Could be refused home birth

[xxembobxx]

Had my booking in appt at hospital and I enquired about home birth. The MW seemed to think I'm not a good candidate for one
My 2nd child was born at home (it was very quick!) and I retained placenta afterwards and haemorrhaged so had to have a D&C.
So the MW thinks because of this I'm at risk of it happening again.
But I have 4 children and only 1 has it happened to. I believe it was due to the fact I pushed before I should have (nobody there to tell me to wait until fully dilated) so I think the chances of it happening again are slim.
The MW also said because it'll be my 5th labour I have a higher risk of bleeding due to my womb being overworked

Does anybody know if I can insist on a home birth and if multiple pregnancies can result in greater bleeding after birth?

 

[Nikki_d72]

I'm not sure on the multiple pregnancy thing, someone more knowledgable than me will be on soon, no doubt to tell you that one, but it sounds a bit suss to me. With the retained placenta, did you have a physiological 3rd stage, or managed, do you know?

How did the births go with your 3rd and 4th children, any problems and were you able to birth at home then?

 

[indigo_fairy]

Like Nikki_d72 I'm not sure on the part about higher risk of bleeding the more pregnancies etc... but I do know you can absolutely insist on birthing at home if you want. As you said you've had 4 children, and had this issue with only 1, so I personally think they might be being a little over cautious. I would do a bit of research and then make your decision, especially if your 3rd and 4th were straight forward too

 

[chuck]

Yes you can insist on a homebirth, it your right to birth where ever you choose and be attended by trained MW's.

 

[Mervs Mum]

Yep what they ladies said - you can't be refused a home birth and what you are describing isn't that unusual especially with a managed 3rd stage.

Where about are you in W Yorkshire? There are some fab home birth support groups up here attended by independent mws who you can ask questions and other parents having or who have had home births.

Eta we've even got free loan birth pools!

 

[xxembobxx]

Mervs mum: I'm in Wetherby so am on the outskirts of Leeds and closer to Harrogate hospital. I'd love any info you could give me about getting in touch with people who have been through or support home births.

Nikki_d72: No idea about the 3rd stage - I had LO at home as I woke up to my waters breaking due to the pressure of the baby coming! The MW arrived in time for the placenta coming out and it was when I kept bleeding they took me to hospital to remove what had been retained inside. It's all a bit fuzzy as I was in shock from having her at home but I don't remember getting the jab they normally give you at hospital

I've never had a home birth before but as I don't have pain relief and I have had straight forward, quick labours I thought I would be ideal for one. Only complications were the cord always seems to be around the baby's neck (every time!) and so I have to hold off pushing while the MW sorts it out. I kinda expect it to happen now and it's always been sorted pretty quickly.

 

[xxembobxx]

I personally think they might be being a little over cautious. I would do a bit of research and then make your decision

I have to speak to my local MW yet so will see if she is supportive. Cross my fingers!

 

[Mervs Mum]

I bet you had a managed 3rd stage with an unplanned home birth hun. That'll be why it was retained. x

 

[Nikki_d72]

Can you get your notes from that birth, or ask the midwife to look at them and see if you got the injection? Retained placenta is more common with it as Merv's Mum says. If that's the reason then it should be easy to argue your case. Like the other ladies said they are not allowed to refuse you anyway but it would be nice if they could be supportive. The nuchal cord can be dealt with as before, at home makes no difference.

Best of luck & don't let them fob you off with excuses! xx

 

[Bournefree]

Check NICE guidelines
https://www.nice.org.uk/nicemedia/live/11837/36280/36280.pdf

Your MW to a certain extent is following these, though she has over stated the number of births you have had as a concern as the guidelines are for 6 or more - your uterus is a pro! (See page 15 - Table 4 Other factors indicating individual assessment when planning place of birth: para 6 or more)

She is right to suggest that your Obst history is recommended to be assesed by an Obst for a previous retained placenta and PPHeamorage. However these are circumstances specific to your previous birth, and are very unlikey to occur again. (see page 14 - Table 2 Other factors indicating increased risk suggesting planned birth at an obstetric unit)

It is YOUR decision - and personally I don't think that you have to feel all is lost in planning your home birth because of these guidelines, far from it. They are there so you can consder them, discuss them and how they effect your current pregnancy and birth.. NOT to coerce you into hospital.
Xxx

 

[hes109]

