midwife staffing Vs getting my homebirth??

[mad4mainecoons]

Just wondering what your experiences were.

the maternity support worker called in today to drop off my homebirth kit (im 37 weeks) and asked how i was, to which i replied excited, and feeling really positive about the prospect of a homebirth if all remains well with me and bump .

and she said, well yes, you will be lucky if you do get one anyway, because the midwives are often too busy and you may be made to go into the hospital to deliver, as there will be noone to attend you at home

so im wondering how common this is, that you miss out on a homebirth for the simple reason of staffing levels!

does anyone have any experience??
im in North cornwall and i suppose it does vary between areas of the country.

Who is going to make you go into hospital though? Someone will be found to attend you surely, I was under the impression that they are legally obliged to, although whether you want to test this and poss end up with an unhappy midwife is another thing...

Sorry that you have been told this after you felt so excited about a home birth, you must feel very deflated.

I'm in West Yorkshire. I went into labour at 3.30am with DD2 and persuaded the MW's to come quickly because DD1 had only taken 6 hrs to arrive. They came straight from another delivery, so no G&A. They stayed until after they were off duty. DD2 born at 7.45.

I presume anyone else in labour at that time would have to go into hospital as they were the HB team on call.

As you say, different regions will have different staffing levels.

Good luck, I hope you get your HB.

I understand your concern but........it is often 'luck of the draw' if the on call midwives are out attending another birth or have been called in to assist in the hospital due to the workload then there maybe no available midwives to attend to you at home. That said the chances of another homebirth plus a busy delivery suite at the same time overnight is quite small - because remember during the day all the community midwives are on duty and can spread the workload where as overnight it is just the oncall staff for the community. On a really positive note - cornwall and devon have one of the highest homebirth rates in the country! So good luck (and try to make it daylight hours!)

Someone will be along in a minute with far more info on this than me, but check out AIMs' website, they will be able to inform you as to your rights to homebirth in relation to staffing issues.

I've just had my home birth assessment visit and asked this question. The MW said it was rare for them to be too busy and they can cope with two at once - it's just if there's 3 that it becomes tricky. She also said that if staff are off-sick they usually find cover so they aren't short staffed.

If it does happen she said to stay at home as long as you can, checking in regularly with the MWs in the hope that one of the other births will finish before you need to go in to hospital and someone can come out to you.

Here's hoping we both get to stay at home!

The problem is it's a vicious circle isn't it? If women back down because they are told there's not enough staff, nothing will change. There will continue to be no staff.

If women insist on their home births, then the NHS will have to work on recruiting, training and employing the needed amount of midwives.

This excuse has been going on for years.

Hoping you get to stay at home - I had mu ds at home and tbh, once I was in proper labour nothing could have got me in a car to go to hospital

I do think though that you have every right to have your baby at home - the first mw who came to me at 9am was due in a clinic all morning which had to be cancelled - and the 2nd mw who arrived at 2pm to be there for delivery also had to cancel her pm clinic! A bit but they both said that it's part of their job to do home births and were more than happy to come to me - and not once did I feel that I was an inconvenience to them.

Good luck - it's an amazing experience

my ds even

I know I'll get shot down in flames here for saying this, but there are only so many midwifes to go round. I know someone has to do something to change the situation, but is that thing really going to be to stamp your foot and throw a tantrum while in labour? And why should it be you?

To give you an example. When I was in hospital giving birth I used up the valuable resource of a labour room and 3 full midwife shifts. (I then went on to use at least 4 doctors, an operating theatre, and a HDU bed. Talk about greedy!) I later learnt that in that time several women were turned away from the hospital due to there being insufficient midwives to go round everyone, and that was with one midwife attending a few women at a time in early labour. One of the women who was turned away was on the local news saying how she had been turned away from 4 hospitals before the 5th admitted her. Inductions and non-essential caesareans were put off for 4 days, with the first ones starting to come in when I was being discharged along with the 3 other women who had emergency sections the same day. The hospital was overwhelmed.

Now this is clearly an exceptional day, but not an unusual one. You can make threats about how if they don't send someone asap and if it all goes wrong 'your family will take appropriate action,' but what exactly will that achieve? If you can answer that question and the answer is 'I will have threatened already overstretched staff into granting my wishes and that will make me very happy indeed,' then go ahead and do it. If the answer might be something more along the lines of 'it will cause me stress to have to behave like that and will result in me being attended by stressed staff, or even worse, no staff at all,' I would be thinking through the flexibility of your plan.

