Unable to have home birth as no midwife

[Grandmatobe]

Just wondering how often women are unable to have a home birth due to no midwife being available and what reason was given?

I'm not sure, but when I was planning for a home birth with my first, the very pro-HB community midwife told me that if I was told there was no midwife available, to insist that we were going ahead with the HB anyway. Apparently they will get someone there. As it happened, when we called for the midwife, we were told that the hospital was closed to new admissions and they couldn't spare the HB midwife. DH said I was refusing to travel an they sent her out. Similarly, a friend was told the midwife was already at a HB so couldn't get to her, but after insisting they released someone from the postnatal ward.

So, in some areas at least, the key to getting a HB seems to be insistence.

I think it depends on the area. My MW told me that if she wasn't available then someone else would be. I didn't have any issues on the day even though my mw wasnt on call that day. The only thing I was worried about was the weather as they wouldn't come out if there was a yellow weather warning out and it was the end of January when we had all that snow.

I think that's incredibly selfish. You ring and are told resources are stretched but you demand it anyway and therefore cause undoubted problems on the ward whilst no doubt getting a midwife who is far from a HB expert to deliver your baby. They will send someone to you, of course they will, because they don't want you to put your baby at extra risk but surely you can see the difficulties you must have caused the other women? Maybe your "I want a home birth" need was greater than their need hey.

Do you like the idea of giving birth on the floor with no pain relief and then using a completely unnecessary ambulance to transfer you and your baby to the hospital when the midwife finally turns up??

I don't think I would want a HB under those circumstances. Our local team are not happy about home births at all,and although women have the right to insist, would you really want a midwife who is there reluctantly?

I too think it is selfish when resources are so stretched.

Sorry, just finished a night shift and possibly a little harsh.

I think some of the above comments are harsh. All the NHS guidance states that (if low risk and in good health) you have a choice about where to give birth, including at home. I don't think anyone is being princessey by asking for a homebirth. Although maybe it's unwise if you know you will get an inexperienced, reluctant midwife.
Nevertheless the system is inherently flawed if there aren't enough midwives to provide this, or indeed to provide one on one care for actively labouring mothers.

Where I live, we are lucky enough to have caseload midwifery and home birth rates are far higher than the rest of the country and outcomes are great. This model is also more cost effective.

As for being selfish, what about women who have had previous precipitate births? Or who have had ptsd related to a difficult first hospital birth?

highlow, I was actually reassured that there was always a midwife on duty to cover HBs so effectively even if I was told there was no-one, there would always be an extra member if staff than would otherwise be on duty. Where I live, there are two linked maternity hospitals in local towns and if they are genuinely short-staffed, they can usually send the HB midwife from there. If it's any consolation OP, the midwife who came to me wasn't reluctant to be with me. It wasn't her who said there wasn't anyone, and she was being paid specifically for what she did that night. Resources weren't stretched an we weren't selfish, as wherever we had given birth, I would be straining resources. (As I said, the maternity unit was already closed to admissions, so ambulances we're routinely being used that night to get people to a hospital much further away).

But a midwife working in a hospital will be covering several women at once not just one as in a home birth. A home birth is taking away from other women.

A woman who is in established labour should have one on one care wherever she is. www.nice.org.uk/news/article/women-in-established-labour-should-receive-one-to-one-care Otherwise staffing levels are dangerously low.

I was told by one hospital a HB probably couldn't be supported, so switched hospitals and had a much better level of care where HB were actively encouraged. You are an individual and this is your birth. Hospital protocol is more demanding on resources, intervention more likely.

I really don't think a MW will turn up huffing and puffing at the inconvenience. IME MWs love a HB, and my three HBs used less resources than my one hospital one.

You are entitled to birth how you wish to and a MW should be provided for a home birth regardless.

Not everyone wants to give birth in a hospital with bright lights, lots of noise and feeling out of control. Past birth trauma could mean a woman only wants to birth at home.

