Homebirth advice please

[MumNWLondon]

I am 32 weeks pregnant with DC3. Both DD and then DS born in hospital MLU, DS in the birthpool. Both births normal & straightforward, particular DS?s (4 years ago) ? used some G&A / tens and then the pool. He was born after only 2 hours of active labour (although early labour (ie from when I knew I was in labour to when I went to hospital was around 7 hours, no need even to put on tens at home that?s how mild it was)). No stitches, he had good apgar score, no problems etc.

Anyway would like homebirth for DC3. I mentioned this to the midwife at my 28 week check. This was my first midwife appointment as I have an underactive thyroid and have been seeing my GP as have needed monthly blood tests. Anyway thyroid all under control, has been the whole way through pregnancy, and I don?t need any more blood tests. Midwife said she wasn?t sure about homebirth as it was written in big writing on my notes ?refused consultant care?.

I did refuse consultant care (after discussion and agreement with my GP) as I had this with my DD and it entailed 3 hour (because of waits/delays) monthly appointments to see endocrinologist, midwife and obstetrician (and it was different people at each appointment, at least with GP I have had consistent care) plus a 2 hour fasting GTT each trimester, as well as extra scans. At 28 weeks with DD I got signed out of the consultant care back into midwife lead care as thyroid under control and an under active thyroid that is under control does not make the birth high risk.

Further after 2 very straightforward births in MLU I would have thought I was an ideal candidate for an home birth?

Anyway I have appointment at 34 weeks to see team leader of community midwifes. Anyway thoughts of things I could do before then? Will take my discharge notes from DS?s birth with me.
Hard to see how I can get signed out of consultant care this time when I never had any consultant care to start with? I have an email from hospital endocrinologist saying I don?t need any more blood tests ? (he is consultant at same hospital but nothing to do with ante-natal endocrinology clinic).

This sounds like the midwife could be just being cautious. It's not that you were refusing treatment for your thyroid, merely finding a much easier/less stressful method of being monitored.

I refused consultant care - I was automatically referred for shared care by my GP because I'm pregnant after IVF, which really annoyed me! - but all I did was see the consultant at my 16 week check up and then just cancel the follow up 34 week appointment (precisely as I worried they'd find a reason to stop my home birth plans). At 16 weeks I also switched myself from the hospital midwife team who had done my booking in to the home birth team as my hospital midwife wanted me to wait to 28 weeks and see how I felt about a home birth then...but it's not been an issue at all with my home birth midwife, probably because home birth is all she does.

There's a very good chance the community midwife will much more relaxed about things, and see that you are a good candidate for a home birth. FWIW, at my hospital you have to "pass" your 36 week check to be recommended for either a home birth or the MLU so plenty of time to get this sorted.

In the meantime, good luck! I'm 39 weeks and am excited about the chance to have my baby at home

PS I'd definitely bring discharge notes, emails, possibly even a letter from your GP confirming that he/she agreed/signed off on monitoring your thyroid as per your notes.

I'm bit confused tbh - i dont see why it matters if you were still under consultant care.

I was under Consultant care and still had hb

At the end of the day the Cons doesnt come and deliver baby - just tell the midwife at 34 weeks that you have considered your options - your thyroid is under control - tell her to look at blood test results if shes that keen - repeat as necessary - thank you for your advice i have taken it on board - I WILL be having a hb

Hi MumLWLondon

it seems to me like your midwife isnt too sure about how she herself would cope with nay complications if any were to arise. These days, depending on where you live, the hospital protocols seem to over ride any decisions a mother wants to make. My first midwife was unhappy letting me have a homebirth as my daughter had echogenic bowel diagnosed at 20 and 23 weeks gestation. I personally think that she may have never done a homebirth for a baby that had this..so I changed my midwife at 32 weeks and she came to my flat (high rise 13th floor) and I asked her for a homebirth..she agreed straight away... she did give me some heads up notes, such as what we would do if I or baby needed an ambulance..one was that I could labor in my bath but not give birth in it and I would need to sort out a parking spot with my housing association for the ambulance.

Sounds to me like you are an ideal candidate..its normally about how normal your previous births were..and yours pretty straight forward. My daughter was my first and I was 20 and with that the first midwife saw this as a potential risk! dont know why!

Well my daughter decided to come at 35 and a half weeks ;) and so I did have a hospital birth with her, but a fully natural, no pain meds, calm birth experience (though the hospital was dirty and oh so horrid) and I self dishcharged us after 4 days, we was better out than in that place.

As the others have said..go get a letter from your GP stating he/she is happy with a homebirth and that thyroid is under control.

Write a list of reasons as to why you want a homebirth and not a hospital birth..include everything you feel is necessary. A midwife should be supporting you in the decisions you make, risk assessing you, and then providing you with the best possible care.

Write a letter yourself, stating you wish to have a homebirth and the reasons why, and also put in there that if any complications were to arise, you would be willing to go straight to the hospital...my second midwife said that this is a good idea to put across as it gives them the reassurance that they can take you to a hospital if necessary.

This was community midwife - she implied that those that are high risk can't have HB. I am technically considered high risk as I should be under consultant care. Yes, I would never have taken a chance on thyroid monitoring but I like my GP and its too stressful and time consuming to go to hospital for consultant care, so felt GP care more appropriate for me.

My 34 week appointment is with the community midwife team leader, so will be more firm!

I have written all my thyroid results in my pregnancy notes, and I already showed her that they are all in normal range (apart from one of results at 8 weeks which was very marginally outside normal).

