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.

Now that's how you debate a point.

I'm in the fortunate position of living in SE London under Kings where the HB care is excellent.

I'm with an NHS team that are exclusively HB, they look after approximately 20 women at a time with 6-8 midwives, some part time. There were two others like it in the area, now only one after the Albany got shut down. There is also a community home birth team at Kings itself who also do home visits and births.

Apparently there was a famous night last November when 6 women went into labour all at once. The midwives from my team rang round and drafted in midwives from other teams to help and everyone was covered on the night. Apparently this is quite common.

I realise that I'm very lucky and not everyone has these resources but it would be lovely if this kind of level of care could be more common in other areas of the country.

I was told this when i was pregnant with my third and i really wanted a homebirth.
Every midwife always said, 'you'll have to see on the day/staffing but they were all very pleased i wanted one tbh. In the end, i was very lucky and got a lovely midwife at my home accompanied by a student which i believe to be the norm as they don't want two midwives out of hospital.
good luck+

Great posts, Boobz.

There are lots of ideas and opinions being passed around here, but I think what I feel most strongly about that while a woman should be able to chose how and where she gives birth it is simply not always possible due to absolute lack of resources, and arguing for these resources to be made available to you during a very vulnerable few hours of your life may not be the best way of either getting what you want or making the NHS realise that they need to increase their resources in maternity care.

I am struggling to understand just where these midwives are going to come from if you ring up and say 'send a midwife' and they reply 'we have none spare.' I fully understand the arguments for a home birth - I have been weighing up the pros and cons myself and have decided that I simply live too far away from a hospital for me to feel comfortable with one. I fully appreciate that the home birth midwives are a dedicated community or MLU team. I am also aware that in my area the hospitals are staffed partially by those midwives from the community team, so in my area, at least, by asking for 2 midwives to attend you you could weel be taking 2 midwives away from a hospital-located MLU.

As for the 'free' NHS, I am aware that the taxpayer pays for it, and because of the enlightened society we live in, we are all able to benefit from the system - even those who have never paid tax or NI. We all pay our proportion, and thanks to the democratic system of government we have we trust them to share it all out in a way they see fit. I pay a lot of tax - my tax bill each year is higher now than my entire salary when I first started working after university. Should I get 'more' treatment because I pay more? Ironically I am among those who have chosen to partially pay for my own antenatal and postnatal care, because I am dissatisfied with the current NHS model of maternity care. So in theory I am paying twice this time, but in reality I am not - I am just paying directly for my own private midwife, as I would be paying just as much tax whether or not I used the NHS facilities.

Finally, noone here is saying the NHS's finite resources and the way they allocate them is necessarily the best way of going about it. But it IS their way of going about it, and it is going to be very difficult for one person at a time to change this. If it is something you feel very strongly about, there are many more ways you can attempt to have a home birth, and indeed campaign for better use of maternity resources, than being a lone voice taking the name of the receptionist and making threats down a phone about what your family will do to them if they can't rustle up something which is physically not there at that time.

Loopymumsy, the Torquay model sounds exactly how I think it should be done. I had not realised it was actually carried out anywhere. This is the method of care I have agreed with my midwife - she will attend me at home when I first call and no decisions will be made until then. However, due to the anal way of doing things round here I have to be booked for a particular hospital if I even think I might be going there.

Just address some of your points Pandora69:

?It is simply not always possible due to absolute lack of resources, and arguing for these resources to be made available to you during a very vulnerable few hours of your life may not be the best way of either getting what you want or making the NHS realise that they need to increase their resources in maternity care.?

If we don?t argue for it now, then when? Next year? The year after that? When a new government has been elected which is promising more funds to the NHS? If you want to bring about change, you have to be part of that change, not just acknowledge that the situation isn?t brilliant, but I?ll leave it up to someone else to change it. And, although I have been trying to be very impersonal about it throughout my posts, I think the one time you can try and make things better for yourself, if not for the wider group, it?s when you?re in the middle of having a baby and you want the best for that baby!

