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.

[brettgirl2]

So a quick Google tells me that this thread is probably about a Trust in sm in Norfolk. A 'special' case at least but absolutely SHOCKING it has come to this.

If I'm right there probably aren't any other hospitals near enough to give women any choice re having to go there.

It makes me so that then people come on here and defend appalling management/government and service. If there aren't enough midwives Erm train some more! It's really hard to get onto the courses.

[NearTheWindymill]

Incredible post Poppet45

[NearTheWindymill]

Sheiliabug. It probably isn't possible this time round to get a home birth unless you go to independent midwives but I had two rather awful hospital births and the third, over which I stamped my feet a bit and it sounds like you have too so they'll know who you are, was perfect. It was fast, gentle, intimate and caring and I was incredibly well looked after.

[atthestrokeoftwelve]

I agree with every word poppet45- well said.

[Treaclepot]

I totally disagree with Poppet as she has working on the premise that HB costs more, they don't infact they cost the NHS less to have a home birth than a hospital birth, thus saving resources and should if well managed mean there are more MWs available on the wards and for HB.

NHS link about homebirths

[HolidayArmadillo]

It really isn't as simple as 'train more midwives'. However not providing a home birth service is not acceptable. Please contact AIMS and discuss this with them, I've known of trusts pay to retain the services of an independent midwife for women in a similar situation. Also contact a local supervisor of midwives, see if they can help.

[BabyWitch]

Very sorry to hear of this, OP.

Have you been in touch with birthrights.org.uk ? Amazing human rights charity centered around birth and pregnancy, headed by a human rights lawyer.

Read their Factsheets and FAQs section:
www.birthrights.org.uk/library/factsheets/Choice-of-Place-of-Birth.pdf
There's also an interesting article by Hermione someone in the blog (or news, can't remember) section.

Then get in touch.

If they are basing this on the fact they can't spare two midwives: they allocate two midwives for worst case scenario - one for mum one for baby if both in difficulties post birth. I know a few second-time, low-risk mums who've been sent just one midwife. (Either way, still less costly for trust).

[HolidayArmadillo]

If I was the midwife being sent out alone I'd not be happy and probably refuse to go. There's just just too much you might need a second pair of hands for, especially at delivery. I'd be putting my registration on the line and wouldn't be prepared to risk it.

[RedToothBrush]

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.

Actually many women DO NOT get those options for various reasons.

They are available in some places, but not all.

There are still limited facilities so demand often outstrips the facilities. If there is a woman in the pool already, you won't have the option, no matter how much you planned for and wanted. You only have to read the threads on MN to see that access to pain relief isn't available on demand to far too many women. Elective Section; well don't even get me started on the politics that are actively trying to prevent women from accessing this in many places. (Oh and please do not make out that women WANT a CS in the sense that they prefer major surgery. If they take that option they invariably have a medical reason for that - whether that be mental health related or physically related. It is a media created fallacy to suggest otherwise.)

Oh and isn't there a substantial amount of evidence to suggest that delayed cord clamping has health benefits. And in terms of how allowing this, is costly in anyway to the NHS? Please enlighten me, why a choice that doesn't cost is a luxury.

And excuse me for saying but isn't having access to a variety of pain relief BASIC not luxury anyway and isn't having support for mental health or physical reason BASIC not luxury?

Many women who want a home birth, do so, again because of mental health reasons - often because of appalling care first time round. Have you seen any of the numerous threads where women have said that they would do ANYTHING rather than go through a hospital birth again. This includes giving birth alone at home without a midwife. Its not one off comments that I have seen saying this. There have been enough to make you realise that actually this is a real issue that should not be neglected as refusing to provide home birth services could genuinely be endangering the lives of vulnerable women and babies.

Women do not fit in nice neat boxes to be processed through a baby factory. They have differing NEEDS NOT WANTS. They are not being precious in trying to ensure that one of the biggest changes in their lives goes in a way that gives them the best chance to be there for their new child in a positive way. A negative experience has long term costs in more than one way - not just financial, but it can be extremely costly.

And lets repeat once again homebirths ARE CHEAPER than giving birth in hospital, so lets not swallow this crap that it is somehow self indulgent.

Its really not.

[Minifingers]

Poppet - are you aware that while 2 midwives attend most home births the overall number of midwife hours allocated to these births is lower than for women having hospital births? The reason for this is that in the majority of cases the first midwife arrives and properly sets up shop when the mother is in strong and active labour - she may have popped in earlier or communicated with the mum by phone but they tend only to make a decision to stay once it can be ascertained that the birth is not a long way off. The second midwife is often only summoned for the birth itself.

Second point: out of hospital births for healthy women, when compared to births to similarly healthy women in a CLU, result in about half the number of emergency surgeries, thus freeing up theatre time and doctors to care for women with complex health issues.

Personally I think that if managers had been looking for a way to provide cheaper services without impacting on outcomes they would have just as strong an argument for suspending access to epidurals for mothers having straightforward labours as they do suspending the homebirth service. It's considered inhumane to deny access to resources which make labour less traumatic - unless those resources happen to be midwife time, rather than high tech, expensive analgesics.

[Minifingers]

Can I also add - NHS services DO come to patients at home in the form of palliative care and district nursing. The NHS process these services to people at home because it is humane and cost effective.

Nobody is asking for obstetric input at home births so your comparisons don't make sense.

[RedToothBrush]

Just to add to what Minifingers says.

My Grandmother is very frail and receives health care support at home. She was very unwell not so long ago and there was talk about moving her into a home. However it was eventually agreed that she would be better at home for various reason and that this would actually cost less. One of these was that she was likely to remain in better health and more independent if she stayed at home. This service isn't actually provided by the NHS itself but through Social Services however the help she gets is primarily driven by her healthcare needs.

