Home birth / hospital back up plan help?

[SweetPeaGirl]

I might be being dumb here, but please help!

So, ideally I would like a home birth. I've thought about it a lot and I think it would be best for me. However, I know that things don't always work out and I could need a hospital birth, right up to the last minute.

The issue is this. I live right next to the boundary between two different hospitals. The one I live in the area for is actually slightly further away, but more importantly it has a worse maternity unit.

The one I'm NOT in the area for is closer and better. It's also the one my GP sends patients to. Despite being in the GPs catchment area, I am not in the catchment area for their home birth team.

So, for a home birth I'd have to go under the team attached to the less good hospital. Which is totally fine.

But my question is - what if I end up needing a hospital birth? Can I can be under the home birth team attached to one hospital, but then if I need to go in, go to the other hospital? Is that a thing?

How far along are you? I'd check as a lot of homebirths are no longer being supported due to midwife and ambulance shortage.

If you do have a home birth there will be an ambulance on standby from the hospital you're registered with.

If you want to be under the other hospital then i'd register fast as i believe if you aren't in catchment they don't have to take you as a regular patient (obv if you're in labour and walk in then they won't turn you away).

I'd register for the birthing centre at the nicer hospital personally. you have more care on hand and don't risk being in a hospital you are unhappy with

If you do have a home birth there will be an ambulance on standby from the hospital you're registered with.

I really don’t think this is true. They won’t have empty ambulances just waiting around.

@sickandtiredagain sorry not an expert on home birth. this was my understanding from someone who was planning a home birth. recent headlines have said they can no longer guarantee an ambulance response so assumed there was a team that dealt with it

@Bells3032 paramedic here. All home births that require hospital transfer use the local ambulance NHS Trust. No ambulance on stand by, no extra ambulances put on by hospital "just in case". There aren't even enough ambulances or paramedics to deal with 999 emergencies, especially now!

@thingymaboob

Do midwives ever do the transfer in their car? Or is it always an ambulance?

my mistake. however, the point about lack of ambulances still stands as you may not be able to get emergency care esp if you're due in the not to distant future or when there's a covid surge

If the midwives have already arrived, they stay with you so they would take you to "their" hospital (in an ambulance which they would call). Midwives can't turn up at a random hospital where they don't work.

Midwives wouldn't transport you in their own car, it would always be an ambulance even if not an emergency situation - there are many reasons why this is such as safeguarding, insurance (what if they crashed the car with you in it!), having equipment available if it did become an emergency situation etc. Etc.

If you are under the home birth team but decide to go to hospital before the midwives get there, you could choose the hospital and go there in your own vehicle.

I'm 18 weeks, due in May, so planning ahead, not changing plans at the last minute 😂

[quote SW1amp]@thingymaboob

Do midwives ever do the transfer in their car? Or is it always an ambulance?[/quote]
Never.

Thanks
I thought that was the case
There was a home birth discussion on a local forum recently, with a mum saying she was now leaning towards a hospital birth because of the ambulance shortage, and another mum replied to say not to worry because if any ambulance is running late for any reason, the midwife will just drive you in their car

It sounded very very unlikely but wanted to check

@DockOTheBay thank you, that's very useful.

Do you know what the deal is if you're transferring to hospital but it's not an emergency, e.g. labour is slow so you could safely stay at home, but you're too tired. Or you're not coping with pain so want to go in?

I feel like in an emergency I wouldn't care where I go, but in other circumstances I might!

I transferred in with my first, I was 9cm, tired and vomiting. The midwife asked if we were happy to drive ourselves (obviously DH did the driving) so off we toddled

Depending on your area you might also have a 3rd option of community midwives for your home birth instead of the hospitals home birth teams so might be worth asking your midwife - you would (i think) then be able to register under your preferred hospital and have your community midwives for the home birth.

Tbh I’ve found mumsnet hasn’t been great with home birth questions - when I posted about mine I was told an ambulance wouldn’t get to me before I bled out and much doom mongering about the ambulance issues. Although you won’t have an ambulance on standby in an emergency (they don’t work like that) if something happened you would be a priority 1.

There is a Facebook group called Home Birth Uk which I’ve found really helpful and supportive.

I had a successful home birth 3 weeks ago so although some areas have cut support for HBs they are still running in some areas and it’s a constantly changing landscape at the moment.

I transferred in with my first. We didn’t have a car, but that was the midwife’s first suggestion for getting in - as we didn’t have a car she called an ambulance, & she followed in her car.

Didn’t transfer for 2nd or 3rd

@SW1amp

Thanks I thought that was the case There was a home birth discussion on a local forum recently, with a mum saying she was now leaning towards a hospital birth because of the ambulance shortage, and another mum replied to say not to worry because if any ambulance is running late for any reason, the midwife will just drive you in their car

It sounded very very unlikely but wanted to check

Not only unlikely but also it doesn’t make sense for her to think that that would make it ok. Some ambulance transfers aren’t serious emergencies (could just be the mother changing her mind I guess?), but I haemorrhaged after my home birth and the paramedics carried a drug that stopped it. I was still transferred to hospital but the bleeding had stopped and they were able to turn off my fluids as my blood pressure had come back up before we even left home. Paramedics do more than just transport you, and therefore a midwife’s car is not a substitute. The midwives had put in a cannula and were giving me fluids (I think, bit fuzzy on details but they definitely did the cannula and someone gave me fluids), but they didn’t carry the drug the paramedics gave me as soon as they arrived. The woman you’re talking about thinks I’d have been carried half conscious to a midwife’s car? And that that would have been totally fine?

@Panda368

Depending on your area you might also have a 3rd option of community midwives for your home birth instead of the hospitals home birth teams so might be worth asking your midwife - you would (i think) then be able to register under your preferred hospital and have your community midwives for the home birth.

Tbh I’ve found mumsnet hasn’t been great with home birth questions - when I posted about mine I was told an ambulance wouldn’t get to me before I bled out and much doom mongering about the ambulance issues. Although you won’t have an ambulance on standby in an emergency (they don’t work like that) if something happened you would be a priority 1.

There is a Facebook group called Home Birth Uk which I’ve found really helpful and supportive.

I had a successful home birth 3 weeks ago so although some areas have cut support for HBs they are still running in some areas and it’s a constantly changing landscape at the moment.

Thank you! In my area home births have continued rising year on year incl through the pandemic, so they're definitely still a thing here.

I will join the FB group and chat to my midwife, thank you.

And congrats on your successful birth!

@SickAndTiredAgain

Yes, it seems insane to assume a hatchback could be any safe substitute for an ambulance in a blue light situation
Especially with London traffic..!

@DistrictCommissioner thank you, that's good to know!

It’s a while since I was clued up on HB stats, but IIRC the majority of 1st time mums who transfer to hospital do so for pain relief, not because of a life threatening emergency. I transferred after 24 hours because I was exhausted & labour was stalling, it wasn’t an emergency that required an ambulance.

[quote SweetPeaGirl]@DockOTheBay thank you, that's very useful.

Do you know what the deal is if you're transferring to hospital but it's not an emergency, e.g. labour is slow so you could safely stay at home, but you're too tired. Or you're not coping with pain so want to go in?

I feel like in an emergency I wouldn't care where I go, but in other circumstances I might![/quote]
They would still want to take you to their "home" hospital. Once those midwives are with you, they and their team are responsible for your care so I don't think you would be able to transfer to another hospital in the middle - but maybe you could ask the home birth team about that?

(Conversely my 2nd came so quickly that the 2nd midwife didn’t get to our home in time!)