?I am struggling to understand just where these midwives are going to come from if you ring up and say 'send a midwife' and they reply 'we have none spare.'?

With the word ?spare?, you imply that the MWs that are in the pool available to all labouring women are actually allocated to hospital birthing women only, and that if there are any floating about not doing anything, then they are ?spare? and can go and attend the home birthing woman. This is not the case. The pool of MWs is for hospital and home birthers equally, and therefore if there are not enough MWs to attend all the women labouring in total at any one time, then (one could argue) that they have to draft in other MWs from other sources to cover the hospital birthing women as the on-call MWs are attending home birthers (rather than viewing it as having to draft in MWs to cover the home birthers, IYSWIM).

?by asking for 2 midwives to attend you you could well be taking 2 midwives away from a hospital-located MLU?.

As stated in other people?s posts above, this argument doesn?t really stand up, but for the moment let?s imagine that you are right. One could also argue that if a home-birther came to the hospital, ended up having pain relief or other interventions which she wouldn?t have needed at home, and suddenly monopolises the time of numerous doctors and MWs, anaesthetists, theatres and equipment, taking 36 hours instead of 8 to labour and deliver etc... this woman and her baby has now used up FAR more MWs, consultants and other staff, hospital resources and so forth, which could have been allocated to women who really needed the extra attention, which could have been avoided if the woman had been able to deliver at home.

?Should I get 'more' treatment because I pay more??

No, and no one has suggested, anywhere, on this thread that one should. We have stated that we should get EQUAL standards of care because we all pay into that pot (and even if we don?t pay, we should get the same standard of care as everyone else).

?If it is something you feel very strongly about, there are many more ways you can attempt to have a home birth, and indeed campaign for better use of maternity resources, than being a lone voice taking the name of the receptionist and making threats down a phone about what your family will do to them if they can't rustle up something which is physically not there at that time.?

I wanted a home birth for me, and by insisting on the MW being sent out, I did my small part in making sure the next person gets theirs too. I didn?t make threats, but I did say I wasn?t going to go in, and that was enough, that time. I hope it?s enough next time (or that my MW is on duty and I don?t have to argue at all!) I feel strongly enough about it to make sure I got my home birth, as more important to me than NHS policy and fund allocation and campaigning for better maternity resources on a wider scale, was the health, safety and well being of my baby, and that remains my number 1 priority now, and for the next baby I will give birth to in about 3 months!

I'm playing devil's advocate here, Boobz, but clearly this is something you feel very strongly about. Have you done anything else to try and improve the NHS's allocation of resources, such as write to your MP? I ask because if I felt strongly enough about something (and there are plenty of things I feel strongly about!) I would do something more than just making a lone stand against it. I would be joining groups that campaign to improve these things rather than using my energy in such a way. It is always much more effective when a like-minded group gets together in a focussed way rather than in emotional circumstances.

And I do realise that your priority is to yourself and your baby - but that is the case for most labouring mothers too. But if it were me, (and it will be my turn soon, too) I would be thinking about all of the different options available to me. If I were so set on a home birth it was going to make me feel as though I were putting myself and my baby in danger I would be thinking about paying for it. Oh, yes - I AM paying for it!

As I have already said, it is one thing to say the NHS ought to be able to provide the ideal, and another thing for them actually to be able to provide it. The way it is suggested that if there are no midwives available they will draft some in from other sources makes it sound as though there are a whole load of trained midwives out there not doing anything. The friend I have who is a senior midwife in a large unit would love to be able to just magic some more up from time to time. Instead, what happens is that they just work a bit harder. Sometimes a bit too much harder.

As I understand it, one of the problems is, if all the immediate midwives are too busy to attend, the hospital will fob you off and say "you've got to come in". They won't necessarily go to the extra effort of ringing round to find someone from further afield unless you stand up to them.

