HB NOT booked; what right would woman have if she phoned in labour and requested HB?

[asur]

Am just curious... I know that if there is a HB booked and when you phone in labour and they say that they are suddenly shortstaffed and you'll have to go to hospital, there is a distinct right to demand a MW be sent to you.

What would happen though if you hadn't booked a HB in the first place? Should they still send a MW if you refuse to go in to hospital?

Slightly different scenario, but I hd ds2 at home unplanned after a very quick labour. An ambulance with paramedics was sent out, but by the time they got there the baby had already arrived. Due to this a midwife was sent for - she was the local mw supervisor as there were a couple of pre booked homebirths and had been dragged out of bed at 3am as there was noone else. She arrived about an hour after the event.

As someone who had an unplanned homebirth (ds delivered by dh) I am very aware of the many things that could have gone wrong - in my case my waters didn't break so he was born in the bag and dh had to deal with that. I was very lucky. You really do need the right people there so please pre book, and if you can't, go to hospital

[HOMEBIRTHS DO NOT TAKE STAFF OR FUNDING AWAY FROM HOSPITAL BIRTHS. THEY ARE A REASONABLE USE OF RESOURCES]

-Sorry Lulumama, but you are wrong here. In our hospital,(and Im sure in others too), if a midwife has to go out for a HB, the labour ward will be one midwife short, or the birth centre will have to close to labouring women while the second midwife is at the homebirth.
Funding does not enter the equation.

women are legally entitled to give birth at home. low risk pregnancies should be offered home birth as the default option IMO.

-completely agree

where and how you give birth can have a lasting effect on a woman's psyche and how she feels about future pregnancies and births and her baby... so yes, i think a woman should be able to choose, and not be guilt tripped into worrying about deprivign other women of anything. which is a fallacy anyway

-again I completely agree with you, and that is why the homebirth should be booked in advance and the staffing and cover sorted so that she will not deprive anyone of anything.

Unfortunately, it is far from an ideal world in the NHS at the moment and I dont see that changing anytime soon.

"if a midwife has to go out for a HB, the labour ward will be one midwife short, or the birth centre will have to close to labouring women while the second midwife is at the homebirth.
Funding does not enter the equation."
But that is your hospitals choice, they have the option of sending out a bank midwife OR a community midwife from an ajoining area OR a independent midwife. Your hospital chooses to close down the birthing centre as it is cheaper for them than the other options.

The phone call scenario goes like this - '3am, someones just had a bba (born before arrival) and the ambulance will be at the hospital in 10 minutes, can you have a midwife meet them at the main entrance with the bba kit'

Now that midwife may be in the middle of looking after a woman on syntocinon, or have worked all night with her client to set up a lovely water birth experience, or even have 2 or 3 women in labour on a busy shift (yes this is the real world!) but she has to drop that patient(s) and go out to the bba. the rest of the staff have to absorb her workload

Where are the hospital going to find someone to cover the rest of that shift? Most nights we cant even fill our quota of midwives in labour ward with bank staff, they just are not there! And you cant just phone up another NHS trust and ask them to send out a community mw, or phone an indie at 3 in the morning and ask them to go to wherever, it just doesnt work like that, NHS politics dont allow for it and you really are on another planet if you believe it does.

Funding has no bearing on staff availability at all, I regularly get texts from my agency offering a £50-100 bonus if I will take a shift at xxx hospital as they are desperate! In London, THERE ARE NOT ENOUGH MIDWIVES to provide the kind of cover you suggest.

I love homebirthing, I have delivered babies at home and know what a wonderful expereince it is, but there are ways of going about it which will benefit both the mother and the hospital.

There will always be unexpected births at home and the hospital will have to deal with that but what Asur was discussing will leave neither happy with the outcome.

re: community midwives, as i said before my central london trust doesn't have a community team for my part of their inpatient catchment area - and in the case of a mate in ante group here not even in hers, despite being a 5 minute walk from the hospital. tis passing strange, think it is concentration of resources on the poor areas of this very mixed area.

I think it must depend on where you live then because my midwife said that they do NOT take midwives away from the hospital as they have a team of community midwives. She said that if the hospital got TOO busy to cope with their own staff, they then call upon the community midwives.

I do agree that it should be pre-booked unless baby is coming at home through no fault of your own. I certainly wouldn't 'plan' to possibly phone and demand a midwife without having pre-booked.

I think the bottom line is, if you are even vaguely interested in having a HB then book it. You can change your mind and transfer to hospital at any point, even once you are in full-on labour on your livingroom floor!

I saw something a while ago, about a Trust which trialed a system where by all women were attended by a MW at home when they first went into labour. THe MW would care for them at home and bring them into hospital when the labouring Mum decided she wanted to go. As a result there was a huge surge of "unplanned" HB's as the women found they were so happy at home that they didn't want to transfer to hospital, even though they had presumed/planned to go to hospital to give birth all along.

I'd do another HB in a heartbeat, it was fantastic. Don't let people scaremonger you out of the idea of HB, and educate yourself (AIMS etc) about the truths and reality of it all. They tried the "If theres not enough MW's on duty you'll have to come in any way" line on me but I just laughed in thier faces and explained that I knew this wasn't true!

Just book your HB and then you are free to decide where you want to give birth closer to the time.

