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.

I lie: I had a quick read and i have to correct something before standanddeliver sues me for defamation,

"Unfortunately many people like standanddeliver;s friend cannot see that the problems were created by not listening to the pregnant woman and her body."

It is well past my dd's bedtime but she doesn't mind.

BE I am sorry you also had a horrible time with your hospital birth.

Foxytocin, I see you are off to bed, so see you in the morning - you can see that we are arguing on the same side for most of our points, can't you? Be both agree that the NHS system would be better with one midwife per labouring woman, that homebirths are generally a very good option for the majority (but not all) women, that something needs to change so that these better ways become more the norm.

You said;
"pandora when I tantrummed complained and demanded my choice for a home birth. I can tell you that it was measured, well thought out, articulate and was delivered by hand to the hospital at 28 weeks or so pregnant. Not at the end of a phone, screaming like a banshee to some poor receptionist at 3am when I was actually in labour."

This is one of the things I am trying to put across as being an approach that IS likely to be recorded and to get to someone with more influence. However, what prickled me right at the start of this thread was this statement, posted by Loopymumsy but lifted directly from the AIMS website;
"What is your name and your status? (Make a note of who it is). 'I have no intention of putting myself or my baby at risk of travelling in labour to the hospital and exposing us to the additional risks of a hospital delivery. If you fail to send a midwife and any untoward event occurs which can be attributed to your failure to provide a midwife you can rest assured that my family will take appropriate action'."

This is a slightly different kettle of fish. This is in my mind, as you put it, "manipulating the very primal urge to protect an unborn child at a time when a mother and her partner are at their most vulnerable. It is a disgusting tactic in my humble opinion." it is encouraging the potential escalation of a very difficult situation in a way which is not going to help the labouring woman in the short term, and not going to help future HBers in the long term.

I hope you can see I am trying to suggest that there are different, less confrontational, more effective in the long-run ways of dealing with what seems to be a very big short-coming in maternity services. Believe me, I am very good at arguing in times of stress, but even I would find it difficult to take names over the phone and threaten my family 'taking action' if something happens.

Sometimes, shit just happens. What the midwife that the OP spoke to is probably trying to get across to her is that most likely she will have a lovely home birth but that there could be a situation whereby it cannot happen due to limited resources. Much the same way that when you do many things in normal everyday life there are disclaimers attached to them. When is it better to find out that you may have to go into hospital/the MLU/birthing centre/wherever it is they recommend you go on the day? Is it better to have the thought about making a back-up plan planted in your mind early, just in case the fabled '6 births between 4 community midwives in one night' situation happens, or is it better to be left like a fish out of water with your plans messed up and no idea what to do next?

I cannot guarantee that things will be any better for me next time, but what I do know is that even though I will be paying for it, I will have access to the 'one woman one midwife' model and will know I have put a plan in place that takes into account a variety of possible situations. I won't be leaving it up to the day in question to start worrying that the thing I most want is not there for me.

I am a strong supporter of home birth (personally and professionally) but if someone used the AIMS line on the phone to me I would wonder about their mental health (seriously) what a bizarre suggestion, and I'm sure not a leg to stand on in court! In my hospital there are a first and second on call midwife for home births so if they are both busy and another mw went out to you you would have to bear in mind the following;

1. You would be taking a mw from another labouring woman who hadn't had the presence of mind to threaten legal action and potentially putting her and baby in a dangerous situation.
2. You would run the risk of the mw who turned up having no experience of home birth and put yourself and your baby at risk.

Midwives want to deliver women at home but we want to do it safely, for you and for us.

Pandora, that quote from the AIMS website was used in my letter. If it was necessary, I would have asked one of my birth supporters (either my dh or my then trainee doula) to use it over the phone.

and use it only once. I would tell them to hang up after wards because in most instances know fully well that it is a game of who will blink first.

AIMS states that if you use it like a broken record, till they agree, then it works. It recommends that the labouring women not get involved because it is too upsetting to be in that situation at the time.

And it works because some hospitals know that first of all, they don't want to accommodate HBs (but will pay lip service and keep their fingers crossed that on that day, they will gamble the woman to give up and come in. It isn't necessarily because they are busy.

