birth. But as I joked to the team on the way into theatre I guess I'm not getting the pool and whale music this time, and they said no love, just the head of the department paged to come in on a Sunday. This is not a misogynistic conspiracy and I don't think getting the OP hett up about the unfairness of it all will make her final weeks of pregnancy bearable, nor will egging her on to take on the entire NHS, but maybe being able to see a bigger picture might help. If I could have a healthy roaring with life baby delivered onto my tummy, being able to glance at my living room ornaments out of the corner of my eye or notice the dust bunnies under the sofa would not in any way make that vision better. The child alone is the utter utter gift. OP I'm really sorry for being ranty, but until you've seen how awful things can turn out (and our experience wasn't as awful as it could be because eventually we all came home), you don't realise how bliddy brilliant a bogstandard hospital birth is. And to tear yourself apart for a lost home birth is just heartbreaking. Dont go searching for the sadness in a joyful time.

Homebirthing means you have 2 midwives, so it takes staffing away from other areas. This must make it a "luxury" of sorts. The NHS trust must have the resources available to support mothers at home, and of they don't reduce it remove the HB option what's the alternative? Turning labouring women away from they're chosen hospital.

HB may be proven to be safe, but it is expensive. And when things go wrong, they can go seriously wrong very fast. I was under HB team for my first pregnancy and i was referred back into consultant led care at 34 weeks due to complications. This saved my life and possibly that of my dd. I'm now pregnant again and have had all my ante natal appts at home (to greater NHS cost I'm sure) and I still won't get the HB due to the complication of a very large absolutely transverse baby.

The NHS is risk averse, and if your trust won't provide the service you want (not need) due to risk or cost, then you have the alternative of paying for private care to get the holistic experience you want. NHS Matermity services want to get mothers and babies through labour as safely as possible, and this often means in hospital.

I would've loved a HB, having been under the care of an excellent HB team twice, but it wasn't to be. I fought hard for it first time, but it turns out the medical professionals were right, and had I pursued an independent midwife for a homebirth there would've been serious consequences. The NHS has to best serve the community as a whole, which means not everyone can have exactly what they want.

I thought it was a statutory duty for midwives to attend to labouring mothers?

No wonder people have to put up with such awful nhs care with attitudes like this . What a thoroughly depressing thread.