Too short-staffed to support a home-birth. WWYD?

[blinder]

Well I'm 36 weeks pregnant, looking forward to a home-birth, and I've bought my lovely pool-in-a-box! But my local midwifery unit says they are unlikely to have enough staff on the day that I go into labour. They say I will probably need to go in to the birthing centre.

I REALLY would prefer not to have to do this for lots of reasons (although it goes without saying that if I needed medical care I would obviously gladly accept it).

So I have a meeting on Tuesday with the head of practice to talk about it.

Should I insist? Beg? Write to my local paper? MP? I don't want to be any trouble but I know a home-birth is best for me and my baby (assuming a normal labour ).

What would you say / do?

I think current guidance is saying possibility of restricting homebirths because of swine flu and issues of understaffing. Maybe find out reasons for understaffing- ie. if its incompetent management or something then push for your right to a home birth but if it is something like swine flu then maybe its trieckier because its not their fault either they are understaffed. Tricky one.

this may be of help

also this

and this page

Hi Blinder,

I am in exactly the same boat as you - would love my planned homebirth but have been warned that on B-Day there just may not be enough midwives available. So I will have to travel 1 hour to birthing centre or 1 hour to hospital down winding lanes... I am NOT looking forward to that at all!

TBH I have rolled over on this as it seems to be something that I can't force and just have to pray that it will work out for the best.

Originally I would have meekly gone to hospital if HB not possible but I rethought this a couple of weeks ago and now am referred to the midwife-led centre so I can go there if necessary (anything to avoid hospital really!)

I don't know what advice to give you, I just wanted you to know there were others out there in your shoes!

I am 36 weeks too - what date is your baby due? Mine is 9/9/09!

Write a stern letter to the Chief Exec of the Trust and to the Director of Midwifery / Obstetrics and Gynaecology, CC it to the HOM and your consultant if you have one.

Tell them that you intend to labour and give birth at home (barring medical complications) and that you have given them enough time to sort out their staffing issues - swine flu or no swine flu.

Swine flu is an additional reason to stay home and birth. Lessen the amount of people you and your baby will come into contact with therefore reducing transmission of illnesses.

I have a stonking letter I wrote to my Trust, using the AIMS letter as a template and expanding on it. Let me know if you'd like to see it.

Having looked at those links posted by NorthernLurker and pseudoname's post I think I might just get a bit more serious about this...

I discussed home birth at my booking in appointment and have continued to talk about it at every subsequent appointment since.

I live in a rural community 1 hour from hospital/birthing centre.

I know my baby and I would be better off at home (medical complications besides)

Hmmm I think I better get letter writing!

Thanks Blinder for this thread - you have found my backbone for me!

Good luck ladies

I had hospital births and was very happy with that. That's the point though - it's your choice and nobody else should be trying to make it - specially not by saying they don't have the staff. That's bad management and not putting the patient first and it will not stand scrutiny.

I'd urge you all to do something. Write, in any way or any tone you like. But make your wishes known.

When a unit is trying to demand extra staff, they need evidence. Your letters are effective evidence that the stakeholders and service users are unable to meet local provision.

The matrons can plea for staff all they like, but if the statistical model works out they need x, and they have x, then nothing will happen. If the statistical model is not meeting the local needs of the communities, as evidenced by complaints 1, 2 and 3 - suddenly there is a little light at the end of the tunnel.

How we, as mums, have to fight for basic things, like a bit of midwifery support, is exactly how the managers have to fight for every last £. Funding is allocated in a complex way, and the services need all the help they can get to give you what you ask for.

If you mention a homebirth, are told no staff, and nothing is recorded at management level, then nothing happens. No one notices. The problem doesn't ripple to the DoH - where it needs to.

They have known long enough that you are booked for a homebirth! It is up to them to arrange cover, their staffing issues are not your problem.

On the day if, after all your letters etc, you call and say you are in labour and require a midwife make sure that dh keeps up the broken record routine that you are labouring, have booked a home birth and require a midwife. Each time they say "but..." he just repeats his statement but better still just put the phone down after he's said it the first time.

If you or DH are speaking to a midwife who is saying that no-one can come then ask for her name and PIN number.

Thandeka - the staffing issue is just because they have a few of the team off sick at the moment. I suspect this may be due to morale. The atmosphere in the unit is manic all the time and they claim to be too busy to do even routine things at the moment. This is one reason why I don't want to go into the unit. I have never been in such a stressed environment!

NorthernLurker - wonderful links. Thank you!

Alibean - 04/09! I'm annoyed for you too! Making you travel for an hour in labour is awful, and a risk IMO. I go back and fore between wanting to sort it out, and just hoping too. I don't feel like I need a quarrel with my midwives or the stress of fighting my corner at this stage in the pregnancy. One of NL's links suggest that this is why they let us down now, because most women will just put up with it when they are heavily pregnant!

pseudoname - you're a great motivator! I'd LOVE to see your letter, thanks! Should I turn CAT on?

Thanks also Treedelivery and Klaw.