If they did not think that they have a legal obligation to provide a midwife where ever a woman requested, I wonder why any trusts has not so far done so. It ought to only take one legal test case to sort it out.

reziken, I can't see why this means that a woman who refuses to come in on the premise that they are too busy should be taking a midwife away from another woman. If, for example, the 2 mws on call for home births are called out, then the unit can call in bank midwives to cover the provision. They do it all the time when the ward becomes busier than they anticipated. It is like a school calling in supply staff to cover illness.

I will happily post my Letter which I sent to my trust on the thread to see what we are talking about.

First at about 20 weeks pg, my then assigned midwife first lied to me saying that if i wanted a home birth I would have to tranfser to another team of midwives because they do not do them. Then she spent over half an hour quietly putting every single negative 'what if' to change my mind. I was actually amazed that this woman was being so unprofessional but I calmly talked to her because I wanted her to loosen enough rope to hang herself.

I then requested a different MW in writing a week later. The Team Leader of the CMW at the next antenatal appt then spent 10 mins preaching to me about how they would support me where ever I chose to labour then finally said 'but if we are busy you will have to come in.' At that point, all hope that I could trust these midwives seeped away from me. They want to look after you, but if you do what they want.

This was when I decided to write my letter to everyone starting with the Chief exec. Under no circumstances I could ever labour in a hospital again. I am an educated woman, with a professional career, church going, you get the picture, but I would prefer to free birth than to go into that hospital again. For a c/s for a medical complication but not ever to labour.

The stories of bullying I could relate which someone else I know went through to talk her out of a hb defies belief. This woman also terrified of labouring in hospital because of an awful first experience, asked if she was the only in in the area wanting a homebirth, the midwife laughed and said 'No, we get asked all the time but when we tell them that we won't come out and will send an ambulance instead, they give up.' That is the sort of arrogance and unprofessionalism that exists out there.

"2. You would run the risk of the mw who turned up having no experience of home birth and put yourself and your baby at risk."

Firstly, for years now, Hospitals have known that they must have provisions for home births. At this point in time, there is no satisfactory reason why all midwives not have received training in attending home births. It is not like being a bus driver an then training to become an airline pilot after all. there may be adjunct responsibilities and protocols for HBs but it is all part of continuing professional development. No 'risk' is involved in home births.
Quite the opposite, having a home births lowers a bunch of risks associated with hospital births.

I'm sorry to contradict you foxy but there is inherent risk in any labour and birth as there is in almost all aspects of life. It is the weight we personally place on those risks that matters I believe. But I would certainly agree that many of the problems labouring women encounter are a non issue at home.
The vast majority of student midwives have no experience of home births because they make up the grand total of approx 2.5% of all births in this country. And they are like the holy grail! As a student you are constantly trying to gain experience of the bloody things which is far easier said than done I can assure you, although we have theoretical training.
I must be honest, far from doing it all the time, in my trust we have to be in absolute dire circumstances before a bank midwife is called in (it is almost unheard of tbh, and never in my experience at such short notice). I am not defending this, I am simply reporting it. I have worked many a shift where staffing levels have made it unsafe but nowt has been done about it.
And I was born at home and had my second child at home (with grudging approval from my midwives, 10 days overdue blood pressure going up. In the end I resorted to castor oil to kickstart labour as there was no bloody way I was being induced again) so I have seen it from both sides and I understand the frustrations of women who want information they can trust.

I am certainly not surprised that many midwives have no experience of home births and student MW rarely ever attend them. It is a vicious circle, isn't it. The won't 'allow' them because of being 'short staffed' so on one gets the training. Those words in quotes because it is outside a birthing unit's remit to tell a woman where she can have her baby. And they won't provide enough midwives even for the birthing units until they start to put women and babies and at serious risk by short staffing. Then they treat home births as if it is a luxury by 'grudgingly allowing' them.

As my pregnancy progressed I began to realise that my midwives were scared of attending a home birth for I bet some of the same reasons you describe. But they can't get the experience without attending them! So they also shoot themselves in the foot by undermining women's choices so how in heaven's name will they become proficient at them.

I bet they don't ration funding like this for heart bypasses, (ie: well off men are also the patients not just babies and women who are later too busy and traumatised to complain) there would be a parliamentary enquiry.