I felt strongly enough at the time of planning my birth and having my daughter at home, to do all I could to achieve my homebirth (including insisting on having a MW sent out to me when I was labouring at home). I feel strongly about it enough to try and help others (in this case the OP mad4mainecoons) to get their homebirth. I feel strongly about it enough to volunteer my birth story when people who always assume they will have their baby in a hospital and think those that don't are in some way being selfish, try to shout the homebirth minority down. I do my small part to get the best for me, my family, my friends, and even a few unknowns on an internet forum. Alas, this is pretty much all I have time for - I don't campaign for better midwife services and I don't write letters to MPs.

"But if it were me, (and it will be my turn soon, too) I would be thinking about all of the different options available to me. If I were so set on a home birth it was going to make me feel as though I were putting myself and my baby in danger I would be thinking about paying for it. Oh, yes - I AM paying for it!". But Pandora, oh yes! I paid for it too, and I have the payslips to prove it!

You keep saying "it is one thing to say the NHS ought to be able to provide the ideal, and another thing for them actually to be able to provide it." You're quite right, but you then assume that the people who give birth in hospital get priority over the people giving birth at home when there is "not enough" to go around. Why do you think it is right to think about it that way around? Why are people choosing to give birth in hospital any more valid in their preference than those who wish to give birth at home?

"makes it sound as though there are a whole load of trained midwives out there not doing anything"

There is it is the bank staff, many qualified doctors and midwifes are on the lists. Maternity units can call up and order the staff when they are needed.

Another thing to think about, Pandora69, is that some women ask for home births having had a previous birth experience where there has been excessive intervention in hospital, or where their hospital midwife has been looking after several women at the same time, and they've given birth alone. Both of these scenarios have happened to friends of mine, leading to ante-natal depression and severe anxiety during their next pregnancy. The "script" that AIMS have published is exactly what these women need, to help them feel confident that if they are low-risk again, they can fight for a homebirth.

Boobz - I'm never going to type out a defence of homebirth again, I am just going to link to your comments on this thread. Excellently expressed.

I had hospital births because of complications, and mostly achieved the kind of natural labours, with only g&a, that I wanted. But I fully defend the right of women to have a homebirth, as all the evidence I've read says that it is safer, and cheaper; leaving more hospital beds and staff for those of us who need (or want) to be there!

At the end of the day they will send somebody to a home birth even if it's an Ambulance which you don't get in but the paramedic's can assist.
I am having a doula and have a mobile number of a lady currently doing her return to Midwifery course who has 25 years experience and will be staying at home.

The fact is you can be left unattended in a hospital due to staff stortages whatever happened to the one woman one midwife promise ? so it's not much different to the NHS where you deliver, if they need more staff then it's up to them to bloody find them from somewhere, it really isn't the problem of a woman in labour at home or hospital.

I really cannot comprehend that anyone would seriously stamp their feet, threaten to sue and demand that someone comes and gives them their dream homebirth.

What an incredibly selfish line to take.

Surely having a baby delivered safely is the ultimate goal and if resources cannot stretch beyond a hospital or birthing unit then so be it. There are many women at great risk in other countries who would be extremely grateful for the opportunity to be able give birth in a hospital with the level of care we are able to access in the UK.

Ok then if I get to opt out of paying my NI which lets face it won't provide me with a pension so my births are all I will have to show for 45 years of contributions, then fine I won't stamp my feet.
We're not lucky we pay for it.
An independent midwife would cost me £3,000, I've paid more than that in the last 6 months.

Boobz - any student of process management would point out that - when comparing home and hospital births, you are making a very basic mistake between average resource costing and marginal costing, and in particular failing to take account of resource scarcities.

Yes, in general if you add up 'salary of MW', cost of running hospital maternity ward including its share of doctors/nurses salaries/utilities and so forth - you will come out with a formula that makes HBs cheaper. After all the mother is already paying all the utilities, the MWs only come out for a few hours so that's a fraction of their salary, the gas and air canister costs very little etc etc etc.

What you fail to grasp with this basic division of costs is that:

(1) The hospital ward is open anyway. The doctors/nurses/cleaners and everything down to the electricity bill is being paid ANYWAY. Provided there is a spare bed, the marginal cost of another birth in there is practically zero and probably less than sending two members of staff out for several hours to cover one birth when they could cover at least two in the hospital.