Right - I'm getting letter-writing tonight dammit.

yes, or just CAT me your email addy and I will send you my letter. I actually wrote two. the first one was a stroppy one telling them to give me a new MW because the first one lied about HBs and then spent another 20 mins trying to dissuade me from booking one. cow.

Blinder - the thing to do is to distance yourself from it.
Enter into and stay in your pregnancy happy karma buble.

You are decided on a home birth, you are writing a letter in calm and clear tones to outline that. You will look forward to seeing a midwife when your labour is established, with a second on call ready for your delivery. You will of course be agreeable to any move suggested on the grounds of medical evidence, and would in those circumstances look forward to meeting a team of health professionals on the delivery suite.

There really isn't anything they can counter - a midwife is required by law to attend you.
The fight is fruitless and will just stress you. Just tell them what you need and let them know you will recieve it. They can fight all they like behind the scenes to give you the care you want. You don't need to even know about it.

ok, that's reassuring advice.

So, this meeting that I am supposed to book with the practice manager - all I need to say is that I will be birthing at home and wanted to let her know. I can also give her a copy of the letter that I am sending to the Trust and the Head of Midwifery.

I'm not there to negotiate or listen to their staffing issues - just to let her know that I won't be coming in. Should take about 5 mins.

That's right, yes?

Pretty much!

What can you do about their staffing issues?

What could you do about them if you were in a delivery room?

Or needed a crash section?

This is my take on it anyway, and lots of people seem to be having home births without needing meetings or advertising for midwives themsolves, so why should you be different?

But I am an idealist, thats why I used to come home from work in such foul moods

but what can you do if they are short of staff on the day?

I would write the letter anyway as obviously staffing matters should be brought to the attention of those responsible for that

but I wouldn't get your hopes up just in case they can't do it - I mean if there just aren't enough midwives to have one sent out to you, you'll have to go in surely

How is the service set up for homebirths?

Why do they think that there will not be enough midwives on the day?

In my area the community midwives go on call for planned homebirths from 38 weeks.

There is no on-call midwifery service prior to 38 weeks or for unplanned homebirths. A paramedic would be sent out to bring the woman to hospital. The hospital would not send a midewife out as it is not staffed for that.

In the OP pos though, a homebirth has been requested from the outset. That should be facilitated.

Homebirths will go by the wayside though if there is a shortage of midwives due to swineflu - ie the midwives being ill.

I delivered mine to the hospital because I was going there anyway and gave them to my consultant and asked him to put it in the internal post.

I realise now that I should have posted them by Recorded Mail.

You don't have to have a meeting with a Practice Manager to discuss it. This is not something they are 'allowing' you to have. It is your right.

If however you still feel like going to the meeting, take along a supportive friend so that you have someone who can listen on your behalf and can back up what transpired. If at any time you are uncomfortable with the conversation you are well within your right to stop it and leave. Subtle power play creep in during these meetings and you will on no acct be the person who will have the upper hand.

Just saw you CAT come in so will receive something shortly.

If anyone else would like my letter, don't be shy. Just let me know.

"Homebirths will go by the wayside though if there is a shortage of midwives due to swineflu - ie the midwives being ill. "

Mears, are you saying that they will not call in bank midwives is they are short staffed due to illness? What about hiring independent midwives to cover the gap?

Well, one MW is off with a broken ankle, one is off on long-term sick and won't be replaced (all the midwives seem pretty pissed off with this) and I'm not sure why there are so many others off.

Although, as I say, the atmosphere seems very hectic and pressured so I wouldn't mind betting the reason is stess!

At any rate, only 5 out of 9 midwives are available apparently, and what with annual leave, not even all of those are able to be called. My 36 week check was done by a midwife from a nearby hospital, and usually works with the high-risk team. She said I should make a bit of a fuss.

I know it's not their fault btw, but I want to do what is best for me and the LO of course.

i wonder - if you need a midwife when you labour anyway - how can they say they are too short staffed?

you will need a midwife wherever you are!

my recomendation: make sure you have a good well-briefed birthing partner to look after you whatever happens

in the end, how can they possibly know? you might give birth anywhere from 37-42+ weeks FFS!

blinder - I would insist on speaking to the LSAMO for you area - she will support you

LSAMO

pseudoname - what I am referring to is a pandemic outbreak which is expected Autumn- Winter. If we have major staff sickness, then care will be prioritised. Homebirths will not be offered or supported is there is a staffing crisis.

Hiring IM will not be an option via NHS

Mears - they all seem very supportive of home-birth in theory and I was offered a home-birth in my original assessment at 8 weeks. It's only lately that they are saying otherwise, and only because (I think) they would have to get approval from higher up to hire extra staff. I think it's purely a funding problem.

fingers crossed foryou wiht you your home birth dont give up, push for it as much as you can - i really really hope you get one..

BUT if you dont .. i wanted a
home birth and for all sorts of reasons didnt get one, and for a few weeks i was gutted. looking back now the way the baby comes out IS totally irrelevant in the grander scheme of things....