MROPs, homebirths & totally losing faith in NHS system...thoughts?

[DoodleMomma]

Hi, I don’t know if anyone can relate or provide any advice on this. Cutting a very long story short, I’m pregnant with our second. We live on a county border so my community midwife is assigned to the NHS Trust in the next door county & I’m booked in to the main hospital in our the county that we live in. This gets more complicated as our hospital do not follow NICE guidelines & my midwife doesn’t understand their processes.

I had a terrible birth with DC1. Was due to have a homebirth but was bullied to be transferred in last minute. The physicality of giving birth was fine, although ended up with a retained placenta needing full manual removal which. The main issue was the politics and how my case was handled before and after.

It was a 4 day labour in total. I had to have meetings with senior hospital management whilst in labour because of the difference in policies between trusts. Had to sign waivers & was pressurised with all sorts of horror stories about how my baby would be taken from me for 48hrs afterwards for monitoring if I didn’t do this and that. No one asked or checked my notes re 3rd stage management, they just stuck a needle in and that was it. I’m very needle phobic but that was ignored. During the manual removal, the anaesthetist was so incompetent that by the time we got to 20+ attempts at trying to get a line in, I stopped counting. The ‘successful’ line then ‘slipped’ and tissued overnight leaving me with an arm twice its normal size and unable to hold my baby. The ward care afterwards was horrendous, I was lied to, again had people trying to take bloods and administer injections without consent & was made to wait until exactly 24hrs after the birth before they’d discharge me. This appeared to be purely out of principle. There was more but I’ll stop there. I’ve since had a meeting about how it was managed & the woman agreed it was poor & apologised. They couldn’t give me much detail however as my notes (3yrs later) are still lost!

So, this time...I’m really worried about being pushed around again & agreeing to things I’m really uncomfortable with. I have terrible anxiety generally & cant bear confrontation. The thought of having to be difficult and fight my corner just exhausts me. Can I have a homebirth even if my midwife doesn’t think it’s a good idea? Presumably if you don’t call them when you’re in labour they’d never know anyway or would that just be a really stupid idea? If I end up in hospital, can I discharge myself? Can I refuse intervention, bloods etc if I wanted to? How have others managed this sort of pushyness from staff? I was really upset in the ward last time because I was so disappointed with the whole situation but it was written into my notes that I was ‘distressed and struggling with baby’. I wasn’t, I was just pissed off with not being considered an intelligent human being.

Wow, long post sorry! Anyone?

“Presumably if you don’t call them when you’re in labour they’d never know anyway or would that just be a really stupid idea?”

If you’re talking about planning an unattended homebirth deliberately without medical assistance, then yes, that would be a really stupid idea.

I feel for you given the experience you had with your first dc1, but what would be your plan if you had another retained placenta for example?

Thank you for replying. I have spoken to my consultant about the likelihood of a 2nd retention & it seems likely that the first occurred because of the medical intervention received in hospital (different hospital to this time). Assume I could transfer in should another manual removal be required this time.

That all sounds horrible. Is it not possible to get a midwife and hospital in the same county? And can you brief your partner or whoever will be with you during birth to be your voice and to be the pushy one so you don't have to be?

How far is the nearest hospital in the other county?
And if this is a different hospital to before what do you mean about not following nice guidelines?
It's also not clear if you've actually discussed this with your midwife, she might be on board.

Unattended homebirth would be a bad idea because you wouldn't necessarily know if you needed to be transferred. Attended home birth against medical advice is possible and you'd have to draw up a card plan with your midwife. But depending on the midwife on duty at the time you might be pushed to transfer sooner than you're happy with it go in straight away, are you prepared to fight that?

I'm not advising going against advice by the way, but if you're going to its much better for it to be planned.

Have you looked at hypnobirthing? I love the positive birth company - very empowering about how to make informed decisions and changing perspective on birth. Might be worth having a look.

