Advice please - need to convince midwife that I am not 'high risk'!

[KelaS]

Hi all

My local hospital (Watford General) basically has two options for birth - the main delivery suite, or the midwife led birthing centre. I desperately want to be booked into the birthing centre, but currently don't meet the criteria - they will only accept 'low risk' births, and my BMI is too high (criteria is BMI of 18-35, mine is 46).

However, they have said that this can be negotiable, assuming I have no complications, and my midwife said that we could discuss it at my next appointment (Fri, when I will be 35+5) and she would see what she could do. So far, despite my excess weight, I have had no complications whatsoever - blood pressure is fine, no issues with blood sugar etc, iron levels are fine even considering I am vegetarian, no swollen hands or feet - midwife has even joked that my pregnancy is so normal it is boring.

So, my question is - does anyone have any advice as to what kind of arguments I can use to convince them to let me book into the birthing centre - I am quite happy to promise not to make a fuss if they want to transfer me if there is the slightest complication, but not sure what else I can say to convince them. Also, any idea what kind of complications they are worried about so I can go into the appointment forewarned as it were?

PS - please, no horror stories about Watford General - I am sure they are out there, but I really would rather not know - can't really go anywhere else or have a home birth, so for me, ignorance is bliss!

similar situation!!!!!

See thread on help need moral support!!!

www.aims.org.uk is a good place to start

and you can ask for a homebirth.. see missvicki;s thread

No real advice on the BMI issue, mine was about 30, not great but not enough for them to worry too much - but just to reassure you if you do end up on the Delivery suite....

I was OKed to go to Midwife led at the Rosie in Cambridge. We got there and it was Shut However when my Midwife looked at my Birthplan she put me in a room just like the ones on MWL - big platform bed and birthing balls etc (not a stirrup in sight ) I had access to a big bath (although the Birthing pool was in use) and Laboured there for most of the time. I actually delivered on a Birthing Stool which as a "bigger Lady" myself was great as it meant I could squat. So the facilities on Normal Delivery Units may well be just the same if you are lucky to get the right room. Make sure they know you don't want interventions unless it is an emergency and they will (hopefully) do their best for you.

Has your mw actually given you any reasons for them considering you high risk - i.e. explained exactly why they consider your weight a problem?

If you have no problems with blood sugar, blood pressure etc then she really needs to explain to you what the deal is!

They might be worried about monitoring the baby's heartrate if you are big - well, they're going to have that problem whether you're on the birth centre or not!

They might be worried about checking baby's position - have you had any recent scans? Is your baby head down atm, for example? It can be quite hard to tell on big ladies but it's not a reason to deny you a normal delivery!!

If they're worried about shoulder dystocia (when shoulders get stuck at delivery) they should know that's far more likely to happen (and harder to treat) if you're stuck on a bed being monitored, than if you're up and moving around in the birth centre.

I did see the other thread, and it reminded me to start this one, as my situation is slightly different I thought it best, although I will be following yours with interest missvicki!

Re homebirth - I don't want one for several reasons, but mainly because my flat is v small, and we live with my sister and another friend, and I wouldn't feel comfortable giving birth with that many people around. So I will be going to hospital, and to be honest, the birthing centre looks lovely - home from home experience, a really cool relaxation room with a big double bed, bean bags, rocking chairs etc.

I'm just not sure how much of them saying 'yes, it is negotiable' etc is them putting off telling me no, and pretending that they are considering it, when the answer will have been no all along, or whether they genuinely will let me book in there if there are no problems. Both the midwives I have met (mine plus the

oops, cut off last message - was saying the midwives are lovely, and I have no complaints so far, just really, really want this

agree with justaboutintimeforchristmas, I would be very cautious if I had a BMI like yours and would want to be very close to medical help for my plan b birth.

I too would prefer the birthing center as i do understand and appreciate i am higer-risk but i've also done some research and talked to other mum's on here and it's not impossible to have a perfectly natural labour as long as i stay calm and relaxed.

I want to avoid all intervention although am not closed to the fact i may need it. I just really don't like hospitals particularly derriford and thought the birthing center would be a good compromise!

I would ask why you can't go to birthing centre, rather than why is the delivery suite more suitable.

The midwife may be trying to protect herself legally cos if anything was to go wrong and you are overweight, she could be accused of negligence.

How near is the delivery suite to the birthing centre. At the Royal Free (my hosp), they are divided by double doors and you can start off in the birthing centre and then transfer to delivery suite if necessary.

Ok, more responses since I wrote my last message!

To snaf - to be fair, it isn't my midwife saying that I am high risk, its just that I don't fit the normal criteria and they will have to make an exception for me. In terms of monitoring heartrate - the only reason they tend to have problems with a doppler is that the baby moves so much it makes it difficult! Haven't had a scan recently, but it does seem to be head down, and she hasn't indicated there is a problem feeling the position. The point about shoulder dystocia is good tho, thanks!

To justaboutintimeforchristmas - I totally get what you are saying, and will be more than happy to transfer to the main delivery suite if there is a need, but it is only straight upstairs so not hard to transfer and I would rather at least start out in a nicer environment, where I can be more relaxed.

kela if it's in the same building then I feel much happier for you

(statistically, your bmi does make you high risk, but that doesn't mean that you shouldn't get individualised care)

This is a midwife-led unit in the hospital (so far as I can see from the OP), not a midwife-led log cabin miles from civilisation. So about as close to medical help as you can get, really.

portandlemonaid it wasn't really clear that they were co-sited until later.

Thanks guys, I do understand that on paper my high BMI makes things more risky (and trust me, I wouldn't have planned to get pregnant while this big!), I just wanted to understand what the risks are. Keep you fingers crossed for me and I will let you know what they say on Friday!

I'd be tempted to tell them that if they won't let you use the birthing center then you'll have a homebirth instead.

You don't need to mean it - just sound convincing!

I bet they'll 'compromise' on the birthing center

is it really worth it....

a safe delivery is all you are after surely...

It is perfectly possible to be safe in a birth centre. Especially if that birth centre is down the corridor from medical assistance, should you need it.

And anyway, what's your definition of a 'safe' delivery? Is it just defined by the condition of the baby, or do the mother's needs have a place at all?

Don't really want to get into blackmail etc - they are really nice, and I am sure that if they tell me it is not a good idea, then its for the best, just want to have as much info as possible before I go in there.

Best of luck, kela. Hope you get what you need

KelaS - may I ask you why you are not happy going into the consultant led unit? I am going into a consultant led unit. I am not eligible to go into a midwife led unit either - but it doesn't bother me - I was well looked after in a consultant led unit last time and I am happy to go in to another one.

Its not so much that I'm not happy with the consultant led unit, just that having looked round both, the midwife led unit looks more like what I want, and would much rather be there.