We are in the lucky position in this country of having free NHS available to us at all times, but the caveat that goes with the free service is that they will do their best in their way to look after you, not always the way you want them to look after you. You can go on about your rights all you want, but they can only provide what they have available to them. If you want to guarantee the exact circumstances of your birth, (and even that is not 100% guaranteed in any birth,) you may have to pay extra for some private care to cover aspects where the NHS is weak, and thank your lucky stars you don't have to pay for the whole lot!

Good luck with getting your home birth, but be prepared not to think your life has been ruined if you have to go into hospital on the day. I am sure midwives don't refuse to attend a home birth simply because they can't be bothered.

why are Midwives needed in early labour?

apologies for odd capitalisation, am MNing while making salad, or should that be Salad

'This excuse has been going on for years'.

Well that isn't the entire story. There have been shortages of MWs, particularly in certain areas, for quite some time, but the demand/supply imbalance has been greatly exacerbated in the last few years by an increase in the birth rate.

I am all for choice in child birth. And, in a sense developing pandora's ideas that we might have to pay for some of this, I am becoming ever more convinced that a European-style (NB definitely not US, but European, with safeguards) health insurance system should be adopted here. Where the money follows the choice then, miraculously, the resources seem to follow more quickly than under NHS-style central-planning. And it is important to note that many of the migrants being 'blamed' in some quarters for the rise in the birth rate in some areas would in fact be covered by insurance schemes back home that could be transferred on here. Much of the sniping over 'resource grabbing' for many types of childbirth might die down under such a system. If you have an elective section or HB on the Continent no one starts to go on about how much it 'cost' or how 'selfish' you are - your insurance pays the appropriate cost.

It strikes me as very unfair that an overstretched ward would have to still send a midwife out because someone threatened to sue, if there was no risk in them travelling in to hospital. why should the women who are in hospital get even less care and attention? Of course you should miss out on a home birth if staffing levels don't allow it. Otherwise you are potentially endangering other women just to insist on a personal preference, not a need. If you are that desperate for a home birth surely you should pay for it.

also, from a legal standpoint, if they couldn't get a midwife out to you and asked you to come in instead, and you refused (with no good reason other than personal preference) then even if you sued successfully, any compensation you received would be likely to be massively reduced for 'contributory negligence' i.e. you refused to take steps to get to hospital and get the medical attention.

I just think that as the nhs has finite resources, those resources should be managed based on needs rather than preference. I can see that for some women, e.g. those whose labours are rapid, then home birth may make more sense however.

I'm in agreement with pandora. I can't understand why we have a 'right' to a home birth if that's what we want. With an overstretched NHS facing significant imminent cuts, I'd far sooner see women paying for home births than, say, IVF becoming exclusive to the wealthy. That doesn't address the OP's disappointment, I know. Just my opinion.

Mad - this happened to me. I was assigned to a very pro homebirth team, but as luck would have it, on the actual day that I went into active labour, the MW I had seen all through my ante natal appointments, and her 2 colleagues, were either off duty or attending another birth. She'd said this might happen, and that the hospital I was attached to would send an on-call community MW out to me, so not to worry.

As it was, DH called the hospital and was told "too busy, bring her in". Luckily, through Mumsnet and all the research I had done beforehand I knew that this could happen, and had briefed DH to stand firm. He went on to say on the phone that it was their care of duty, as per the NHS charter on homebirths, to send one out, or draft in an IM to come out to me. They said to him "you are being very irresponsible, we can't send anyone out to you, you're putting your wife in danger" - basically trying to scare him into bringing me in. He got off the phone and told me what happened... I said I would keep labouring at home and see if I could keep going like this until 9am and my lovely MW came back on duty (was about 10pm at night - had no idea how dilated I was but had been contracting for 3 days and nights already!) so wasn't sure if I would make it to 9am, but wanted to believe I could! As it was, the hospital phoned back 15 mins later and said "we're sending someone out to you"... and so the MW arrived an hour later and I was 5cm dilated and started on the gas and air (which I was gagging for at that point!) Second MW arrived about 4am and baby born at 6:15am.

So, I would say, stick to your guns. As someone else has already said, there doesn't seem to be any cases where the NHS haven't sent someone out to you, even after saying they were too busy - so you just need to be confident and they will get someone out to you.

Good luck - homebirths are amazing!

Pandora69 - We don't have "a free NHS", as you stated. We pay (a lot) for it from our salaries! We are the clients, the NHS should be serving us.

OP - Get your OH to read the AIMS website with you, as it may well be him having the conversation with the hospital, not you.

crossposts with Boobz!

I posted the above, intentionally not including a response to Pandora or Tiredfeet, as this debate has been done elsewhere on MN and where I have chimed in before (so am only repeating myself) but it?s worth picking up on Lymond?s point which is of course right: The NHS is not free!

