Can I be refused the option of a homebirth because there isn't a midwife available?

[pobletsmum]

I am 29 weeks pregnant and still at the stage of exploring my options. I have boked a doula to be with me at the birth, assuming that I wil go ahead with a natural birth (still considering elective C-section after traumatic 1st birth). Last week I broached the subject of homebirth with my midwife. She was very supportive of the idea, but felt the need to tell me that there's a small but realistic chance that I might not be 'allowed' a homebirth on the day. If I went ino labour during the day, the community midwives would definitely be available to attend the birth at home. However, if I went into labour at night, there might not be a midwife available to come to me. Our hospital is very short staffed (aren't they all?), and at night there are 2 midwives at the hospital who are allocated to cover homebirths (I think this might be for the whole county!) and if one is sick, or is covering someone on delivery suite for some reason, I might be forced to go to hospital to give birth. I can kind of see the logic in what she was telling me, but I'm not happy about it. When pushed, she estimated that this happens to approx 1 in 10 ladies having homebirths (sent to hosp for staffing reasons, not medical problems).

What are your experiences of this? Does it sound normal? Can I do anything to insist on a homebirth (short of staying at home without any mw, which I would definitely not do)?

My issues around this birth are mostly anxiety-related, so as far as possible I want to plan my options, although I will be ready to change my mind at any stage. I don't want to plan a homebirth if it might not be an option. Of course, if I needed to go to hospital for medical reasons, that's a totally different matter.

I hope this makes sense and that people will be able to help, or at least give opinions.

Thanks

It's a tactic, hang on will find the AIMS site for you. There's a phrase you can get your partner to say which suggests it's their responsibility and that they need to find you one or face legal action as a consequence. So no, not really, they can't refuse because they're understaffed.

Here you go:

"I have been informed that you have a shortage of midwives and when I call in labour the Trust may not be able to send one and I shall, therefore, have to come into hospital. I understand that it is Government policy that the NHS should support women who intend to birth at home. In a House of Commons debate (20 Dec, 2000) Lord Hunt of King's Heath stated: 'The Government want (sic) to ensure that, where it is clinically appropriate, if a woman wishes to have a home birth she should receive the appropriate support from the health service. At the end of the day, it must be the woman's choice'.

Your midwives have been aware of my intention to give birth at home since ...(insert date). I have no intention of taking the additional risk of a hospital birth in order to alleviate your staff shortages, although I am prepared to transfer to hospital should a medical complication arise. I suggest that, if your hospital is short of midwives, you contact the Independent Midwives Association and arrange an extra-contractual referral.

I expect a midwife to attend when I call her in labour. Should a midwife not arrive and any untoward event occur that is related to your failure to respond to my needs and those of my baby, my family will take appropriate action and we shall hold you and the Director of Midwifery personally responsible for this failure.

If, when you ring for a midwife when you are in labour, you are still told that a midwife cannot attend because they are short staffed, we suggest that you, or your partner, responds as follows:

'What is your name and your status? (Make a note of who it is). 'I have no intention of putting myself or my baby at risk of travelling in labour to the hospital and exposing us to the additional risks of a hospital delivery. If you fail to send a midwife and any untoward event occurs which can be attributed to your failure to provide a midwife you can rest assured that my family will take appropriate action'.

So far, in every case to date that we know of, the Trust has provided a midwife. You may also wish to ensure that the authorities know that there are problems in your area so you could also send copies to the contacts listed below."

From \link{I have been informed that you have a shortage of midwives and when I call in labour the Trust may not be able to send one and I shall, therefore, have to come into hospital. I understand that it is Government policy that the NHS should support women who intend to birth at home. In a House of Commons debate (20 Dec, 2000) Lord Hunt of King's Heath stated: 'The Government want (sic) to ensure that, where it is clinically appropriate, if a woman wishes to have a home birth she should receive the appropriate support from the health service. At the end of the day, it must be the woman's choice'.

Your midwives have been aware of my intention to give birth at home since ...(insert date). I have no intention of taking the additional risk of a hospital birth in order to alleviate your staff shortages, although I am prepared to transfer to hospital should a medical complication arise. I suggest that, if your hospital is short of midwives, you contact the Independent Midwives Association and arrange an extra-contractual referral.