Monkies

"Just book your HB and then you are free to decide where you want to give birth closer to the time"

I wish it was that easy

But why isn't it that easy? Does it depend on your area?

Because despite having no current issues with this pregnancy my community midwifes have decided not to be supportive

I was recently at a BBA. My client called and asked me to go over. She was labouring beautifully. She hardly made any sound. About 15 mins after I got there she changed the sounds that she was making. I looked up expecting her to say it was time to go to the hospital. Instead she told me that she could feel burning between her legs. I had a quick look and we called 999. The paramedics were fab and arrived within 7 mins but as they came into the room the baby slid into my arms.

They radioed for a mw and it was another 40 mins before she came. They had to send the ambulance back for her. When she arrived she was harrassed, anxious and not best pleased. She clearly didn't enjoy being in the home and away from the hospital. This was not helped by the constant phonecalls that she got from the hospital telling her that she was urgently needed.

In short, plan and book your homebirth. As mintpurple says it's a resource that is taken away from the hospital whereas pre-booking the homebirth does not take the resource away.

Baby and mum both doing fabulously and I walked on air for a very long time. (It wasn't planned and I wouldn't particularly want it to happen again. I like being at planned hbs...but if it did happen I would hope to act in the same way as before)

a lot of very interesting points being raised here and I appreciate all comments.

Just for the record, I'm not planning on requesting a mw at the last minute, was just curious of what the rights would be. As I said before, I won't explain my situation as that would definately change the discussion but thanks for all the input.

(Marslady - glad your client had such a nice experience, even if not planned. I hope the MW didn't ruin it for her)

kazbeth
baby not breathing, pressure on cord, PPH, shoulder dystocia etc.
All the above are competencies that all midwives are required to have training to deal with, and the immediate actions for all of them are the same in hospital as at home.Rolf is maybe saying more about the trust she has in her midwife to do these things, than questioning if the others would do the same.
Rolf for my last 2 births, i've been attended by 8 different midwives,only 3 of whom(over 3 births)I'd met before - they were all stars

asur
I think it's important that you really do a lot of research on your situation, and find out if you are someone who would be truly ill advised to have a homebirth-for me, the dealbreakers would be:
a previous classical C/S at term
a diagnosed major heart defect in the baby
a diagnosed neural tube defect(no talking SB occulta)
a diagnosed omphlalocele or similar
renal agenesis
I was type 1 diabetic (even though i think the rationale for induction is a bit wooly)
placenta praevia less than 3 cm from the os
more than 3 previous sections
rhesus incompatibility
H/O pre eclampsia and still with the same partner
for twins or breech I'd probably be begging an IM to let me do their decorating afterwards

Kazbeth and Jamila - I'm very lucky where I live in that I know all the midwives in the community team and would trust any of them to provide an excellent standard of care. We have the highest homebirth rate in our area (if not the country), partly because there is such a good team. I would also know that if they advised me to transfer to hospital they weren't saying it lightly. I think without that degree of trust I would not be willing to have a homebirth.

Similarly, because I trust them I felt it was sensible to listen to their advice when they told me that they thought I should deliver in the hospital. So no homebirth for me

If you phone up to request a midwife not having previously mentioned homebirth they are going to wonder why. They are going to wonder if there are any child protection issues that you are trying to hide by avoiding hospital. Sorry but they would have to take that in to consideration if you phoned in the middle of the night and unexpectedly asked for a midwife for a homebirth.

maxbear, would they have to consider that. Really? No wonder many women would prefer to avoid the healthcare establishment entirely!

That a womans choice to avoid medical intervention, more specifically, medicalisation of a natural process might lead to queries regarding child protection issues strikes me as completely absurd. Particularly given that many women prefer to birth at home with the (supported) belief that homebirth is generally safer and less traumatic for both mother and baby!

I know of freebirthers and know more women who have homebirthed who have enjoyed natural, healthy births and babies than I do women who have birthed in a hospital..... in fact I know not of one woman who has enjoyed birth to it's fullest potential when under the care of a hospital. Trauma, judgement, coersion, misinformation, lack of support, threats, failure to progress, pain, PTSD, extreme and overt and unnecessary continual monitoring, PND, callous obstructitions, and fear seem to be the common outcome, particularly of first time births, inclusive of my one hospital birth FWIW.

...and avoiding all that potential negativity would be perceived as a child protection issue?!

Hmmmmmmm.

asur, I homebirth rather than freebirth because of some of the issues mentioned in previous posts regarding resources. If at the last moment, I wished for a midwife, in a freebirth situation it could deplete a hospital resource, plus I could end up with para's who would definitely be absolute strangers. Community spirit I suppose, share resources to the best potential where possible . Luckily, my midwife is a like minded individual who I'd invite to my birth were I freebirthing anyway!

Well, maybe I'm wrong to think that but I work in an area with a lot of child protection issues and there have been cases where this situation has arisen. (we still have to try and sent a mw, but sometimes the police as well )

I am not suggesting for a moment that the child protection issue would be raised due to requesting a hb, far from it. Only that we have to be careful and protect ourselves where there are child protection cases, there is also often a history of violence and problems with drugs and alcahol. Sorry if I mislead anyone unintentionally I'm not always very good at expressing myself about these things, especially when my three year old is badgering me and chatting in my ear about smiley faces!!