I think using language like ?stamp your foot? and ?throw a tantrum while in labour? is neither fair nor accurate either.

People say that it?s not fair for a labouring mother at home to take MWs away from a hospital (where it is understaffed) as this takes away resources from the labouring women at the hospital. But why should the women labouring in the hospital have preference over the resources? Why should they have the MWs and not the women at home (we ALL pay our taxes)? Women who give birth at home cost the NHS LESS ? if more women gave birth at home it would be of benefit to the NHS, not a detriment, and therefore there would be more money and more resources to go around for everyone. The government recognised this and set up the rules for the homebirth charter which states everyone is entitled to a homebirth (just as everyone is entitled to a hospital birth, if that?s what they want) so that a woman has a choice of how to give birth and bring the baby into the world, and also to improve health services for EVERYONE. By just saying ?oh, they haven?t got anyone to send, I?ll go in then?, the whole aim of the system breaks down as the service doesn?t improve. Therefore homebirths become even more marginalised, NHS midwife units and labour wards become more expensive as more and more people have medicalised births costing the NHS more money, and thus it is even more over-stretched than before etc etc ? a vicious circle ensues.

Also, tiredfeet says ?of course you should miss out on a homebirth if staffing levels don't allow it. Otherwise you are potentially endangering other women...?; the issue I have here is, that it is statistically proven that if you have a healthy, risk free pregnancy, that it is actually SAFER (for both mum and baby) to give birth at home. Why should the homebirthing mother put hers and her baby?s safety below those of a mother labouring in hospital? Women who are insisting that these homebirthing women should come in to the hospital because otherwise they are endangering other (hospital-birthing) women are actually themselves putting others (the home birthers and their babies) at risk. The only way we can minimise the amount of risk to BOTH sets of women is to make sure the system improves (by reducing staff shortages), and it won?t, if you don?t make sure the rules put in place in the first instance are upheld (i.e. both hospital and home births are attended by MWs, not just hospital births).

Two thoughts - in my HB, my local HB team were busy (they were actually attending another HB when I phoned to let them know I was in labour): another mmidwife from a neighbouring area was drafted in. It took her a little longer to get to me, but that was what happened. Local team busy = widen the net and get a midwife from out of area. There are arrangements for these things.

And the other one is that old chestnut that (round here for sure) you are not taking a midwife away from someone else, not taking someone off a busy ward, you are using a different resource of midwives-who-do-homebirths. Who have made that choice and that is their job.

I got DH fully briefed on what to say after mugging up on AIMS. It wasn't a problem when I went into labour and we didn't have to use those tactics.

But, I did have about 4 occasions in the next 10 days when the community MWs were coming to check on me and DS where they had to cancel their appointments with me because they had homebirths on. I didn't mind a bit. IMO it's much more important to have MWs for HB then to have a quick look at my stitches and they would have come out/I could have gone in if I really felt I needed to see a MW. And of course the MW assistants came out.

Our MW told us they have extra staff on at night because that's when most women deliver. If the hospital is staffing for staff convenience instead of the realities of giving birth that is wrong and should be changed.

Two thoughts - in my HB, my local HB team were busy (they were actually attending another HB when I phoned to let them know I was in labour): another mmidwife from a neighbouring area was drafted in. It took her a little longer to get to me, but that was what happened. Local team busy = widen the net and get a midwife from out of area. There are arrangements for these things.

And the other one is that old chestnut that (round here for sure) you are not taking a midwife away from someone else, not taking someone off a busy ward, you are using a different resource of midwives-who-do-homebirths. Who have made that choice and that is their job.

I missed this the first time from tiredfeet: ?I just think that as the nhs has finite resources, those resources should be managed based on needs rather than preference.?

So to take your thought process to a logical conclusion tiredfeet, as the NHS only has finite resources and homebirths cost the NHS less money than a hospital birth, all women should be denied a hospital birth because it costs the NHS more? Not many people would agree with that argument, I don?t think, as women should be entitled to be in a hospital to give birth if they want to, as a PREFERENCE rather than a need (i.e. they could very well have a homebirth but WANT a hospital birth) because it makes them feel safer / they want access to pain relief etc.... so why shouldn?t a woman be entitled to have her baby at home, if it makes her feel safer / more able to deliver the baby without tearing etc? With your NHS funds argument, all women should be told to go back home when they turn up at the hospital in labour, as it costs the NHS more to have a baby born in a hospital...

I was also very clearly told to let the delivery suite know as soon as my contractions started so they could make sure they were properly resourced. For me that was 7.30am when waters went and very mild contractions.

MW arrived 8.30pm (when things started moving along a bit more). Checked me and went off to get equipment after checking that was ok with me.

DS arrived just after 2am.