I expect a midwife to attend when I call her in labour. Should a midwife not arrive and any untoward event occur that is related to your failure to respond to my needs and those of my baby, my family will take appropriate action and we shall hold you and the Director of Midwifery personally responsible for this failure.

If, when you ring for a midwife when you are in labour, you are still told that a midwife cannot attend because they are short staffed, we suggest that you, or your partner, responds as follows:

'What is your name and your status? (Make a note of who it is). 'I have no intention of putting myself or my baby at risk of travelling in labour to the hospital and exposing us to the additional risks of a hospital delivery. If you fail to send a midwife and any untoward event occurs which can be attributed to your failure to provide a midwife you can rest assured that my family will take appropriate action'.

So far, in every case to date that we know of, the Trust has provided a midwife. You may also wish to ensure that the authorities know that there are problems in your area so you could also send copies to the contacts listed below.\AIMS} site.

Sorry, was distracted, it's from AIMS ignore the second part of my post, it's a re copy.

Yes it can happen. It happened to me. I wasn't told about the possibility until I was 37 weeks.

I made a VERY BIG complaint to the supervisor of midwives at that point, but it still happened to me. The homebirth site gives some really good advice on what to do should you go into labour and the hospital refuse to send a midwife. It's not that they forced me into hospital exactly. I actually came home after being checked once. My choice was to stay at home with no one but my dp (and no pain relief) and hope the labour lasted long enough for the community midwives to start their shifts at 9am or go into hospital.

Crap or what?

Great stuff WWW and I really don;t want to put a downer on this but I did all that and basically got told they would be putting someone on the labour ward at risk if they sent anyone out. If I wanted a midwife or pain relief I had to go into hospital otherwise I had to hold on at home and call in every hour or two to see if they had anyone they could send yet.

It's absolutely appalling and it's only in writing this that I realise quite how distressed I am about it.

I would strongly advise you do everything WWW suggested to maximise your chances but IMO hospitals use the vulnerability of a woman in labour to deny homebirths using shortage of staff as an excuse.

Oh I'm sure it happens wisemen, it's appalling.

Ummmm...

Well I had a homebirth booked, but when dh rang to say things kicking off, was told noone available to come out. So got my mother round (was getting pretty sore) and got to the hospital an hour later. Was 10cm and ds born 40mins later.

Apparently just after we'd left the ward had rung to say a midwife from another area was willing to cover (was a Friday night). But obviously was too late by then. Wouldn't have thought that she'd have made it in time, but might only just....

In the end was not so distressing as was only in hospital for about 2 hours. As soon as ds was born, and while was being stitched, I started to ask to go home. Quite emphatically. And left the hospital at 11pm, with their blessing, on the condition that the midwife would do the post-natal check on ds the following day (rather than my staying in overnight to see the paed the next day).

On the one hand, I almost wish I'd had the gumption (or rather dh, I was incapable of speech because was a very quick labour) to say would stay put. But did not want to run the risk of birthing without a midwife. Also, really really wanted the gas and air.

The way I see it, there truly wasn't anyone available. I wasn't going to give birth without medical assistance. I laboured at home as planned. Got out quickly and had many of the advantages of a homebirth while just failing at the last hurdle. So tried to be pragmatic about it afterwards though I did feel somewhat cheated.

Also, having planned a homebirth meant was in a very strong position WRT refusing to stay overnight.

Hopefully you wont find it happening to you - if only 1 in 10 then more than likely that you'd get the birth you want.

another site homebirth.org

Forgot to say that I believe some health authorities allow gas and air to be delivered to planned homebirths in advance. I would definitely ask if this is an option because it might give you an extra few hours at home by which time a midwife would hopefully become available. You may not need any pain relief at all but I would have stayed at home a lot longer if I'd had gas and air to hand and who knows might then have got my homebirth? Obviously having a doula with you should help you feel safer labouring without a midwife and will probably be better at staying calm and standing your ground with the hospital.

I feel really awful saying all this because I don't want to add your anxieties but it is a real possibility and as WWW says it is better to have planned for this eventuality.

I had gas and air at home both times.

I didn't want to take the chance, community midwife visited at 18 weeks, and was with me for 5 mins before called off to home birth in hammersmith (we are in hillingdon) due to shortage. It was then we made the decision to go with our independent midwife. Costly, but the only option where I was guaranteed cover.

