What would you plan for birth?

[Pinksorrel]

I realise the best laid plans go awry, but I still have to make one!

Second baby is due in a few weeks. I live in the Highlands, and currently there isn't a proper local midwife service because housing is impossible to find for workers (curse of second homes, rich people moving into area, etc). So it's unlikely I'll be able to give birth in MLU locally, and home births are also not covered just now.

So choice one is to have the baby in A&E, maybe without a midwife. Doctor/nurses would be available. Pain relief options limited. No option for emergency c section. This local hospital is about half an hour away so I can definitely get there in time.

Choice two is to try to make it to Inverness. Takes just over two hours if there aren't too many campervans! All medical options are available at Inverness. But my first baby came in four hours from first twinge, so I think there's a high chance this baby will come in the car on the way through!

First birth was uncomplicated and this pregnancy is low risk.

Would you risk the car journey through, or risk the reduced facilities available locally?

I think you should consider hiring a doula, who will travel, could even stay nearby around your due date.

Obviously talk to your midwives, but my first labour (planned at home thankfully) was 3.5 hours!

I am about to give birth again and I've just been in to meet with the consultant midwife, we talked about how the second labour is very likely to be quicker (!) and covered what would happen if midwives didn't get here in time/ home birth services were suspended etc.

Her very clear answer was baby is better being born at home than in the car or the car park of the hospital. Which does indeed make sense.

She said in that case you would call an ambulance and tell them that your last labour was precipitous and you are not going to be able to safely leave the house.

I think she's absolutely right.

I would be nervous about this but that's just myself. Is there any options to stay up in Inverness close to hospital around due date.

Otherwise I second what pp said about hiring someone with experience like a doula.

If you need a C-section it could be life or death and your nearest option is 2 hours away, too risky op.

If the local MLU was an option , that's what I'd choose. I'm mindful of the lack of c section availability, but low risk women on second babies have birthed locally for generations, so this would not be unusual. It is obviously a consideration, but the c section issue in itself would not be enough to persuade me to go to Inverness iyswim.

The doula is a good idea , but I think it would be very expensive. Two weeks in a hotel 😮 But I appreciate you thinking outside the box!

I could go and stay in Inverness, but this could be a couple of weeks and I just really don't want to disrupt my toddler that much so close to the birth of number two. Also, my husband can't take that time off work so we'd have to wait for him to drive to Inverness to look after the toddler before I could go to hosp anyway, so no time would be saved. And husband would miss the birth.

I guess my main worry about the local A&E birth is that A&E doctors are less experienced than midwives, and that they might not be so good at preventing tearing (or sewing it up!) or encouraging the placenta out, and things like that. Maybe I'm wrong about this.

After a natural birth your placenta is likely just going to come on its own, mine came out after 53 minutes with just some movement and sitting on the loo. You'll just want to check that it all looks intact, keep it in a bowl until someone can check it.

I think even if you did decide to go to the local hospital, your labour might be so fast you don't or can't leave the house so preparation for an unattended home birth is essential either way.

You're right about a doula being expensive, but you might be able to find one that will do visits beforehand and phone calls rather than physically be there on the day? Just to get you prepared. That should be a cheaper package.

If you call an ambulance when you start feeling contractions then you'll have them there to either transfer you or if baby needs some extra care afterwards (I'm sure they will be fine).

My inclination would be that you are far safer at home than in A&E - but I know that's not everyone's perspective! Hard decision!

There's a home birth support group on Facebook run by Samantha Gadsen that's full of good info.

Think it's just called, Home Birth Support Group UK.

I'd definitely rather go to a&e than attempt to home birth and call an ambulance! It might only be one paramedic (sometimes ambulances single crew here) and I think an a&e doctor would be preferable. At least in theory they can do forceps etc. Ambulances might not be in the local area at the time anyway, so it could be ages. Quicker to drive.

Obviously we'll be prepared for accidentally free birthing (DH and I are reading up on what to do about likely complications) but I don't want it to happen if we can avoid it.

I'm not against home birth btw! I would actually have really liked one for my second (and last!) but won't get a chance to try unfortunately.

What about going to Inverness for an induction at 39 weeks so you know you're in a safe place and can plan the delivery a bit better?

I think the idea of being induced at Inverness is a good one, based on my own experience. My second birth was fast and fairly uneventful, dare I say lovely! But things got a bit hairy afterwards so I was pleased to be in a hospital let’s say that.

That's fair, you have to do what you're comfortable with ☺️

Maybe a late induction at Inverness is a good idea!

I've no idea if they'll let me have an induction without medical need, but I'll ask. It would be another option to consider. Bit terrified of inductions though tbh! I really think I'd rather free birth in the car without pain relief 😬

I'd investigate option 1 - hire a doula and stick with the local hospital

if that is impossible, then ask about being induced in Inverness. can someone look after the toddler if you & DH had to spend 48 hrs in Inverness?

(my babies were both induced and it was fine).

I might be wrong, but I don't think most Doulas would agree to be at a birth without a midwife there - they don't have any medical training. I would probably go for A&E in that situation unless baby was past due date when I might start thinking about induction. I was terrified of getting induced but it was far more positive than my spontaneous labour and my Elcs.