(2) THE basic scarcity at the moment is MWs. Pandora is absolutely right. Simply dividing up their average salaries to obtain cost hours (wherever they are working) does not take away the fact that if there aren't enough to go round then you can't allocate them both outside and inside the hospital at the same time if there aren't enough. The logical conclusion of your argument Boobz is that, in terms of value for money, every mother should have a HB. It doesn't take more than a few minutes to realise that there simply aren't enough MWs to cover that.

NB - this is not to say I am against HBs. Not at all - see my above post - I am all for choice. But simply doing very basic cost divisions to determine which kind of birth is 'cheaper' is not going to allow for such choice.

What about the cost of intervention which can be avoided by a relaxed mother giving birth in her own surroundings and the lack of infections requiring treatment following hospital births due to exposure and poor cleanliness, I bet those costs are never measured.

When I had my hb, one midwife came at 1 pm then another one to bring the g & a, then another one (dont know why) and then a student midwive who ended up looking after dd1 as our emergency childcare had let us down. The labour only lasted for 2 hours but I ended up in hospital as I was losing too much blood. I have cost a lot of money to nhs and I regretted it !

but how do you factor in that hospital births when comparing like for like risk factors in pregnancies that:

there are higher risks of birth injuries (like tears which may be more severe) and c/s which means longer hospital and require more care in the long term. Appts to see ob/gyns, injury repair etc.

that after more traumatic deliveries women are more likely to suffer PND and PTSD.

that babies are more likely to not breastfeed after hospital births which have long and short term health costs for the NHS.

But, foxytocin none of these 'costings' will make up for the fact that the basic constraint, at present, is lack of enough MWs to go round. And - NB- I think that is a real failing - but I rather despair of current NHS central planning and think that a proper insurance scheme would help. (Yes I know we have all paid contributions for years. But sadly they think the money is all theirs, in a big pot, and fell out of the sky. When you pay your (continental) GP every time you go (and get paid back by insurance) , surprise surprise, he makes himself available in the evening as you come out of work. If you paid the MW a special rate to see you at home (and got paid back by your insurance) - I bet there would soon be more available to come out for your HB.

So bellissima it strikes me the Australian/European/USA system of opting out is the way forward or else you don't pretend to give people choices if there actually when push comes to shove aren't any.

i stamped my feet and threatened to sue if midwives used staffing levels as a reason for not attending my HB.

Feel free to call me selfish. I call it looking out for myself.

While from the outside that looks incredibly selfish then you have not walked a mile in my shoes.

the ones I was wearing when I was taken to hospital in an ambulance with pg complications, induced, left to labour on my own, patronised and ignored. I then slipped into unconsciousness and only came out of it at the height of contractions, hearing someone screaming like a stuck pig first before I realised it was me who was screaming. By the time I was 'discovered' in my room I was already 5cm dilated and was told by a midwife who put me in a wheelchair to not scream so I wouldn't frighten the other women. [i still fucking hate her].

I ended up in HDU having eclamptic fits while dd1 was still inside me.

yes this is all in the UK where a hospital was supposed to be the safest place for me.

Then there was the impression of being raped which has still not left me nearly 5 yrs later. That i think they call PTSD. Taht is what the lack of support in supposedly the safest place should be.

Tuesday night, I found myself hyperventilating just watching the trailer at the start of 'there is one born every minute'. Hyperventilating at all those women on their backs, in labour.

What I have learnt from that experience is that too many women go into hospital to have babies safely, only to be saved from the crisis the lack of support creates.

You really need to see 'the business of being born' before you think that women who want home births are selfish.

I was going to delete this rant after typing it but what the hell... why waste the effort.

this thread has recently been done before and I was far less ranty and much more sensible here

bellissima. one woman to one midwife is a basic health guideline of preventative medicine.

this is not a luxury. i would think that the cost of 1 ob/gyn could finance 3 midwives. (training, salary, pension)?

don't get me started on middle managers.