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.

Sorry, just RTFT.

I honestly don’t know why you would decline something as non-envasive as BP checks. Strikes me as a little bit odd. I personally would worry about the risks of undiagnosed pre-eclampsia/eclampsia, placental abruption and/or fetal growth restriction (which is not always picked up on fundal height measurement - hence ladies with pre-eclampsia/chronic hypertension are usually offered growth scans). Pre-eclamptic women do not always present with protein in the urine or obvious symptoms. It is easy to put a headache, nausea or abdominal pain down to something else if you aren’t being given the whole clinical picture.

There are so many things I would consider declining but BP checks aren not one of them.

A close friend and my SIL both nearly died from preeclampsia... I just don't understand why you would refuse a blood pressure check?

You say you’ve declined bp checks as you don’t want decisions made on what could be normal fluctuation.

You do realise that doesn’t happen?

A bp profile would be recommended in the case of an episode of raised bp to get a good picture over a period of time. Medics know enough to know what’s normal fluctuation and what isn’t. Blood tests are used in conjunction with bp readings where there’s raised bp. And if the bp isn’t serious then the blood results will demonstrate that.

For those of you who have actually answered the question, thankyou.
I'm not asking for them to do anything. I do expect to be given all the information necessary to make a decision. Which means that if nothing has changed in the last 16 weeks, I should be being given the same advice now as I was then. There has in that time been no change in the level of risk, however they want to designate it. What I don't agree with is talking me into a home birth (wasn't my initial plan but I'm now sold on it being the safest option) and then change your mind at the last minute.

I'm not here to discuss the medical implications, I've had those conversations with my midwife and they're mitigated against. For what it's worth what tests are offered routinely depends on the trusts etc, and in my case preeclampsia would have been picked up just as quickly - diagnosis is dependent on finding protein you might have high blood pressure before that but you don't have preeclampsia before that point. I do recognise that's not the only issue people are having but it seems the most common concern.

And I've not objected to blood pressure taken in labour. And staffing levels are a non-issue here.

OP, it seems you have a simple solution to your problem. Have your BP taken.

BP normal = lovely Home birth for you

BP high = monitoring/treatment to prevent your death or a stillbirth

I simply cannot understand why you are refusing a simple, non-invasive test.

"OP, it seems you have a simple solution to your problem. Have your BP taken.

BP normal = lovely Home birth for you

BP high = monitoring/treatment to prevent your death or a stillbirth

I simply cannot understand why you are refusing a simple, non-invasive test."

^ A million times, this.

You're putting your midwife in a horrible position. Not all raised BP is pre-eclampsia, although that's certainly what I'd be most concerned about. A persistently raised BP (even if it's not pre-eclampsia) puts you at a far higher risk of a PPH. Which, dealt with at home, is the stuff of nightmares.

You've got choices, yes, but the one you're making is bloody stupid. You've been to the trouble of going to a consultant appointment, but a BP check was a step too far?? Sure, it's your legal right yadda yadda yadda, but you could put everyone's mind at rest, stop the arguments and have yourself a lovely home birth by just having a cuff around your arm for a minute.

Just to reiterate: you can have pre-eclampsia without protein in your urine.

If you are willing to have your BP taken in labour, when it’s far more likely to be high or show strange anomalies due to the immense stress your body is under, it makes no sense that you wouldn’t have a baseline done.

While you do have a right to choose, it sounds like you are just being difficult for the sake of it. It's a BP check. Not an invasive procedure.

Abnormal blood pressure in pregnancy can draw attention to a number of problems that otherwise might not be picked up on. Just because you have been classed as low risk doesn't mean you will continue that way for the entire pregnancy. Things can and do change, hence the reason for these routine checks.

How would you feel if something went wrong with the pregnancy or your health because you chose to exercise your right to refuse a BP check?

One more thing about your question - place of birth is often treated as theoretical until you are 36/37 weeks. Because you could go into premature labour before then which would make the point moot as nearly all prematurely labouring women present at hospital.

So it’s not surprising that they have waited until 36 weeks to make an issue of this. I had similar frustrations with my last pregnancy - dodging the conversation and then a mad rush in the last weeks to have my homebirth ‘approved’ because it was against NICE guidelines.

There is a good Facebook group called Home Birth UK where people can support you through navigating these issues.

OP you have every right to refuse. BP checks are quite useful, you can buy home blood pressure monitors that you use by yourself at home and no one but you will know the results, would you be open to doing this? That way, you could inform them that your blood pressure is okay or if your blood pressure is high, you can make your own decision as to whether you decide to seek help for this to hopefully make home birth still safe for you.

I would hope that the rational responses about why health professionals can't deem you low risk with unknown Bp is clear now. Yes, they probably should have told you sooner rather than later and it's poor communication that that didn't happen.

That being said, finalising birth options at 36/37 weeks is fairly par for the course anyway. You can stay where you like to give birth. But certainly in my area a midwife is under no obligation to drop off the home birth pack if they feel that the birth is in anyway not low risk. Do you understand why you can't automatically be thought of as low risk?