Thank you all very much for your responses. Beewisemen and pooka, sorry to hear that you did end up in this situation. I'm so glad now that I have a doula booked. Hopefully she can do all the difficult negotiations with the hospital if that is what needs to be done.

I think I will write to my MP hurdicure. It won't make a difference to me, but could help other women in my situation in the future.

Having pondered this a bit longer, I think I would almost be better off (psychologically) to plan a hospital birth. At least that way, I'll be mentally prepared and they're very unlikely to turn me away, although our delivery suite does occasionally have to close to admissions & send labouring mothers to a different hospital, but that's another story...

Oh don't do that! Honestly, even though I ended up going in I am still incredibly pleased that I planned a homebirth and nearly got it.

And also, I was unlucky. No other person I know locally who has had a homebirth has had this happen to them. Just bad luck.

You have a doula? That is brilliant! If I could change anything, it would have been to have had a doula or someone similar to be rational and my champion. Not that DH isn't great, but he's no more bolshy than me.

Also, if I had had the gas and air at home in advance, I think that would not have gone in when I did, and wouldn't have missed the phone call saying that another midwife had been drafted in.

But hey ho! I still get all dewy eyed when i think about ds's birth as it was wonderful despite the hospital and so completely different to labour with dd.

Thanks pooka

You are allowed to give birth at home. I think they have a statutory duty to provide a midwife. You're even of course allowed to give birth alone or with your doula or partner helping. My father delivered my sister.

My independent midwives brought gas and air to my home with them. They had to send out for more as we never expected I'd have 2 separate 7 hour labours, one for each twin though....

This happened to me - I was booked for homebirth, called for the midwife when I went into labour and was told that there were none available and that I would have to go to hospital. Which I ended up doing. Nonetheless, I had a good birth experience, and I have no real regrets about it.

I would say, go ahead and plan for the homebirth. But, as with all birth plans, be prepared to accept that you may have to follow a different route to the same outcome.

Here's the thread about it.

BTW, paramedics carry G&A (as I found out ).

how fab that you have a doula - dn't worry, she'll sort it all out for you - you can ask her to phone the hosp/mw to let them know you are in labour and she can deal with any problems they might try to throw your way while you concentrate on you. i had a bag packed in case i needed to go in unexpectedly but it doubled as the 'place' i was keeping all the baby clothes etc that i needed for the birth anyway so it was handy for the doula/mw/dh (honestly he was the worst at finding anything!) to find the bits they needed as and when.

But you are allowed to say I am not coming in and then they generally do feel they have a legal duty to send you a mid wife.

pobletsmum - I think you have two options.

1. go with the advice given to you by your midwife as described in the OP and think yourself extremely lucky to live in a country that tries hard to support women who wish to have a home birth and provides the resources free-at-point-of-access when those resources are available

1. go for a hospital birth

But Xenia, if there is no midwife, then how are they going to magic one (or rather 2) up for the homebirth?

I know I could have stayed at home. But then would have run the huge and probable risk of giving birth unattended and that is not something I was prepared to do.

It's all very well "knowing one's rights", but in practice not everyone is, in the midst of labour, up for having a discussion about statutory requirements and staffing levels.

And that is why I think the plan of having a doula is an excellent one.

When I was giving birth at home with the first twin the local hospital sent their head of midwifery services and another mid wife who sat in my kitchen for about 5 hours. Complete waste of NHS resources as my own midwives were there. But they just don't always want the risk. They can always get someone off her shift and out of bed or from an agency if they want to. I don't know of a single woman left alone at home. They just have to find someone and they do. But if I were having a first baby I wouldn't want to take that risk, I agree. I'd probably then be persuaded in. With baby number 1 we did a deal that I could go home after 6 hours having given birth in hospital and that worked out quite well.

I think my problem though was that by the time I found out there were not midwives, I was less than 2 hours away from giving birth. Obviously I didn't know that, but I do think that if we'd waited at home any longer, then we might not have had a midwife in time.

In then end, we left for hospital at 7.45pm. Missed a phone call just after 8pm to say that a midwife would drive over from the next health authority. Arrived at hospital just after 8pm. Had ds just before 9pm. So timings very tight.

Can guarantee that next time I will be ringing at first twinge to make sure that get in the system for someone to come