I'd be very concerned about getting to Inverness in time. Who is having dc1 and how quickly can they get to you? This will add time to the travel time.

This sounds difficult! Honestly, I think I would ask about an induction. I'm just not sure I would feel the a&e staff would have that much idea if things went wrong, but then again maybe they are much more used to it in that sort of hospital. I think I'd want to know quite a lot more about the A&E staff, eg what would actually happen if your placenta didn't come out and you needed it removed? What would happen if they baby was having problems breathing? Is it also a children's a&e? Are A&E keen/happy to have people give birth there? How likely/unlikely their will be a midwife? If they could reassure me I'd be more likely to consider it.

Side info here but as a veteran of three home births - the placenta was slow to emerge the first time and the midwife had a trick whereby you blew hard into the top of a narrow bottle (think wine bottle) and that pressure got it out. Did the same for all births after that and midwife 3 was very surprised - hadn't seen that before or been taught the trick. I think by number 3 I was just pretending the bottle was there but blowing as if it was.
You're in a rubbish position with this one. Giving birth in A&E doesn't sound much fun and not does birth in a car or induction. It's scandalous that you're faced with this. What does your community midwife suggest?

Thanks everyone for your opinions, it really helps.

It is a small a&e, so not your typical town/city experience. Staff are generally used to dealing with all sorts as there isn't another a&e for 100 miles. If I had a baby in the MLU (if it was available) and there were complications, it would have been the a&e doctor who came to help. So yes, they are semi-experienced I guess. I will ask more about exactly what they can do if there are complications.

I have loads of childcare options with extended family in the village, so leaving the toddler for a day or two is not an issue, and they can get to us in five minutes. I will consider induction if it's allowed. I don't think the baby is likely to be late though, as number one was a wee bit early.

The midwife says they recommend everyone tries to get to Inverness, but if I don't manage it they'll look after us at a&e. If I gave birth in office hours I'd hope the midwife would pop in and lend a hand! But evenings and weekends there is no midwife.

@margegunderson that's fascinating! I'm away to Google that! I agree it's scandalous that local women are in this position, but that's just what happens in isolated rural communities when lots of people move into the area to work their city jobs remotely, or retire, or have a second home etc. These things aren't illegal, but driving house prices beyond local salaries ruins small communities, and have left us short of healthcare professionals, teachers, etc, none of whom can find anywhere to live (even sometimes doctors are priced out). It sucks!

It is really scandalous, if there's anywhere that really needs community/home birth midwives it's rural communities.

I do feel really passionately about home birth, women's health and British farming / rural life in general so maybe it's a very specific clash of interests for me 😂 but I think it's a very important issue that absolutely no one is talking about!

You don't have to be induced post dates, any time from 38+ when baby is cooked. they have plans for this for people more rural in Scotland - some of the islands fly their patients to mainland few weeks before birth, planned induction, home afterwards.

@PregnantandPissedoff pretty sure that's not the case for people where I am (never heard of anyone doing this, most people just do the 2+ hour drive in active labour) but it may well be usual for folk in the Outer Isles. I will definitely ask about early induction and keep it under consideration.

@twoundertwowho I could also rage for hours about this! 😆 It really will be the death of small isolated communities if it's allowed to carry on unchecked. There are things the government could do to retain housing for people who are working in the community but they seem unwilling to do anything. Probably because they all have second homes themselves.

I think you need to be in easy reach of Inverness. Too much can go wrong during childbirth and the reason maternal mortality has reduced so much is because medical interventions are now available. I would look into an induction in Inverness. X

This.

I'm pretty appalled that the NHS can't provide basic maternity care within a reasonable distance of where you live, but getting angry won't magically make midwives become available.

I'd go to Inverness and have an induction for convenience.

Oh and by the way, you shouldn't need their "permission" to be induced. They are the ones who can't offer you basic maternity care in your area and have put you in this position. Any time from 39 weeks is ideal from the baby's point of view. And you can have an epidural.

It's a similar setup in my area. We are encouraged to go to the nearest city hospital which is also approx 2 hours away, I ended up doing this with my first. It wasn't a comfortable drive but we managed it. We were triaged by phone as there was no midwife available locally though I think if my contractions had been closer they would have checked me at a&e before we set off.

I'd definitely aim for Inverness if I was you. My second was a planned c section and that was actually a relief, so if definitely recommend asking for an induction. I think there is a good chance they will say yes as a&e births are really kept as a last resort here.

@RosaBonheur we can't blame the NHS for this one. They are recruiting and actually hiring midwives, and other HCPs. I've seen these people on Facebook housing groups begging for accommodation. There never is any, so they have to decline the jobs they've been offered. The fault lies with the government, and I also think there is a small amount of personal responsibility at the doors of people who buy houses in the area without actually intending to work in local jobs.
But thank you for your advice, and everyone else too ☺️

I guess I'm really worried about induction (especially if it's early) because of risks of extra intervention. The pain on the pitocin drip sounds horrific too, and I won't have an epidural because of the increased risk of assisted birth and the damage this can do in terms of tearing, prolapse etc.
I would consider an ELCS I suppose, but I don't know if they'll give me one just because I want to avoid delivering at the roadside. If I'm going to do that I'd better crack on and ask, as time is running short!