right to choose - antenatal tests and birthplace

[AcornNest]

I am very lucky to have had a very straightforward pregnancy, very low risk and no concerns.

Because of the low risk pregnancy I have chosen a home birth. This was discussed at my booking appointment and at several other antenatal appointments and the midwives have been very supportive of it throughout (the first actually recommended it).

Throughout the pregnancy I have declined certain tests. I fully understand the reason for those tests, and my midwife was happy with the conditions under which I would consent (eg any other indications of problems). It was made very clear that it's recommended for xyz reasons, but also that I had the right to chose.

Now, at 36 weeks, I'm being told that I can't book a home birth because I have refused these tests (with midwife still recommending it). I was asked to meet with the consultant to see if they would sign off on it. Consultant didn't understand why she was seeing me, because she only normally sees high risk patients which I'm not. But their policy means that she had to recommend a hospital birth, although she was very apologetic about this and wanted to help but couldn't.

So all the medical advice I have been given recommends a home birth (if this were not the case I would not have one). But the official recommendation is that I have a hospital birth.

Do you think that my choices with regards to antenatal testing should affect my ability to choose my of place of birth?
And, if so, at what point should I have been made aware of this?

And this isn't about whether or not people think I've made the right decisions, this is about whether or not I should be bullied into medical tests that I don't want.

You declined a not intrusive, very quick test which in turn made things more complicated for you? Just why?

I can understand why they’d be worried about home birth if you won’t let them do BP. It just makes it more worrying and harder for the Midwives.

It’s not about being allowed or not. You birth where you like. They aren’t actually obliged to send a midwife if you just ring up, by the way. They are obliged to send one if one is free. Otherwise they send medical care - meaning an ambulance.

Have you considered an independent midwife? Wish I’d used one. Was bullied horrendously by NHS professionals (low risk pregnancy and birth).

@girlwith I'm not dismissing preeclampsia as a crock of shit, I'm dismissing the notion that op is automatically high risk because she simply hasn't had the test. Entirely different.

Blood pressure is a risk factor and can be the only symptom (the baby sends messages to send more blood over to it because it’s not getting enough of what it needs and your bp shoots up as your body tries to satisfy the request.) Also it’s a 2m non invasive test with an arm cuff! No hospitals these days have spare midwives to send off to people who refuse to come in, even if they have to im sure they’ll have solid emergency reasons why doing so would put multiple women in danger not just one bloody minded woman who doesntknow the facts. Fgs.

Ah... that's not quite what you said. You said that "all this you aren't low risk is a crock of shit".

I didn't say she was high risk. I said that a medical professional couldn't say she was low risk. Again, pretty different. They're saying the risk is unknown. Which it is. So, up to you if you ignore the recommendations of professionals but you can't demand to be deemed low risk if there are unknown factors.

Don’t be rediculous time

One of my births (quite recent) two Midwives attended, they phoned the MLU for an update on staffing at around 9pm and were told the MLU was empty (four Midwives covering) and only one lady in delivery suite (four Midwives available) so they could stay with me as long as required. They hung around for ages after to observe feeding etc which they don’t when they are short.

This time of year is notoriously quiet, it’s perfectly possible there will be Midwives spare to attend an unplanned home birth.

When I say recent I mean a couple of years ago, I don’t have a newborn.

I do have a newborn nephew though and everything was very quiet for his birth too.

Not like springtime births when Midwives are overrun

I don't think you can make a blanket statement about what conditions and midwife availability is like everywhere. At that notoriously quiet time of year, my hospital is having to send around 1 in 5 women to another one in a different authority. They wouldn't have staff to send out to a hb, it'd be an ambulance.

Completely your choice where to give birth.
Completely your choice as to what tests you consent to.
Completely the consultants choice as to whether to sign you off as being suitable in their opinion.

They can’t sign you off if they don’t have the complete picture of which BP is a significant component.

They can tell you anything but at the end of the day if it goes pear shaped and you consequently take legal action whatever they told you is neither here nor there. There is a piece of paper where they have signed that they did not agree suitability due to lack of relevant information needed for decision making. This covers themselves, hospital and system.

I said ‘perfectly possible’ I didn’t give blanket assurances.