Would it be an option to hire a doula or private midwife who could advocate for you? (Appreciate this is not necessarily financially viable, and should not be necessary, but could help you out)

Thank you all so much. Had considered a private midwife etc but £3k+ around here so out of the question. Originally I wanted a planned section this time purely to reduce the likelihood of the unknown happening again but it’s not supported by this hospital (this is the bit I was referring to re them going against NICE guidelines). Could have one at midwife’s hospital but am reluctant to go to there as that’s where I was last time. Because of the bad experience before I decided I’d definitely go to our hospital this time but it’s causing more trouble than it’s worth because the midwives don’t often deal with them. Not much difference in distance between hospitals, 25mins to each but arguably easier motorway journey to ours.

Is this sort of pushy behaviour typical of the care others have received? It just feels such a battle.

Thanks Emelene for hypnobirthing suggestion. DH and I did actually take a course before DC1 as was planning a homebirth but it didn’t work out for reasons out of my control. Will try again this time though :)

Sounds like an awful experience.
To be honest my experience is that in hospital, the birth experience is much more trammelled by the care pathways than a home birth. The midwife may not intentionally bully you, but can’t allow you to deviate from the hospital policies.

If you or your husband can’t advocate for you, you need to find a birth partner who can. I was lucky, my mum has worked in the nhs and knew what I wanted.
My first dd, her job was to deal with the health professionals, my partner to focus on me. This worked really well. I wish I had had her there when I gave birh to dd, as I was much more pushed around. It was a far worse birth experience.

If you have got a friend or relation who can do this, great, otherwise a doula.

Good luck.

(Speaking from personal experience of 3 births, 2 hospital, 1 home)

I wouldn’t say not contacting the hospital while going into Labour was a stupid idea at all, I find it baffling that anyone would say it is, for the simple fact - many women do it! My 2nd birth was at home and beautiful, my third I was pushed into going to hospital as they said I would bleed a lot - low iron. I didn’t bleed “a lot” and because my placenta hadn’t come out they tried to rush me into theatre before I shouted at them and said give me a sick bucket I went to the toilet and pushed it out, it was simply a big placenta. I’ve had no problems in the past and now will never have another hospital birth, I’m staying at home for this one. With or without their say so. If you tryst your body then do what’s best for you, my last hospital birth caused great upset something I will never allow again, my body my rules! Xx

@jt123 you sound like my old self before I became a nervous wreck! Think I need to take back the reins with it all & really get a plan pinned down for this time.

My DH is lovely but not the type to speak up so will definitely investigate a doula. Didn’t really know what to expect with the manual removal last time (didn’t even know such a thing was possible!) but if they said it had happened again I’d be terrified going to theatre by myself knowing what was coming. Definitely need to consider this 2nd birth partner malarkey

I’m at a hospital in a different trust to my community midwife. I’m not sure how the whole thing was organised, but once I was referred to the hospital I was given a second booking appointment (so one with the midwife, one at the hospital).

Since then I’ve received most of my care at the hospital and only seen my community midwife about 3 times.

If it isn’t too inconvenient for you, I would ask the hospital about being seen by them primarily :)

If it's important to avoid the hospital from before check which hospital you'd be transferred to from home if the need arose. You can refuse to go to a particular hospital but they won't take you to a different one (so not really an option in an emergency).

Jt123 not contacting the hospital when in labour is fine, but I think it should be discussed with a midwife and planned, so she knows the risks and the signs for when medical assistance might be needed.

What do you actually want though? A further hospital might be an option for an elcs as you won't be travelling in labour (although will have to do the trip with a newborn). If you'd be happy in hospital without intervention then you can refuse anything you don't want, but if you refuse they don't have to treat you "not enough data". It should be fairly easy to discharge yourself against advise but I expect discharging baby against advice would be made as difficult for you as possible. If you want a home birth push for it, tell them that's where the baby is being born don't ask.

Thanks @BumbleBerries. The travel to hospital isn’t an issue really. I’m not overly enamoured about an elective, just seemed a much simpler process (in terms of avoiding manual removal, politics prior etc. Not suggesting CS is simple!) but the recovery doesn’t fill me with joy. The ideal would be a natural birth where I feel I’ve been part of the process (either in hospital or home, assumed less chance of intervention at home) as opposed to a lot of noise and things just happening to me I guess. I’ve no plans on being silly and going against medical advice where genuinely necessary but at the same time I’m not interested in getting pushed into a situation just because it’s easier for them or to satisfy arse covering I suppose.