[Poppet45]

I'd forgotten dd has benefitted fom at home nhs care 3 months of weekly at home hv visits because her immune system was too weak for baby clinic, and aged 18 months or so follow up care by a paeds respiratory nurse after she was hospitalised for pneumonia, as well as play-based physio sessions for her weaker left side. But from the examples we've thought of at home based NHS care seems to be largely limited to the infirm, the immuno compromised, the housebound and the dying? I'm not sure the next logical group to require it are women with the lowest risk pregnancies. But I accept thats just my opinion... And I totally respect womens need for a healing birth experience (I dearly would have loved one myself) I just fear right now those expectations cant always be met

[lauramcdora]

Dear Sheilabug I'm so sorry to hear of your stressful situation. I wonder where in the country you are. I suggest you get in touch with AIMS which I imagine you may have already done by now and knowing your rights then speak to the SOM (Supervisor of Midwives) at your local hospital. It would also be worth speaking to some local doulas for advice, even if you don't want to use their support at your birth many will be happy to help you find your way within the NHS.

Good luck I really hope you get your home birth.

[LaVolcan]

Do those who think home birth is a luxury realise that most HB midwives are Community Midwives spending their time doing mostly ante- and postnatal work? For those who grumble that their CM never answers the phone, or they can't get an ante-natal appointment for xx weeks, then remember this if you are one who thinks it's right that they should prop up the hospital services.

Poppet45 Unfortunately, it's the thin end of the wedge. Community Midwifery has been cut back, HV's are being cut back. What will stop the powers that be saying that 'most women and babies don't need HV's, it's a luxury, so why have home based service at all? Those that need it can go to hospital.' It's you and your child who would suffer.

Nor is HB about a 'healing experience'. For a substantial number it's both safer and cheaper, and it's what - a few hours of a midwife's time for each birth? It's not even the sustained care that an elderly relative will get - I know that my DM had the district nurse calling regularly twice a week for about half an hour for 5 years - so about 250 hours of her time, which is far far more than the average pregnant woman will get.

[RedToothBrush]

But from the examples we've thought of at home based NHS care seems to be largely limited to the infirm, the immuno compromised, the housebound and the dying? I'm not sure the next logical group to require it are women with the lowest risk pregnancies.

What other groups are there? Don't virtually all of these fall into a category which requires care with relevant equipment or observation?

I just fear right now those expectations cant always be met
Again why is that? Is that because home birth is more expensive or is it because of poor management? Its a situation where those expectations SHOULD be being met because they are actually reasonable expectations which are not a drain nor a demanding request.

[GemmaPomPom]

I had a home birth with DS and everything went fine, he was born relatively quickly and I had no pain relief as the gas and air canister they brought was empty. But it was all good. Loved it. Recommended that everyone should have a home birth.

With my DD born just over a year ago, I did not have the option of a home birth as they are not available where we live. I had to have her in hospital.

How glad am I that I did not have a home birth. I haemorrhaged, lost most of the blood from my body within seconds and by the time I got to theatre (literally less than a minute away) my heart had stopped beating and I was close to death.

As they were pumping donated blood into me, it was leaking out through my uterus. I had 3 separate operations under general anaesthetic so that they could stop the bleeding. I spent 2 days in intensive care with so many wires and drips going into me that I even had them going into my neck.

Women do die in childbirth. It very nearly happened to me. Had I been at home, there is no way I would have survived. Please consider this when choosing where to give birth. I know that we always think it won't happen to us, but it does happen.

[Minifingers]

With respect - how do you know that being in hospital didn't contribute to your blood loss? Haemorrhage is less common after homebirths and as far as I'm aware there have been no deaths from this cause despite 10's of 1000's of UK homebirths in the past few years. The reality is that the thing which is most likely to kill you is a DVT, which you are much more likely to have following surgery. And guess what, you're twice as likely to have surgery if you choose to have your baby in hospital.

[RaRaTheNoisyLion]

I wouldn't have managed in the OP's situation. I would have had to register with another trust and book a hotel room if they didn't agree to a c/section.

[RaRaTheNoisyLion]

'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.'

I had a Homebirth BECAUSE hospital was the far riskier option for my baby and me. That is why most people choose homebirths.

The risks of hospital were unacceptable to me.

[Minifingers]

Poppet is assiduously ignoring all comments flagging up the fact that homebirth is associated with better clinical outcomes for low risk women.

[RaRaTheNoisyLion]

My Homebirth required just over an hour of midwife care from one, and 35 mins from the other. No drugs. No equipment except scales. No post-birth amendments. Most of the time was spend writing to cover their arses which they would have done in hospital.

[RaRaTheNoisyLion]

I haemorrhaged with my first. I blamed it on the hospital setting and refused to birth another child there ever again.

[LaVolcan]

Poppet and Gemma's cases for me illustrate how we have set up an expensive system which caters for the extreme and emergency cases, for which I think we would all be thankful. Of course no one wants themselves or their baby to die in childbirth, but does this really have to be at the expense of long-term morbidity for a significant number of other women?

You might think this is just about the 'luxury' of home birth, but look at how post-natal care has been chipped away. 40 years ago, you were given the option of a 4 or ten day stay in hospital or the midwife would come to see you at home for 10 days post delivery at a minimum. This was the norm, and not justfor CS births either. Now what do we have? Read the threads about post-natal care, or the lack of it, to find out.

Cut backs like these may well have long term health implications e.g. PND, gynae surgery in later life. Some say 'we can't afford a better service'. I would suggest, that we can't afford not to change things.

[LaVolcan]

RaRa - same with me, time and drugs wise. The midwife got there at 2:50 ish and was gone by about 4:45 pm. The second never made it, much to her annoyance because she wanted to get some home birth experience. How selfish of me to ask for two hours of the midwife's time.