The RCM states that all hospitals must have a home birth team. The Trust in inner London where my friend was so severely bullied to force her into hospital was told by the RCM to set up a dedicated home birth team in 3 months, to apologise to her, pay for an independent midwife to look after her for the rest of her pregnancy (from about 33 weeks and IM look after a woman till 6 week post partum). And to pay for all home births via an independent midwife for every other woman who requested a home birth till the Trust had a dedicated home birth team in operation.

When she (with my encouragement to contact AIMS directly) did not back down we had no idea that we could or would bring such change. We just thought they'd agree with her home birth plan.

All this change for herself and for the other women in her area was done with the support of AIMS. My friend chose a water birth and had a lovely rest of her pregnancy and home water birth.

Articulate women and women with big gobs like myself have a duty to complain and fight for the other women who are unable to do so because they are too busy or who can't find out how to have their very reasonable choice respected.

I cannot imagine working under these battle field conditions. My hats off to midwives for tolerating them. The more women accept that 'at least you have a healthy baby' and other platitudes that make us shut up about our mental and physical trauma in maternity units, the more they will cut maternity provision. It is talking about it and fighting for services that they will allocate more money and midwives to us. Maybe we will one day get the one midwife to one woman provision where ever we want to birth. The money is there within the trusts to provide for home births but they will spend it on something else unless you make them spend it on us.

"The RCM states that all hospitals must have a home birth team. The Trust in inner London where my friend was so severely bullied to force her into hospital was told by the RCM to set up a dedicated home birth team in 3 months, to apologise to her, pay for an independent midwife to look after her for the rest of her pregnancy (from about 33 weeks and IM look after a woman till 6 week post partum). And to pay for all home births via an independent midwife for every other woman who requested a home birth till the Trust had a dedicated home birth team in operation.

When she (with my encouragement to contact AIMS directly) did not back down we had no idea that we could or would bring such change."

Now we're getting somewhere! This is a good example of what I have been trying to suggest all along. The time to make a stand that will count for something is earier in pregnancy, or even when you are not pregnant. But not during labour, which is what was suggested right at the start of this thread.

The other sad truth about organisations such as AIMS is that, whilst arguing for a woman's right to choose a HB, it lobbies against her right to choose an elective caesarian. If you support a woman's right to choose her method of childbirth you can never support such an organisation. They are typical of the 'you can have a choice provided I agree with it' childbirth bullies.

pandora69, The whole point of that statement to be read out on the phone during labour is that you have already asked, demanded, complained to the hospital and CC'd in all the relevant parties like AIMS and they have reluctantly agreed to support your home birth.

If when you ring up to claim your hard won midwife support for labour, if then they refuse, you get your DH, doula to say that statement and hang up.

exactly, Babieseverywhere.

because it does happen like that and partners do have to do that rigmarole over the phone when a woman's birth supporter calls for a midwife. they still try to force her in.

bellissima, can you show me evidence which back up what you are claiming? i have never heard of that before.

Looking at AIMS campaigns, they look to reduce the rate unnecessary C-sections and some elective c-sections will fall into this category. But they also campaign to support the parents right to make decisions and won't that also cover the right to have an elective CS ?

I guess that means AIMS hopes to support women like me who don't want another CS from getting the best support and hopefully reduce the number of CS that way.

My interpretation of the AIMS campaign was that they wanted to reduce unnecessary CS's - and in that I wouldn't include those requested by the mother if she has a genuine fear of childbirth. The CS rate in the UK at the moment is nearly 25% - almost 2.5 times the level recommended by WHO to optimise outcomes for mothers and babies. If that rate can be reduced by giving more support to women before and during labour surely that's a good thing?

Re. starting your campaign for MWs at a HB early in pregnancy, how many women are aware that they need to? I see so many threads from women that aren't "allowed" to book a HB until they're 36 or 37 weeks, and who don't seem to get any information about it till that point. I can see the logic of preventing MWs doing unnecessary paperwork preparing for the possible HB of women that will change their mind for either personal or medical reasons - but it does make it difficult to know whether you need to start writing letters. If I was feeling really cynical I'd say that refusing discuss any issues until such a late stage was sometimes used as subtle way to dissuade women from continuing with their HB plans...

