Choosing where to give birth

[Chasingbaby2]

Looking for some wisdom and advice please.
Due my second mid March, first was a planned amazing homebirth and I'd love the same this time but had a few curveballs this time and not feeling so confident.
First was a breeze (pg and birth) this time I've had low papp a, hypothyroidism and am having regular growth scans for those reasons. 31 week scan showed baby on 25th centile and high cord PI. Im aware that may or may not lead to further issues, next growth scan in 2 weeks hopefully will give good news.
In the meantime I've been exploring hospital options just to prepare myself but been told that having had a levothyroxine dose decrease in the third tri, the birthing suite is now not an option. This has added massively to my anxiety that I already feel about the hospital.

I'm swinging between wanting reassurance constantly and wanting to decline all of it honestly. I have no faith in consultant lead care, mine works half a day a week! I guess I'm anticipating resistance to home birth and looking for some perspective. Is there any point challenging the birth suite decision? How reckless would it be to stay at home and stand my ground?

My main reservation about a home birth is the ambulance response times at the moment, do consider that.

I'm not sure they are the same as general response times though, I've always understood that midwives call straight through it's not the same as ringing 999. It's not a huge worry in my mind as I can see the hospital from my house. I will ask my midwife about this though, thankyou

I think you're a bit naïve if you believe that. There's a limit to the no of ambulances. if a midwife calls it's not going to magically conjure an ambulance if they're all out on jobs then they are all out. People dying is usually more important than someone going against medical advice to be at home.

Honestly you sound high risk and they are advising you to be on the birthing suite. if they say they won't provide midwives or are having a shortage of them (some places aren't offering anymore due to shortages) then are you prepared to freebirth alone?

Eerm thanks but that's not what I'm suggesting at all. If I have support to be at home I will be, if not I will go in. The birthing suite have different criteria. Bit harsh tbh forgot what a shark put mumsnet can be. If you can't say anything helpful probably best to keep your opinions to yourself.

Could any of the issues they have identified impact the birth itself, or is it that they think you/the baby are more likely to need care afterwards? That’s the thing you need to work out and then make your decision from there.

I have hypothyroidism and my thyroxine dose shifted throughout pregnancy (as is normal) - no one ever suggested that would affect my birth choices.

That's a very good point, thankyou. Potential growth issues (nothing identified yet, just monitoring) could result in advice for monitoring or early delivery. So it would be a case of assessing that advice if it comes, and practically either would require labour ward if I decide to accept them.
Hypothyroidism with a recent dose change is a refusal criteria for the adjacent birthing suite in my trust at least, I know they all have different rules. That one seems a bit sketchy to me as there's no specific risk pointed out and I could still have a homebirth so it doesn't make allot of sense. I've also looked up the criteria and it actually says "hypothyroidism where an increase in treatment is required in third trimester". Mine was a reduction, and barely out of range anyway so I'd argue it's still well controlled. Just got unlucky that I was tested 1 week into the 3rd tri. I might challenge that one and see what the actual basis is.

@Chasingbaby2 that thyroxine thing is a joke. It’s normal and expected for your need for thyroxine to increase early in pregnancy and then reduce as the baby produces its own thyroxine. It happened to me every time.

Insufficient thyroxine can affect the baby’s growth, but it’s still unclear why they are saying this means you couldn’t give birth in the birth centre. You should definitely push them on this, and if it’s a blanket policy based on the fact that you are no longer “low risk” simply because you have seen a consultant due to your thyroxine dosage, I would really push back and probably opt for home birth.

Thankyou this was my feeling too, I've got a call with the consultant midwife next week to talk about it so I will definitely challenge it. Ultimately my heart is with homebirth and so I think if some issue comes up that means we need to get baby out that would be Labour ward by default. I'm OK with that as it would be informed decision (I'd be asking all the questions as I'm very against unnecessary intervention) But I will cross that bridge if it comes. Blanket 'no' to the birthing suite without good reason has pissed me off, I wanted the option available.

OP, I have no knowledge of the specific conditions that relate to your pregnancy, but as someone who was also fiercely anti intervention unless absolutely necessary, confident of my own body and ability to manage the feelings of contractions, and a fear of hospital and being ‘out of control’ that I felt I would be more relaxed and progress better at home, I do understand your position.

The thing is, you are an experienced Mum now, you know you can labour and deliver your baby with confidence, which enables you to advocate much more effectively for yourself if you do need / choose to be in hospital.

I would have felt much more relaxed contemplating a hospital birth for my second than my first.

Thankyou, that makes sense too and a big confidence boost. A big part of the hospital anxiety and feeling out of control comes from being hearing impaired. Normally I'm a super confident person and it doesn't affect me otherwise but the hospital is so hard for me to hear and communicate. Countless complaints, even from my amazing midwife have come to nothing. So I have to weigh up the impact of that anxiety to the birth too. I'm sure I'd have been flagged for high pressure by now if they only had my hospital readings to go by, the ones from my home visits are so much lower.

Do see if the consultant midwife will make an exemption to allow you to use the birthing suite. (Assuming that's something you want / would prefer to a home birth). In my trust they do this all the time for borderline cases; the "guidelines" are not binding and are up for discussion of individual cases. Perhaps this is true for your trust also, but the community midwives don't all know it?

Agree re: Mumsnet being harsh.

I'm going to ask them to reconsider, thankyou.

Just an update, we did get cleared for the birthing suite, there was a discrepancy in the criteria which they agreed was unfair
I did have an induction on labour ward in the end for other reasons but it was fab.
I had a homebirth midwife look after me in the hospital. She left me to it largely, other than breaking my waters. Brilliant unmedicated birth and physiological third stage.

Lovely update: congratulations.

Congratulations, best wishes for you and baby. I’m glad to hear you had a positive experience in the hospital and it’s really nice of you to come back and take the time to share that. Enjoy the baby snuggles 🥰