I was also the one who pointed out OP may not get a midwife if she just phones up on the day.

There are no certainties around birth, even things like staffing!

GYMBALL - just curious, why did you refuse GTT? It's not particularly pleasant, granted, but detection of gestational diabetes is very important. It helped keep my placenta and my second baby healthy and safe through the last 10 weeks of my pregnancy.

I recently spent a few days in hospital after my birth and it was NOT quiet, out of 8 days 2 or 3 were maybe less busy, otherwise labour and postnal wards were full, not sure why people think it's quiet time?

Quite right, LadyRenoir. There is no 'quiet time' for maternity staff and that alongside staffing shortages and capacity issues means that someone who just refuses to come to hospital may not get a midwife at all.

Some nhs trusts have a policy that those labouring quickly at home or unplanned homebirths etc will only get an ambulance and a transfer into hospital and not a midwife at all.

You can't make a blanket generalisation. And those in hospital when it's quieter - Chances are you got a quiet day, but all of those babies due will be born within 2 weeks of due date. So you may be the only woman birthing on that day, yet the day after there could be many more and units could be closed due to having no beds.

Depends where in the country you are I guess

Where I work you’d get an ambulance sent, and that could take hours to arrive. Your consultant is entirely right to refuse to agree to a planned homebirth. If anything happened to you or your baby as a result of an issue that could have been picked up if you’d allowed the correct monitoring, then they’ll be torn to shreds at the coroners court and the trust wouldn’t have a leg to stand on, legally speaking. I’m really confused as to why you won’t have it checked? The likelihood is that it will be fine in which case your plan goes ahead. In the unlikely event that it’s raised, it will be checked on more than one occasion and would lead to further investigations to establish whether there is a problem or not. Having a slightly elevated BP was the first thing in a chain of events that led to my baby being born at 35 weeks, small but healthy, rather than potentially dying.

What tests haven’t you had?
They are correct to turn you down for a home birth as without all the facts they can not be sure it would be safe.
If something is picked up on a test that the baby may have a potential problem the team is ready. The paediatric team and neonatal unit will be aware and ready. Without that information you put the midwife in a very dangerous position not even mentioning the potential danger to the baby should it have an undiagnosed problem.
Why not just get the test done and then plan your home birth? You could just say you don’t want results if it’s such an issue for you but at least the medical team will know if you are safe to give the home birth to. If the test shows a problem meaning a home birth is not suitable you could be saving your baby’s life

You can decline any tests you like and still have a home birth.

Many women decline all blood tests. I only have blood tests if I have symptoms to suggest I need one (e.g symptoms of anemia) although I do know my blood type and rhesus factor - but even if you were rhesus negative you have the right to decline the anti-D.

Many women decline scans. I can see why they do although personally I like to have an anomaly scan to rule out previa or accreta, just in case.

Declining urine tests or BP checks are less common, but your still perfectly within your rights to decline. You could also do your own urine tests at home (dipsticks are readily available online) and you could monitor your own BP at home too? I know many people who have freebirthed (unassisted) including unassisted pregnancies but most will check their own blood pressure (monthly/bi-monthly and then weekly or so in later pregnancy).

I hope this helps.

OP, If I hadn’t had any tests I could also declare that i was having a “very straightforward pregnancy, very low risk and no concerns”.

But I have had basic tests that show this actually isn’t the case. You’d never know by looking at me, and I feel fine.

If you are so desperate for a home birth let them take your blood pressure. It will take 2 mins and there will be no need for deception (ie going into labour at home with the expection of an unplanned home birth).

Or if a test shows you have high blood pressure you can do something about that may save your life or stop you having a still birth.

Bad things happen OP and ignorance doesn’t prevent them.