I don't know anyone who doesn't have a genuine fear of childbirth by the time the media and usually maternity unit has finished with them, it's usually worse for 2nd time mums because despite the fact they should be filled with confidence that their bodies are capable, they've usually had such a god awful experience at the hands of the "professionals" the fear/fight adrenalin is racing through them by 20 weeks.

foxy - simply look at the objectives on their website. Simply talk to anyone who is involved with the organisation. They are against all forms of choice for women in childbirth but obsessed with one choice - even if that means stamping your foot, using emotional blackmail on the telephone and then putting the receiver down - oh and the mothers labouring away in hospital can go hang because I'll frighten them into sending two MWs for me, me, me. How very mature.

Your emtional and rambling posts about hospitals clearly indicate that you have grave psychological issues with them as institutions. To those of us with children who have particular disabilities - not even life-threatening ones - hospitals, with all their frustrations, funding problems, inadequacies and waits, are not places with life-threatening diseases and death waiting along every corridor. Some of your more emotive declarations and death-rate predictions are frankly barmy. Maybe you need some counselling to get over whatever bad experience has caused this trauma.

In my area, homebirths are attended by community midwives not by hospital ones. Homebirths are not taking resources away from the hospital, but are in fact relieving pressure.

The community midwives need to have homebirths so that they can keep their quota (and license) up.

If the on-call midwives are not available, they send a bank midwife or someone from another team.

Our local labour ward does close every so often, but not because of a shortage of midwives, but because all the rooms are occupied. If they need more midwives, they can get them from the bank.

My understanding is that there are enough midwives to go round - but a significant proportion don't want to be tied to a full-time NHS job. Many hare happy to work part-time and supplement with bank jobs.

"simply look at the objectives on their website. Simply talk to anyone who is involved with the organisation."

righty-ho, so it is not something objective which they have stated. It is something to infer based on your hangups life experiences and expectations which to be fair to you, must be quite different from what mine have been over my lifetime.

"They are against all forms of choice for women in childbirth but obsessed with one choice"

Are you able to provide more concrete evidence of this or is this once more, one of your inferences.

• even if that means stamping your foot, using emotional blackmail on the telephone and then putting the receiver down - oh and the mothers labouring away in hospital can go hang because I'll frighten them into sending two MWs for me, me, me. How very mature.

So in your opinion, we haven't addressed this point ad nauseum or do you have selective understanding eyesight.

"Your emtional and rambling posts about hospitals clearly indicate that you have grave psychological issues with them as institutions." Yup. I did do. I have admitted that already but not in so few words. The NHS midwives on the ward that night I went into labour put thise 'grave psychological issues' there and I am still fucking peed off that the treatment I didn't receive create them.

Have you got a hangup with my honesty of my experience? Then that is your issue. Not everyone may want to hear about it but they are certainly able to avoid reading them.

"Some of your more emotive declarations and death-rate predictions are frankly barmy." Have I predicted death rates? I know I have said that that the 'care' on wards on many nights buts many babies and mothers at risk. That is different from predicting death rates.

"Maybe you need some counselling to get over whatever bad experience has caused this trauma."

I have so been through the mill on this one. It haunted most of my second pregnancy. I wish now that my consultant had recommended me for therapy because I needed it most then. I wish I had shared those fears with my friend who is a mental health nurse. The only person who actually listened to me when I was pg was an anaesthesiologist. (My consultant made an appt to see him because I think he thought I would go for an elective c/s.) We actually discussed why i was so fearful about being in hospital and gave me some answers to some of the questions I still had over what went wrong the first time (first time someone in the health service actually gave me sound answers rather than being patronised). When I left his office about an hour later, I felt like I had been used to wipe the floor. But I could also feel that it was a new beginning and it was onwards and upwards from there.

The lovely home birth of dd2 has also been effective therapy. I am so over this trauma. Does that mean for a moment that I will forgive and forget, not a chance. I can write so freely about it now because I am no longer suffering mentally with this. I will keep on sharing how bad that experience was because I am quite sure that many women out there have had traumatic birth experiences but it is taboo to talk about these things. We should be pleased that we have a healthy baby. I ain't that kind of a martyr. I don't live by those rules and no one should.

here is more emotive ramblings from yours truly. As I said, I intend to keep talking about it because no one deserves what dd and I went through.

