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?

Can you tell me where you get your information from HighLow please?

Last year NICE updated their guidelines to say that MLU were the safest place to give birth for low risk women, and that home birth was just a safe as MLU.

My HB midwife didn't arrive in time for the birth so make sure you & DP know what to do in this scenario!

The hospital knew I was in labour for several hours beforehand but didn't want to send anyone out until the later stages.

The area has a better service now so they will send someone out as soon as I'm in established labour this time.

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.

^^ this was my experience too. The first time I was told no one would be available until shift change and I should go in. I refused. They came out, all was fine.

Second time was just told to ring in in plenty of time so they could gauge how many HBs and cover it sufficiently.

Very worst case is that the paramedics will deliver. They love it (better than an rta) and are fully trained.

Home births are great, don't be put off. Go for it!

I'm sitting here feeding ds, born at home on good Friday. we had midwives here (1, plus my community midwife as she was just coming off shift and wanted to come) for an hour, then another two came 3 hours later for less than 5 hrs in total, including pushing him out and all the checks, stitches etc.

How is that selfish? I would have used a ton more resources unnecessarily if I'd been in hospital.
Oh, and first labour, vbac. Couldn't have gone better, but it was a long 2nd stage and if I'd been in hospital I think they would have been more jumpy, would have continually monitored, lots of things that would have meant me probably having a longer Labour or possibly epidural, gas and air etc (as it would have been harder to manage the pain/discomfort there, more tempting just to go for what was available)forceps etc, who knows. The journey into hospital alone would have set me back hours I think As everything progressed so well at home but I had contractions very close together from the get go.

Go for it op, I loved it and I've had two very different experiences. I think the chances of them telling you there isn't anyone aavailable on the actual day are slim, they have to support you and will probably just send out a SOM if they have to.

People who complain about hb being selfish are failing to see the bigger picture, that for low risk ( actual risk, not hospital policy risk, like scar rupture for example) first or however many time mother's, home birth can be a great option that results in better outcomes for everyone as the cascade of intervention doesn't occur as much.

Congratulations miss sounds like a lovely birth.

Agreed, with my homebirth I had in total around 4 hours of medical time (MW came out to assess for half an hour then left, arrived 30 mins before birth and stayed for 2-3 hours after birth).
Hospital birth I was in hospital for 36 hours so far more care/cost to NHS. Was kept in overnight taking up a bed for an additional 18 hours because they didn't have anyone available to discharge us.

Is there a One to One midwife service in your area? I had a fantastic home birth with them.

My hospital has v large community MW team (25ish of them). Last time was told would only be an issue if two other hb were already happening in my area. I then asked more questions (has that happened before? How many hb do you have a week? Etc). Their answers reassured me it was v unlikely that there would not be a community mw available. And indeed, it was all fine.

Ds2 was due to be a home birth. When I phoned at the appropriate stage of labour they said I had to go in as the 'once in a blue moon' of two hbs at the same time had happened.

As I had just felt his head descend I said there was no way I'd be able to move as I really fancy giving birth in the back of the car. I may have used more colourful language. We were advised to call 999, two lovely paramedics arrived just as he was crowning and delivered him, a midwife arrived 20 minutes later. Because it was down as being planned we didn't have to go in.

For ds3, again hb planned. By some miracle I had the same midwife the whole way through who said she'd go unofficially 'on call' for me. When I went into labour, again it was a 'once in a blue moon' occasion with no one available. The lovely midwife came to me even though she was off shift and delivered him - she called in a friend as the second.

First birth took up less than an hour of time from both paramedics and midwife, second birth took just under three.

really didn't fancy

Congratulations! I have had a hospital birth and 2 home births.

At my second homebirth I had a really long early labour - had the mws our a couple of times to check on me only to find I was still only 1cm so they went back to other patients.
by late evening it's a busy night and so instead of a specialist home birth midwife they send a community midwife (a bloke in fact) still 1cm. He goes home.
Few hours later established labour has definitely kicked in. I ring again - hbmw says they are all at birth's, no one can come out. They suggest I go to hospital to be checked, and if it is established labour it will have to be a hospital birth. Agree that this is okay. MW says they will ring hospital arrange, but instead they ring back and say the hospital is also very busy and has closed it's Labour ward So I can't go in. The MW says they will try and get someone out to us but it will be 2-3hrs as they have to sort paperwork etc for the births they're already at.
half an hour later I am in a state and reckon I will give birth soon (it's my 3rd!) so we ring an ambulance and the hb team again who say they are sending a community MW over and will send a hb midwife asap.
Paramedics are great but I'm not quite as dilated as I thought, community midwife takes over, says I'm only 3cm(!) but stays, hb midwife arrives too, baby arrives about half an hour after hb mw does and community MW does the actual delivery (his 2nd ever!).

I won't lie I did get a bit panicky when no one would come out and the hospital was closed. It was completely different to my first hb where everyone was perfectly happy to come and hang out at my house for 24hrs of slow progress, but I did still have an attended delivery and all was fine. I think it would have been worse if I had been planning a hospital birth, I have no idea what the hospital birth back up plan is.

So... Overall, yes it wasn't the best experience but I was still happy to have planned and had a homebirth.

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.

Statistics don't show that at all. They show that the safest place to birth your baby, including for first time mums, if you are low risk is in an MLU (which includes free standing ones). A hospital is not the safest place statistically for anyone low risk.