Why would you turn down BP?? No you may not have other symptoms first and you could become very ill if a raising bp is missed.
You are obviously not medical. I assume a first time mother and I assume you live in that bubble where nothing bad ever happens????
Well in the real world things go wrong. Your priority and duty as a mother is to put the health of your baby and yourself first and that means above any idealistic dream of the perfect home birth.
In your case you can probably have that birth by having a bp done occasionally. Really just do it!
Oh and before I get told off by everyone. I have seen births go wrong, I have seen women have strokes post birth due to high Bp and I have had to deal with the resus and death of a baby when parents went against medical advice and had a home birth when told clearly it was not safe.(they actually had the arrogance to hire a private midwife who they didn’t tell about the baby’s position).
Funnily I now have very little patience for fools. The moto is safety first if all is fine crack on and do as you like have the baby in a pool surrounded by candles and unicorns to the music of a harpist. If you have a problem you want and need people who can and will keep you alive with the best equipment near by. The end result for both scenarios should be an alive baby in an alive mother’s arms. That is what matters and that is all that counts. Have your no done and sort out your home birth hopefully you are fine.

Shocked at this!!! Why on earth won't you have your bp checked??? Risking the life of you and your baby and your not exactly a young mum either!! I'm with the hospital,no way should you be allowed a home birth without such important checks!!

Your place of birth is your choice. NHS midwives have a duty of care to you and they have to support you whatever your choice. There is no such thing as 'signing off' on a home birth. You don't get approved for it or allowed to have one. Though they may make it sound like that, but it's not actually the case. You can choose to birth wherever you like, even against medical advice, and they have to support you.

I'm planning a home birth. It's not the same, but I declined the GTT (it wasn't recommended with my first birth, which was also a home birth, I'm just a teeny tiny bit more overweight this time by like 1 BMI point, so I technically now fall into the category for whom it's recommended). I didn't feel like I needed it as I'm not otherwise high risk (other than being like 10lbs heavier at the start of this pregnancy than I was last time when I wasn't considered at risk). My home birth midwives were fine with that. No one ever mentioned it again.

Now in the case of BP though, I do think something to consider is what you plan to do in labour. Midwives will want to measure your BP in labour. It's part of the standard checks that all midwives do including for home births. They'll also want to use a doppler to monitor baby's heart rate on occasion (usually once every 15 minutes in the 1st stage and every 5 in 2nd stage, though they can be a bit flexible depending on the situation). Yes, you may have fluctuations in pregnancy (though if it fluctuates to extremely high, even on occasion that can be an indicator of something you need to get checked, but you'd likely also have other signs of pre-eclampsia). But in labour, BP is a genuinely good indicator over time and in comparison to your standard measure of distress. Eclampsia (not the the pre form) can come on very quickly in labour and as you aren't having your urine checked, it can be a good indicator that you or baby is in distress. Eclampsia can be fatal within the hour. So I would seriously consider what your plans are in that case. If you don't want any BP checks in labour, it is probably wise they've advised a hospital birth so they don't risk the transfer time as you may not have that much time in a serious situation. I think that's probably reasonable given the circumstances. But ultimately it's still your choice where you birth. In labour though, I would probably just consent so you know the midwives have all the information they need to give you advice and I would get on with having my lovely home birth.

All of this "you aren't low risk because you don't know your BP" is a crock of shit.

No it’s not. In order to be low risk, there need to be no complications of pregnancy or complications in a previous pregnancy. Therefore in order to categorise the OP as low risk, they need to know her BP is normal. If they don’t know whether her BP is normal or not, they can’t say she is low risk.

I'm dismissing the notion that op is automatically high risk because she simply hasn't had the test. Entirely different.

That’s not what people are saying. No one has said she is high risk, but as she hasn’t had the test we can’t assume she is low risk either. Obviously they have to err on the side of caution and without the test to prove she is low risk, no one can assume she is. That doesn’t mean she’s high risk, just that she cannot be confirmed as low risk.

There may have been something in the tests that showed having a home birth may be risky so can see their rationale behind recommending a hospital birth. Personally I am risk averse and would choose hospital birth any day of the week. If there is a complication you dont know about it'll be a long ride to the hospital even if you only live down the road. You absolutely should have been made aware of this when declining the tests though so I do feel for you but now you just have to do what you feel is safest with the information you have available. Good luck x

If you’d declined scans, or had not had at least a full blood count during pregnancy, I would be inclined to say that a hospital birth might be safer.

If you’d merely declined serology screening, Downs testing or testing for gestational diabetes, I wouldn’t have thought it would have any bearing on your suitability for homebirth.

I guess you're asking them to risk assess a situation that they don't have the information to safely assess?

I'm high risk but if I decided I wanted a Home birth they can't refuse?