Community MWs attend Hbs, hospital MWs attend hospital births. Having a home birth uses a completely different MW who wouldn't be in hospital anyway.
I've had two home births, in my area they have two teams of community MWs on call at all times. So can cover two simultaneous home births. Given that the rate of home birth is so low, you'd have to be pretty unlucky I would think. Certainly both times, I got the first on-call team attending mine.

Do you like the idea of giving birth on the floor with no pain relief and then using a completely unnecessary ambulance to transfer you and your baby to the hospital when the midwife finally turns up??

Are you a midwife? Crikey.

I think this partly depends on whether resources are truly stretched or it's just something people are told to say to a request for a MW at a HB.

I have had one HB and two hospital births. All were painful, but recovery from the home birth was far better (it was the second one)

As I mentioned up thread, although in my area the HB midwife is based at the hospital, she is not included in the unit quota so is always technically available, unless at another birth. This, even if the labour ward is stretched to capacity, it should close before she is actually required there, as it is not her job. As my midwife explained it to me, the team will say she unavailable, because they would always like another pair of hands, but technically, she will always be available, hence insisting it is what you want (and have a right to). In our area, if you need to be transferred to a labour ward, she remains your midwife. Thus, as someone has said up thread, it doesn't really matter where you are, because you would need a 1-to-1 midwife at that stage anyway. She just attends to you in a different location.

"Do you like the idea of giving birth on the floor with no pain relief"

I thought that was precisely the point of a home birth...

"and then using a completely unnecessary ambulance to transfer you and your baby to the hospital when the midwife finally turns up??"

Erm... why would she need an ambulance and being transferred to hospital?? Again, the point of having a home birth is NOT needing to be transferred anywhere... when the baby is born, it stays at home.

Um....I gave birth on the floor with no pain relief in hospital twice
Not sure why that wouldnt be possible for you?....

Is this a political post/question, or a genuine one?

There are many studies that show home births to be just as safe (if not safer) for normal, low risk births and a woman absolutely has the right to demand she births at home. She may be taking a midwife away from a hospital and using resources in that way, but even if she went into hospital to birth, she would still be using the exact same resources plus the extra resources of post-natal care.

What's all this about giving birth on the floor??
Many women choose to give birth on the floor, even in hospitals.
Many women who decide to have home births give birth on thier bed, sofa, standing up, hired birthing pools etc etc wherever they feel comfortable really.

And why would a normal home birth need to then be transferred to hospital via ambulance or other transport??

There are some incredibly naive, uninformed opinions on here.

Sorry, that read as if home births don't receive post-natal care. Of course they do, but not using the same amount of resources a hospital birth generally would.

I was told I might have to go in if the area duty MW was already attending a birth. In the event I got the supervisor of MWs because she was the only one who answered her phone! Very lucky for me because baby was in an odd position and in the mlu I would likely have had an instrumental because I wouldn't have had the support of an experienced MW (cqc gave my local mlu a warning about their low staffing levels).

Wow some snarky replies on here!
Home births are actually cheaper for the NHS. If more resources were put towards it in the first place more women would feel confident in choosing it and it would save money and resources in the long run.

For the record, I gave birth on the floor with no pain relief in both hospital first time and then at home second time. The home birth was far nicer.

I think that demanding to have a home birth is naive Lj. The suggestion that all will be marvellous at home is not always the case. First time mums have a 40% chance of transfer to hospital (so that ambulance mentioned earlier may well play a part). Statistics show that hospital is the best place for first time mums and however low risk your pregnancy there is a whole heap of complications that can arrive out of nowhere and threaten the safety of you and your baby.
Ringing up and threatening to have your baby alone if necessary is madness. If the hospital resources are stretched then I think it is dreadful behaviour to demand that someone wastes time driving to and from your own home. If you do end up transferring as an emergency, you'll wish that the hospital resources weren't so stretched!

I thought that a stand alone midwife unit was shown to be the safest place for a first time low risk mother? An MLU is probably just as likely to get closed if there is pressure on staffing, as a home birth service is.

It's not selfish to ask for decent care IMO.

I think pepper that you're moving more towards whether or not you agree with homebirths in generaL and not really about this situation tbh.