Take a breath foxy, calm down, and look at the AIMS website. Or indeed, note people like Tangle authorising me to have a section if I have a 'genuine fear'. Gosh, that's kind Tangle. But what if I just want one? What if I just think that's 'best for me and my baby'? Like what if you just want a HB despite any advice from a medical professional? Now, I have never argued against anyone on MN who wants a HB despite medical advice, (just check out the threads - I've suggested that someone might have a scan of a previous section scar but I have NEVER judged her ultimate choice) but I do wonder what the medical professionals of the WHO might say in such a situation about 'optimal outcomes'. But I suppose that's different then? I suppose that is 'knowing what's best for me and my baby' - despite what any doctor/MW might say) - whereas of course when it comes to sections you and AIMS get your judgy-pants on and only approve of them being done in certain circumstances. It's called hypocrisy foxy.

And as for hang-ups, I think your lengthy and often incoherent ramblings indicates just who has those.

call it and me what you like bellisima.

can you not see how your post at Mon 15-Feb-10 09:41:22 used my personal information about my circumstances to attack me? I found it deeply unpleasant. The sort of thing people point out that they hate about Mumsnet sometimes.

I feel therefore there is no reason to discuss your issues with AIMS or this topic with you

And for that alone, I am offski. Enjoy the rest of your day.

foxy I am not aware of any information about you other than that on this thread. I am in no way 'using personal information' other than responding to information you have freely given on this thread, and on this thread alone. I am sorry that you have obviously had a terrible time in childbirth. I reiterate that I have never, ever, argued against anyone's choice of a HB. But I cannot let my sympathy for you, or anyone else desiring a HB, agree with the 'aims' of AIMS, when it comes to making phone calls and slamming the phone down. Nor can I agree with the 'aims' of AIMS, when it comes to denying women their choice of childbirth just because it differs from the choice of AIMS supporters. I have been attacked, told my 'views need adjusting' and told that I am 'ignoring medical advice', when I argue for a woman's right to choose a section - often by the very same posters who come on here and argue a woman's right to a HB, no matter the medical advice and no matter the scarcity of resources. I call that hypocrisy. pure and simple.

yup, I freely gave info about myself and you responded with things like this:

"oh and the mothers labouring away in hospital can go hang because I'll frighten them into sending two MWs for me, me, me. How very mature."

and this:

"Some of your more emotive declarations and death-rate predictions are frankly barmy. "

which are deliberate misinterpretations of what has discussed and you totally ignore posters like MmeBlueberry's straight after.

What you have said about me doesn't count for jack. You cannot get me upset, even if you read my posts as emotive. I am so over it.

So I feel no need to engage with you. You are just pixels on a screen. I have no desire to go trawl through your past posts anywhere to find out anything about you or your ethos on births. I am pleased that you support women's choice to have the sort of birth they want, where ever they want it. What you think about me and AIMS count for jack.

I support those too so we are really on the same team.

As said already, have a good day.

Some of your quotes about hospitals are emotive and scare-mongering - and deeply upsetting for those of us who have to take our children there on a regular basis - personal information which I have freely given out and about which you are already aware. Hospitals are not frightening places just for sick people, and I'm sorry but I don't agree with AIMS' notion that you take away the people working in them so that they can attend to a far smaller quotient. If you read my thread properly it is AIMS' telephone tactic in this regard that I call deeply immature - I have not accused you of actually using it. Yes I agree with choice, and have suggested a better means of health funding to meet that choice. But I don't think that AIMS methods of last-minute resource targeting are a mature or considerate means of dealing with current funding and resource levels, no matter how traumatised anyone has been (and I accept that you certainly have been) by a past experience.

the quote below about hanging up the phone is not about AIMS. It was about me. AIMS does not advocate hanging up the phone. It advocates the broken record tactic - staying online till they acknowledge that they have a duty of care to send a midwife and send one.

"How very mature." that is your response to the tactic. Completely disregarding the fact that the hospital is neglecting their duty of care to attend a birth irregardless of where it is occuring (and whether or not it was a planned or unplanned home birth.) You would you call the tactic of scaring women into hospital, immuture, either, would you?

oh and 'emotive ramblings' charmer of a phrase there to summarise my experience.

I don't know who you are or your experiences with hospitals. You have outlined them on this thread and I really am not interested in reading the minutiae of it here or elsewhere. you put paid to my interest by that charmer of a post of yours which you are now protesting was ill thought out.

Don't worry, it is hard to offend me. rhinohide. I just thought I'd pull you up on it because it deserves to be pulled up.