Independent Midwife at hospital birth in Liverpool

[Rolf]

I am 25 weeks pregnant with my 4th child and I'm thinking of engaging an independent midwife. I have dithered about trying a homebirth but I have a history of anaemia, GBS and PPH and on balance I think that I would rather have the certainty of knowing what my plans are, than worrying about results of GBS swaps, blood count etc.

I am usually quite assertive but not in labour and would really like someone with me who can ensure that I'm left alone rather than bothered with hospital protocols about VEs and so on. I know I'll need antibiotics for the GBS but apart from that my labours have all been pretty straightforward. I'm fine about having a managed 3rd stage, given the previous PPH. My consultant is happy for me to deliver in the midwife-led-unit.

I know that an IW would strictly be a birthing partner rather than wearing her midwife hat, so I wondered about getting a doula instead. However, I think it would be helpful to have someone with the training and experience to not be phased by my medical background.

In my previous labours I have been ok for the first bit. I've been able to breathe through the contractions and so on. But with each labour there has come a point when the contractions run into each other without a pause, and I start to panic and then lose the plot. The best analogy I can think of is that it's like wading slowly into deep water, then suddenly being overwhelmed by a tidal wave so you can't breathe or pause to gather yourself together. I'd hope that a good independent midwife could help me deal with that and I'm interested in trying hypnotherapy techniques to prevent me from panicking. My DH is quite resistant to learning the techniques so I'm thinking of learning them with the IW so that she can work with me during the delivery. This is obviously not something that I could rely on the hospital midwife being about to do.

So, after this stream of consciousness, I'm wondering if anyone can help me with these queries:

I have quick deliveries - on average about 6 hours from start to finish. The only time I've not been induced, I got to the hospital 30 minutes before DS2 was born. If I had arranged to meet an IW at the hospital that's a pretty huge hourly rate she's getting! I need to get there earlier both to get my money's worth and, more seriously, to get the 4 hours antibiotics I need for the GBS. But if the IW and I end up with v little time at the hospital together for the delivery, is it unreasonable (or tight) of me to expect a reduction in the fees? Is that something their contracts tend to cover?

Can anyone suggest a tactful way of raising with my consultant that I would like to bring an IW into the hospital? I have received very good care at the hospital and really don't want to insult them.

Can anyone recommend an IW who helps with deliveries at LWH?

hi first things first congratulations on your pregnancy
i have read about IMWs since the birth of my DD as i am considering a HB with the next one if i ever get pg as far as i can tell if you had an independent midwife with you in hospital they would be there purely as a support and wouldnt be allowed to interfere with the birth etc (due to insurance reasons as far as i can tell) they can be quite expensive and she would be an expensive birthing partner. worth it for the pre and post natal care but during the labour and birth not of much medical use. i would maybe consider a doula as they can be extremely knowledgeable in the medical side of things and would be a great support during labour and birth and pre and post-natally as for fee reduction i think your situation would be assessed on the expected care that would be provided by the IMW.
also just a quick question...where in liverpool are you from?? i am in walton
hope that helps in some way
xx ei xx

I'm in north Liverpool!

Yes, that's my understanding of the role an IW could play in an NHS hospital.

I've wondered if an IW would be more confident about things like the GBS and PPH history, than a doula would be. Maybe an experienced doula would feel ok about it, but I thought that an IW who is used to working on homebirths or at a birthing centre, might feel more able to act as an advocate in relation to some of the interventions I have experienced in the past.

Hi Rolf - I can see your concern about the speed of your labour etc, and why you would want a birth supporter of some sort, but I cant really see any need for you to have an advocate for the GBS and the PPH - as you have said you want the IVABs, and are happy to have a managed 3rd stage, so with respect, what do you want the IM to advocate for, as these are everyday events and you agree with the management that the hospital will suggest? I cant see an area of conflict that would need a strong supporter unless Im missing something in your post!

I think a doula would be a much better option as she would provide the necessary support and advocacy if needed, at a much cheaper rate.

As for the reduction in costs for an IM - well you will still be paying for her pre and postnatal care, her being on call etc, and she can only book so many clients so they dont overlap etc, and she still has her living to make. I agree that it will be likely to be easy money for her, but on the other hand there is no guarantee of that either, so while she might reduce the fee a little, I wouldnt expect too much discount!

Im a midwife in labour ward by the way, and I would never feel insulted or threatened by am IM being there, but I would wonder why you felt you needed one, as I do now.

Good luck whatever you decide

Hi Mintpurple - thanks for your post.

My post was a bit of a stream of consciousness, wasn't it .

Looking at my previous labour, there were times when, in retrospect, things would have been very different had I had an independent advocate with me. I was induced at 38 weeks and things were progressing nicely when, at 6cm dilated, the midwife told me that, according to the hospital policy on inductions/timings, she needed to break my waters. Looking back, I'm pretty sure that she was trying to give me a hint to decline, but I didn't pick up on it. She broke my waters and the rest of my labour was very fast, violent and frightening.

Ironically enough, the midwife had misread my notes and I hadn't been in labour for as long as she thought, but that was a completely innocent mistake and is a separate point.

When I told my community midwife about it she understood why it had happened and said that any of the community midwives would find it abhorrent to have break a patient's waters in those circumstances, and the hospital midwife probably hated doing it. I'm sure that an IW would have picked up on the hint and would certainly have realised the error in reading my notes.