I will take with DS's discharge notes, plus email from endocrinologist confirming I don't need any further monitoring. Just trying to think of everything!

Also wanted to add both DD and DS normal sized babies (7 5 and 7 14). No indication this baby will be any different.

Go to www.aims.co.uk
They can't actually deny you a homebirth - no one can make you go to hospital to have the baby. I appreciate that you might not want to get militant about it (I didn't) but it is helpful to know your rights. Obviously you don't want to put yourself or the baby at risk but doesn't sound as if you are at all and so if you want a homebirth there is no reason why you shouldn't be "allowed" to have one - you are a grown up and should be treated as such.

Oh, hadn't realised this was a community midwife already! Still does sound like she's being overly cautious. You may have been high risk at one point but your two trimesters of monitoring have downgraded you to normal/low risk, as per your previous midwife-led births.

I think being firm and clear with the head of community midwives at your 34 week check, with reference to your notes, previous history etc, is a good idea. After all, they can't refuse you a home birth!

My sister, who has no thyroid at all, is currently pregnant and she has been told that although her pregnancy (her first) needs monitoring, her labour is unaffected and there is no reason why she couldn't have an HB if she wanted. She, however, does not want. She wants drugs all the way!

I realised she was a community midwife..my first midwife was just that -denied me..then my second was sent from the city hospital -and agreed.

She can not say whether high risk pregnancies are able or unable to have a HB. Its not her choice its yours. She doesnt have to attend therefore change midwife now.

I was high risk, under consultant care until 27 weeks and then disharged. I would just keep fighting your case cause sounds to me like a HB would be a lot easier and less stressful for you and baby.

They are community midwifes attached to the big London teaching hospital where I am booked in. Can't change midwifes unless I change hospital (or go private). She didn't say no, just she wasn't sure. Want to make sure I am all prepared for appointment at 34 weeks with team leader.

Would like to be at home as want to be sure of having waterbirth (only one pool in hospital), because I do not want to hear others screaming in labour, because I don't want to travel to hospital in active labour and because i would ideally like to get straight into my own bed afterwards. Also think will be nicer for DD and DS (not that they will be there, more that I will be at home straight afterwards - although both want to watch their baby brother being born ).

Have you thought about getting an independent mw, or doula?

I find it so infuriating shelling out money on independent mw's, but sometimes it can make things easier and less stressful.

I had a full blown argument with the first mw I saw when I was expecting my second. she told me that in no uncertain terms, my placenta would stop working at 40+10. (maybe she was right...if my baby was born 30 mins later he would have been 40+11!!!!!!)

Anyway, It is your choice where you give birth and you cannot be denied.

Be strong, home births rule!!

Alex - no need for doula, I am very confident in my DH as a birth partner and in my ability to birth my baby.

I see the role of the midwife as a lifeguard by the swimming pool - ie if its all safe she'll just observe.

But yes, will consider IM if prob with NHS midwife - incidentally my v close friend is IM midwife - she is begging me to let her deliver baby, I wouldn't have to pay her, just think that might be slightly weird? (Her DS and my DD are in the same class at school, we do school runs together and she lives a few houses away) - but the baby might come during the day and she teaches midwifes at local college part time.

ok sooo..my very first midwife was in solihull, community midwife at gP practice - lovely woman but I had to change GP's as moved into Brum centre. So my evil first midwife atnew GP's was a community midwife with the GP practice. I hated her and even the receptionists laughed when I said I wanted to change midwives..they knew how awful she was...so they arranged for a midwife from city hospital (where I wasnt registered as planned to have baby at heartlands birmingham 10 miles away) to come to GP practice and my home for visits. She was lovely. My nasty midwife said that I had to change my hospital to the city as i wasnt in catchment area...while this was going on had scan and baby was seen to have echogenic bowel at heartlands where I was registered..consultant was evil -seriously and said baby had chance of being down's, having CF and looked to have cleft palate and lip and asked if I wanted an amnioentisis to rule it out, when I said 'no' she asked me If i would like to terminate!
so I arranged private scan at MUMS and the consultant there was amazing. I told him everything and he changed my hosital over to solihull where I really wanted it to be, he liased with the city hospital midwife and he then suggested that I could have future scans with him at solihull hospital (as he worked both at heartlands and solihull and MUMs - busy man)so this is what I did.

was registered in Birmingham city centre at GP's, had midwife from City hospital, and consultant at solihull..and was sue to deliver baby at home woth midwife or at solihull with consultant, whichever I needed at the time.

A lil push and a shove here and there was all that was needed. And I didnt have to pay for the detailed scans as he worked for NHS. Anyways ended up- first stage of labor at solihull, transferred to heartlands for birth and city midwife calling me after birth to arrange meeting to go over homebirth! lol...no one informed her I had had the baby...was so funny!

I totally agree with your definition of a midwife! That really sums it up actually.

I would love to deliver, or at least be there during the birth of a close friend. I would think of it as an honour. And I'm sure if you went into labour in the day, I'm sure your friends students would not mind!!

I also love how you have confidence to birth your baby. Why do so many women not I wonder.

You sound totally empowered and I have no doubt you will have a beautiful home birth!

I am studying to be a midwife at the moment, and I love that saying about the lifegaurds! Im going to use it as my statement everytime I attend a HB when I pass! how brilliant, I think this is how it should be too and is why im gunning for a HB next time around.