Taking your IM into hospital with you

[pandora69]

I read on another thread that someone took their IM into hospital as a doula. This is what I am planning to do, but haven't heard much about it. I was wondering if anyone else has done this and how it went?

I had a rather bad birth with first baby which I believe was excacerbated by several poorly handled midwife shift changes. The hospital I went to was a large teaching hospital - supposedly a centre of excellence -but frankly it felt more like a sausage factory. Not one of the midwives who dealt with me read my birth plan, even though I was in there labouring for nearly 20 hours. (The first person who actually read it and spoke to me about my wishes was the SCBU sister who was lovely, although I felt sadly that my baby needn't have been in SCBU had what happedened earlier not been so appalling.) Poor OH was a bit useless - the situation we found ourselves in was far removed from anything discussed in our antenatal classes, and he made futile attempts to talk to the midwives about our wishes and was effectively batted away each time. By the time he was pushed out of the operating theatre amid shouting surgeons and paediatricians he was in a bit of a state of shock.

I am aiming for a VBAC this time and have appointed an independent midwife. She seems very competent and knowledgable, and most importantly she is very understanding of my wants and worries. She is most experienced in home births, many of them HBACs, and is more than willing to look after me in labour at home. But I live in a very isolated place a long way from the nearest hospital. As it was the nearest hospital that was the location of my nightmare last time, I am opting to travel even further. I do not wish to be at home and need emergency transfer and end up back in the teaching hospital again. (I am aware that in the case of certain very rare emergencies I would be too far from any hospital to get there in time, and am not so hung up about the location of my baby's birth, more about the method.) The slightly smaller and bit further away hospital is apparently happy to accommodate doulas as well as OHs but the big hospital will only allow one birth partner - OH or doula, but not both. My midwife has attended a number of births in this particular hospital, and says that they are a bit sticky with some requests that go against hospital policy, eg she has managed to persuade them to allow a VBAC to use the birth pool when it is not policy to allow it.

I am optimistic that this time, whatever happens, I will have a friendly face acting in my best interests. I hope that this will go a long way to preventing the errors that happened last time, and help me labour in the most effective way.

What I am interested in is hearing from anyone else who has had an IM but gone into hospital with them. I read a lot about people's experiences with IMs at homebirths, but none about IMs in a hospital setting.

Just me then!

I've hesitated to answer as, although our IM accompanied us to hospital, we hadn't planned a hospital birth - due to issues with my health (non-pregnancy) that caused me to be admitted, DD2 was induced at 36 1/2 weeks. We had vaguely discussed what role our IM might take if we needed to transfer in during labour but hadn't really got into details.

Our experience, which more or less matched our expectation, was that our IM was very much a supportive presence. She didn't take a lead role in discussing options with the hospital medics (for want of a better collective term) - but I think that was mainly due to the fact that both DH and I were quite proactive on that front. We're also towards the edge of her area so she doesn't have contact with this hospital often - I don't know if that made her more cautious of legal implications if she was perceived to be too active in offering a different viewpoint or asking too many pointed questions. She did help us make decisions and gave us an independent medical viewpoint. She was treated with respect by most of the hospital medics we dealt with - especially the MWs (who I think appreciated the fact that she'd seen me labour before and therefore had insights that they'd be foolish to ignore) and the more medically oriented Drs. However, the Obs consultant would walk into the room, fail to acknowledge our IM was even there and then stand and talk to us with her back to our IM. Our IM said this wasn't unusual in her experience .

A lot of the reasons we opted to use an IM were to do with continuity of care. Even though she couldn't take a lead role in our clinical care within the hospital, she still did a huge amount of careing. That was more important than I can say, and means we have no regrets whatsoever about using an IM and would do so again - probably even if we decided to plan a hospital birth.

I'm not sure if that's the kind of answer you were looking for but I didn't want to leave you completely unanswered. Good luck

Thanks Tangle.

what you said here;
"A lot of the reasons we opted to use an IM were to do with continuity of care. Even though she couldn't take a lead role in our clinical care within the hospital, she still did a huge amount of careing."
rings a lot of bells with me.

I transferred into hospital from home with my IM with my third baby.

When we got there they immediately said that she couldn't provide any clinical care for me in hospital.

However - once the door was shut on the delivery room she actually played quite an important clinical role. I passed my decisions by her re: augmentation and arm, asked for her to give me her thoughts. The NHS midwife was very respectful to her, and I got the feeling she was grateful for her input.

When I gave birth my midwife caught my son. The NHS midwife wanted to pick up my son, get me to turn around (I gave birth kneeling) and then hand him to me. My IM stopped her and told me to reach down from where I was and pick him up from the bed myself. I know it seems like a trivial thing but it made such a difference to me to do this - my first birth was a forceps birth and my second was a s/d, followed by my ds needing resucitation. To pick my third ds up from where I'd pushed him out - well it was wonderful!