Other comments I have had about my labour were that the paediatrician didn't need to be in the delivery room whilst DD was being born - she could have waited outside the door. And that I could have asked for the venflon to be removed after being given antibiotics, as I was surprised at how much having one restricted my mobility - I couldn't weight bear on that hand, for example. I would prefer to have it re-sited later on than have it in throughout labour.

I am surprised that it didn't occur to me to deal with any of these things at the time but, especially given my history and the generally very high quality care I've received, I become very passive and accepting in labour despite being nothing like that the rest of the time.

Obviously there is no reason to think that this particular set of circumstances will arise next time, but it did make me realise that having someone like an IW or doula could be very useful. Because of the combination of GBS, PPH etc, and also because my history is complicated anyway (3rd pregnancy late m/c; 4th pregnancy foetal abnormality) it might be expecting too much of a doula. Or am I underestimating the skills a doula would have to offer?

and breathe !!!!!!!

you sound extremely knowledgeable yourself now and know just what you would want to happen, and not happen

i know a couple of people who have been induced at 38 weeks + due to precipitous labour so that they do not have the stress of a BBA or a birth on the formby bypass

are your main worries:

speed of labour and feeling out of control?

GBS & IV ABS

Interventions that are not necessary

Hi Lulumama - am breathing .

Not really worried about precipitous labours - they aren't THAT fast and I know that a fast labour reduces the GBS risk. I'll get more worried nearer the time about logistics/childcare etc but right now not too worried.

Not worried about GBS as I'm opting for the belt & braces policy of having ABs despite quick labours. Bit worried about silly venflon but not hugely so.

Worried about the stage where I forget to breathe and panic sets it. With DD I really really thought I was irrevocably losing my mind. DH found it very distressing too. And unnecessary interventions make that more likely, don't they?

DD is sitting on my lap and we're looking at her fingers saying "is it glue or is it snot?"

So - given my rambling posts, do you think I should go for a doula or for an IW? As a doula, what would you have done in the situations I've described?

x

Hi Rolf - have heard great things about a doula Jenni who does the yoga classes at L'pool Womens. I enjoyed her yoga classes and she's supported a friend through a homebirth really amazingly. And I think her most helpful thing was in helping my friend not panic (which had happened in her first labour - second with Jenny she didn't panic).

Sorry, I don't know about all the other stuff - PPH and GBS etc. but maybe its worth trying a chat with Jenni and asking her what she would have done as a doula, and see what you think of her answers?

She has posters up with her number all over the Womens next time you go (but does get booked up), or I think if you did a google she would come up if you looked up pregnancy yoga? Sorry if this sounds like an advert!

what would i have done? why, i would have smacked you round the chops, told you not to be so silly and given you a stern look!

or gently reminded you to focus, to just concentrate on getting through the contraction, to breathe with you and make eye contact if necessary... wipe your face with a cold flannel, offered you a sip of water..and be calm, gentle and strong for you.. and make sure your DH was nt about to keel over !

hard to say.. some women respond more to firmness , other to softness

would have found out what worked for you , previously if anything, to bring you back to the task in hand in previous labour

TBH, unless you want a homebirth, then you are paying for a very expensive doula IFYSWIM.. but i can recommend Judith Kuratec, i thikn she covers your area...

a doula will be your advocate, your voice and your focus ....

jenni is good, and selina is also in your area.. she is on DUK too...

LOL - but would you have queried the request to break my waters, or is that just outside a doula's remit?

Can't find Judith or Selina - is it pregnabain?

I agree with the v expensive doula concern!

Hi kayjayel - yes, I've heard of Jenni and she sounds v nice. I'll call her if I decide on the doula route. Unfortunately I can't get to her classes - they clash with DCs' bedtime and DH gets home too late to take over.

i know - it was so much easier without a toddler I only managed 4 of the 6 yoga classes myself cos of the same thing, and had to get a babysitter to make 2 of those! I heard of a saturday morning one in west derby, but it may be mythical! And a bit out of your way.

Just an aside on IM's - we wound up having IM's for DD (long story) and signed up for them at about 36 weeks. At the time we were very focussed on the birth, but looking back we really got our monies worth in the pre- and post-natal care. It really was in a completely different league to that provided by the local CMW and worth every penny.

Good luck, whatever you decide .

Saturdays are no good for me either. I guess they are best for 1st time mothers working in town .

Tangle - that's interesting that you feel so positive about the ante-natal benefit despite bringing in the IM late on. I'm broadly very happy with my NHS care - it's just the delivery room bit I'm bothered about.

I've been typing IW instead of IM - doh

i will email you those details, rolf.

i would never never question a midwife, in her clinical role. what i can say is
'X has said she would prefer for her waters to break spontaneously...' and refer to the birth plan ... i am an advocate and a voice, but never an interferer or someone going over the top of the mothers' needs or the MWs ability to do her job...if there was a pressing need to speed things up, then that should be explained to you.. and i can always ask a MW to clarify something before it is done and you always have the final decision
as a doula i would have supported you antenatally, and rasied all these queries about how you would prefer the birth to go and get them in a birth plan, before you are in labour, so that your wishes are already recorded. i am there to reinforce what a woman wants, not to make decisions or stop a MW doing anything IFYSWIM

Rolf - given how late we took them on a lot of the benefit was in the post natal period. But even ante-natally the first appointment with the IM made us realise just how little time the CMW had. The CMW wasn't bad at all (and the more I read the more I think she's a very good midwife), just under the usual NHS pressures of too many patients and not enough time. It was also our 1st, so maybe we felt in need of more hand-holding.

Thanks Lulu