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 have never known an area which sends the home birth mw away from a shift on delivery in the labour ward. The only time I've heard of overlap in that way is when short staffing on labour ward has resulted in the mw who should have been on call for homebirths being called into hospital. That happened to a friend during a very snowy period when those who lived further couldnt' get to work. She was asked to go in and did.

I didn't have any issues. I was warned that ,if another home birth was going on at the same time I might be asked to go in. But to the MLU not labour ward. In reality, it was very, very rare. As it happened, my second mw came from the free standing MLU as they had no one in that night so she could leave two mw's on duty there in case anyone arrived and avoid having to call out the mw on call as second mw.

This-
" Rhiannon Davies - whose baby girl Kate died six hours after being born at a Shropshire midwifery unit miles away from the nearest operating theatre - believes the advice is flawed.

An inquest into her daughter's death ruled she could have survived had she had been born in hospital.

Ms Davies told Sky News: "It's a value-for-money policy, it's a dangerous policy and it will put women's lives at risk.

"There's really no such thing as a straightforward pregnancy.

"Even as a second or third-time mother, you have no way of knowing if your baby might be born with a cord around its neck or whether your placenta will break down as you're delivering."

The new advice should save the NHS money as it is more expensive to give birth in hospital than in a specialist birth unit or at home.

Critics say that could force women into giving birth without doctors, against their wishes".

That is a case study of a very specific case. Read the place of birth study.

That is a case study of a very specific case. Read the place of birth study.

No one can predict what will happen, you have to take all that into consideration when you plan these things really. For example when I had ds2, at home, labour began at 7am and was full on from the start, and he was born at 10.30am. I had a midwife who probably arrived around 8.30 and found I was about 4cm so she stayed, then another one turned up whose face I don't even remember as she was there for about an hour perhaps, including cleaning up the carpet

I did have a minor PPH (about 500ml?) and there was a chance of transferring, I was told after - they were panicking slightly till the injection stopped it - but it was not far to the hospital, well, 30 minutes to the main one but there was a downgraded A&E about 5-10 minutes away that would have sufficed if I'd been bleeding out...they said they wouldn't have gone there though.

I had tried to take the risk of transfer into account when I decided on a HB

The thing is I was then much quicker to recover at home, while in hospital I had all sorts of problems, was taking up a bed both times for many hours till I was allowed to be discharged (the paperwork! OMG how long does that take - and having to be 'passed as fit to leave' by a doctor, or three - it takes bloody ages and I was sitting almost catatonic, alone, on a bed, unable to lie down as the baby was on the bed, unable to put the baby in the cot as I couldn't walk, (epidural), unable to eat as I felt so anxious and sick and vulnerable in front of the other people. I sat in pain and stared out of one grey window on a January day from 2am to 5.30pm, until someone turned up to take me home. I couldn't even contact them as I had forgotten my phone in the ambulance.

Epidural availability or not there is no way on earth I'd have a baby in hospital again, and what a waste of resources anyway, considering I had nothing wrong with me and was just waiting for them to go through the motions and let me out.

And hang on. The inquest heard problems had been identified during pregnancy and she should never have been at the MLU. That detail is from the BBC report.

The Place of Birth study does not argue that home is safest for first time mums though does it Penguins?

HighLow - I thought your posting style was familiar. I am pretty sure I know who you are under a new name. I'm not going down your rabbit hole again.

In this area if the midwife is covering a home birth you will get the option to come in, or an ambulance with a paramedic.

If the ambulance arrives an you are actively delivering they will deliver the baby. If you are not in that stage yet they will give you the option to come with or to leave. It is your risk of you remove to come to hospital.

I wonder if Highlow would have jumped in, saying how unsafe it was if someone had posted saying 'How often does your CLU turn women away; what do you do when the nearest one is 40 minutes away and you are just about to deliver?'

Penguins I was thinking the same thing!
.....bangs head against wall.....

I don't think either position is helpful taken to an extreme. Insisting on a home birth with long transfer time and/or difficulty in making a midwife available is not in my view a particularly wise course of action. However neither is declaring that home birth is intrinsically dangerous and reckless.

The evidence shows home birth is safe and women should be supported in that choice but women also have a responsibility to weigh the risks themselves and not prioritise 'having a lovely birth' over all other considerations.

Severe PPH is life threatening and the poster who mentions it below will have given her midwives some very anxious minutes. That could neither be predicted or avoided but yes it must be borne in mind and she obviously did.

I've had three 'normal' deliveries. On the second the cord was round the baby's neck and she required some attention to ensure she had not aspirated meconium. On the third I had a PPH which thankfully was arrested and did not require transfusion. On both occasions, with hindsight I can now say I and my baby were safer in hospital than we would have been at home. That doesn't mean that I think nobody should ever have a home birth. It means that with the benefit of hindsight I can see hospital was the safest place for me. That's not a luxury afforded to expectant mothers and so anybody considering where to give birth has got to take a stab at the issue and make the best choice they can. To do without properly accepting the additional risks and accepting that plans may need to change accordingly is, in my view, foolish.

Well put northern lurker.

"On both occasions, with hindsight I can now say I and my baby were safer in hospital than we would have been at home".

Two questions: had your baby aspirated meconium? And are you sure you would have had a PPH if you had given birth at home? Healthy women are more than twice as likely to need a blood transfusion if they opt for a hospital birth (compared to similar women who opt for a home birth).