My IM then left as she had been with my for two days and was feeling ill and exhausted. I wasn't paying her and felt a bit guilty about how hard she'd had to work for me so I pushed her to go. We arranged to meet her back at home. Sadly after she left I had a bit of a pph and was treated very rudely by the doctor, who was contemptuous about me transferring in from a homebirth.

Was so glad to see my IM when I got home the next day!

Tittybangbang, thank you for telling your experience. My midwife has already told me that she will not be able to provide any clinical role, but has said that if the NHS midwife is doing all the monitoring, then she will be able to pay more attention to me.

I feel mildly annoyed with myself that I can't even begin to think about a homebirth. But the travelling time to the hospital is just too long for me, and if I were transferred it would most likely to be to the closer one that I have an issue with.

I finally got my hospital notes through this morning about my last birth, and there are lots of very bizarre things in there that apparently I agreed to, but am sure I can't have done! Apparently I told them I would like an episiotomy (thankfully didn't come to that!) and told them that I would rather stay curled up on the floor in the delivery room than use the pool when it became available. i recall being in labour for 40 hrs and banging on about the pool the whole time. I am fairly sure I didn't refuse to use it when it was finally free! Here's hoping my IM can move things more in the direction I want even if I am a bit incoherent this time!

I used an IM for my hbac, so whilst I didn't have any experience of being with her in hospital, we did make a plan b before the birth just incase I did have a hospital birth.

What you have said about your IM paying more attention to you is spot on. She will be monitoring you and your progress without you even realising it, and you won't have to share her with any other labouring woman.

Why do you feel annoyed at yourself for not entertaining a hb? Is it because you would actually quite like one but the fear of transferring to the nearer hospital is too overwhelming?

I would recommend going through your previous birth notes with your IM. I did and it helped lay a lot of ghosts to rest. There were some outright lies in my notes too

I used an independent midwife as I was planning to birth at home with DD1. In the end, we needed to transfer very early on and ended up with an emergancy CS.

My IM was brilliant in that she kept both of us calm at a difficult and panicky time and explained what was going on (as it turned into an urgent situation). I can't say for sure but we were treated very well by the staff on the labour ward and I had a second, wonderful midwife with me all the time too, who worked for the hospital and got to see consultants etc very early on. All of these facts are wholly uncharacteristic of the labour experience of most woman at this hospital, as I understand it. I suspect that this was because IM, who has experience as a very senior midwife in that PCT was around and advocating for us.

I am so pleased that I had her in hospital with me and the continuity of care was invaluable.

I understand that some IMs can act in a clinical role, if they have an honorary contract with a PCT. Otherwise, it's still useful to have an advocate and experienced supporter with you at what can be a daunting time.

I am going for ELCS next time round (it's a personal choice, nothing at all against VBACs) and am still considering an IM as having someone there for me throughout pregnancy and the early days was so helpful.

Best of luck...hope it all works out for you.

ILikeToMoveItMoveIt, I'd love to have a home birth, but I definitely needed doctors with my first. Although things happened over such a long time scale the drive down a series of bumpy lanes while only about 4cm was so incredibly painful (back to back baby, and waters already gone, so leaking away in the car for 45 mins - nice!) I have no great desire to try an even longer drive this time at a later stage. If I planned a home birth and ended up transferring into hospital it would be at a much later stage, and probably in a bit of an emotionally charged state.

I also shy away from a homebirth because my aunt had a similar first birth to mine and ended up with a very severely brain damaged child who died as a direct result of his birth trauma at the age of 12. He got stuck and needed to be out in minutes, but there was noone there to help her in time. A 50 min drive to hospital just doesn't sit well with that experience for me.

I had an IM for my recent twin birth that I regrettably opted to do in hospital.
She worked with the other midwives, who I think were quite scared and cautious with me not having continuous monitoring. Although they didn't want her giving me any care she ended up winning their trust and being the one to hold the monitor to my tummy.
She ensured that I didn't have anyone except midwives in the room, by shooing the consultants out. She made sure everyone read my birth plan and discussed it with them - outside of the room and out of my earshot so I could stay calm and focussed in the delivery room. She helped in many ways, and was effectively a medically trained doula, but she managed to win them over so that there was a good working atmosphere amongst them and I think they were glad she was there in the end. She was the only voice I really heard apart from dp - if she made a recommendation for me then I heard it, but only then.

She also provided my post natal care for a month so that was thoroughly done rather than just having one visit before being discharged...and she gave me lots and lots of breastfeeding support.

I was glad I had her, I just wish I had had the courage of my convictions and stayed at home.

I had an IM and transferred in from a homebirth (for pain relief). She was fantastic at knowing what I really wanted and encouraging me not to sway from that without being pushy with me. The NHS midwives were very careful with how they treated me (total opposite of previous experience).

Just wanted to say that I actually did go back to the hospital I'd had a bad experience in, despite not wanting this at all at the start of my pregnancy. My IM had organised a debrief there during my pregnancy. She had a lot of experience working with that hospital so I decided to go there if needed on the proviso that the mw who was there for my first birth was not to treat me under any circumstances.