You do need proteinurea for a diagnosis of pre eclampsia....its part of the rcog definition. However pregnancy induced hypertension which is the condition with no proteinurea still has a lot of risks.

I understand why I might not be classed as low risk but I'm not the one saying that I am. My midwife is saying it, and my notes say it.

Didntcomeheretofuckspiders:
You're right, my (very) poor wording. I agree you can have pre-eclampsia without protein just as you can have it without high blood pressure, what I should have said is that you can't be diagnosed without having both (according to nhs procedure).

Unicornberry:
I offered to do this as a compromise and was told not to. Apparently those machines aren't accurate enough and they didn't want me to base anything off of them. I also said I'd be happy if they monitored it for a longer period of time as standard instead of single readings but they decided against that since there were no other concerns.
I'm genuinely not trying to be unreasonable, but I need to be able to trust my midwife and I can't do that if I don't trust the data that they're using.

The standard machines aren't calibrated for pregnancy and are based on a man, or something like that. They will still give you a much more accurate idea than no BP checks. They can't stop you checking your own BP or doing any other tests yourself. I'd buy one and do your own checks, then contact aims and join the Facebook group Home Birth UK for some more advice. It is worth checking your BP just in case. Good luck, I hope you have a great birth

You're really overthinking the whole thing OP. It's BP. Mines been high a few times and they've just done it again at the end of the appointment of whatever. Never been an issue!

Realistically OP if they get a one off single reading they are just going to ask you to hang around for half an hour so they can do it again, if still high they might refer you up to hospital where they’ll check it again, etc. It is highly unlikely any interventions will occur as a result of a one off, because medical staff are well aware BP can fluctuate and it’s so easy to check again.

What consequences are you worried about from checking BP? It’s worth really thinking that through when you are deviating from standard care, so you can be clear with HCPs.

Mines always high when I'm talking, so I have to shut up so they can redo it.

Just get it checked. I understand why some people decline some tests, but this is such a non issue. Midwifes have enough to deal with as it is.

Am I right in thinking the reason you don't want them to test your BP is because you are concerned it will be high and then they won't sign off on a home birth?

I had twins 16 months ago and my pregnancy was very straightforward... until it wasn't. BP and urine checks saved one of my babies lives. They were raised for a few weeks and closely monitored. Then my BP really spiked with no other real symptoms - I was sent in and had an emergency section a couple of hours later. I admit I didn't feel great, but not enough for me to have gone in without my MW insisting on it. Thank goodness she did.

No one is going to make any decisions based on one high reading. If it's high, they'll repeat it, and see what happens.

I don't understand why you would offer to monitor your own blood pressure as a compromise.
What are you going to do with that information if your own reading is higher than normal?
Very dodgy ground expecting the NHS to pick up the pieces if a problem arises from your ignorance. Midwives should not be expected to put their livelihoods and PIN on the line because you think you've been better educated by Dr Google, by facilitating a potentially risky home birth.
You are being unreasonable.

I think you're putting your midwife in a horrible position. She/he are being asked to make a risk assessment with insufficient information. As others have said they don't make a decision from a one off reading, it gives them an indicator/baseline (the baseline is no longer relevant for you I guess) and let's them assess whether they need to do anything more (like further monitoring).

If what you want is a nice calm home birth your birth partner on the phone begging a midwife to arrive/paramedics rather than midwives turning up is absolutely not what you want. You might think there's no shortages but what if someone is off sick. Realistically you can't guarantee a midwife at your home (and I know that's true of all home births but you're running an extreme risk having one by stealth as it were because they don't have seen the home and you won't have a birthing pack).

It feels like you've backed into a corner and got yourself stuck. I can't really understand why you're objecting because the feeling that a one off bp triggers an intervention isn't true. And if you're prepared to do it yourself what's the problem. I know it's tough to climb down but maybe in this case it's right, with your end goal in mind.

ha! (I'm so clever) I just knew from first post that it was BP refused.

Have you had ANY monitoring tests in pregnancy? Wee? Palpitations? Scans? Ultrasound?

Once labour starts, You could stay at home, wait until the latest possible moment, ring the MW unit & they will send an ambulance. If you're that far gone the paramedics will arrive just in time to attend your birth at home. Or maybe afterwards. Which means no pain relief.

You don't have a right to choose where to give birth. You have a right to be attended. There's a difference.

Not to derail, but why would a homebirth be safer?

Not to derail, but why would a homebirth be safer?

Not directly relevant here but low-risk second or subsequent time mothers have better outcomes giving birth at home or in an MLU. NICE guidelines are to actively encourage them to birth outside a hospital for this reason.

Giving birth in labour ward actively increases the risks for various interventions, perhaps because women are more tense, because doctors over-intervene, or both.

Or rather, we KNOW that medical professionals often over-intervene in birth
What's harder to figure out after the fact is which interventions were necessary and which weren't.

I imagine (just a guess) as you haven't had the tests they cant say that your definitely a o.k to have a home birth maybe it's a rule to protect you all. Just a guess though. You should have been told from the very beginning.