I have been told that I can't have a home birth because my BMI is not in the ideal weight range and therefore I am at greater risk of complications during pregnancy. I have made the decision that provided I have a healthy pregnancy, I will give birth at home.
Because of the lack of support shown to me by the midwives (I live in Harrogate), I have done a lot of research on home births and even read an excellent book called Home Birth - A Practical Guide by Nicky Wesson (published Jan 2011). Whether a midwife attends your birth appears to be a grey area as although the Midwife's Act states every woman has a legal right to a midwife to attend the birth, it excludes the word 'domiciliary' which covers birthing at home. Having said that it is also not recognised as correct and safe practice to be allowed to give birth without the care of someone from the medical profession.
In my case I feel the key to getting the support for the home birth I desire is about how I put my case across to the midwives, and this is possibly the case for most other expectant mothers with the same desires. For example if you have a higher BMI, you're told you're at an increased risk of induction, c-section, post birth haemorrhage etc etc. However, having a home birth does decrease these risks. It is also about accepting that if something was to go wrong during a home birth, you have an adequate plan for transferring to hospital. I'm probably saying this a bit 'loosely' but every pregnancy is at risk of having complications, even in the most healthiest of women with the most straight forward of pregnancies and most of the risks quoted could just be down to coincidence. It is also worth noting that because home births are a lot rarer these days, many midwives don't have the confidence to attend a home birth therefore that could be the factor affecting your midwife's support for your birth choice.
Another thing to think about is that evidence shows that when women attend hospital when at a certain stage of labour this slows labour down greatly as does all the medical intervention such as IV access, stress, internal examinations, in bed monitoring etc. This is what leads to greater need for a c-section, instrumental delivery and an episiotomy.
As this is my first reply on this forum, I am unable to put up links but here's a few places to find help:
The leeds homebirth support group has a facebook page.
The NCT has an excellent section on home births.
The Association for Improvements to Maternity Services has a good website as does the home birth website.
If you google search for 'daily mail home births' you get a lot of articles that look at both aspects of home birth allowing you to weigh up pros and cons. Do remember though that in the cons, they don't mention the flaws in the research quoted or other factors which may affect the results.

Hope some of this info helps. You really must stick with your choice and consider reading Nicky Wesson's book - fantastic advice and lots of home birth stories inc high risk pregnancies.

Best of luck with everything.

Hannah x

 

[xxembobxx]

Hope some of this info helps.
Hannah x

It really does, thank you Everyone on here has been so supportive and informative.
Do you think Harrogate is more weighted towards medical birth as opposed to natural? I had my LO at Harrogate last year and it was mostly ok but then I didn't have any preferences apart from I didn't want any drugs (not even G&A). I was a bit miffed I had to lay on the bed to give birth when I had assumed a kneeling position which was far more comfortable.
It's my 5th (and last!) child so I really want a relaxed birth in any position I find comfortable. Not finding the MW's at Harrogate to be too supportive but my community MW seemed quite positive although we won't be discussing it in depth until my 28wk appt.
I shall use my time wisely in gleaning as much info as I can

 

[irish_cob]

My BMI was 38 ish pre pregnancy and is now 41 or 42 depending on whether MW uses her computer or cardboard wheel thingy, and I'm going for a homebirth. They can advise all they want, but they can't force you into hospital. My pregnancy has been totally straightforward, no bleeding, blood pressure fine, all blood results good, both scans fine, there's nothing I can do about my weight at this stage anyway, plus it's normal for me, I've always been big ever since I was a teenager, I'm never going to be a BMI of 20-25, I'd look ridiculous!

 

[hes109]

Sorry for late reply!

I do think Harrogate is very much weighted towards medical births and it's so scary. Obviously I'm not dismissing the need for medical intervention where the situation requires it. But in a straightforward pregnancy with no anticipated problems for birth, why should this be medicalised? It's a normal physiological process which our bodies go through! I just find it hard to understand all the restrictions imposed on pregnant women who have been assessed as high risk as most of those restrictions are proven to lead to complications.

I have had a few appointments with the MW at the hospital and in the community and haven't found any of them supportive towards my decision of a home birth. I recently had a 23 week appointment with the consultant who said that providing all goes well in pregnancy then there is no reason why I can't have a home birth. This was also supported by the aneasthetist. However, the community midwife isn't convinced and told me we wouldn't discuss it again until I was 36 weeks! Obviously if I'm panning a home birth I need to make preparations pre 36 weeks so I will do.

Whatever anyone tells you, just remember it's your baby, you've done this before and so long as you can justify to yourself why you've chosen to give birth your way, then why should someone else tell you different. Every birth is different and if you start birthing at home and encounter a problem then you can transfer to hospital.

I know you've done this before but if I can help in anyway with info to support you having a home birth then just ask. I feel like I've read every book and article going!

Best of luck, Hannah x

 

[xxembobxx]

I have had a few appointments with the MW at the hospital and in the community and haven't found any of them supportive towards my decision of a home birth. I recently had a 23 week appointment with the consultant who said that providing all goes well in pregnancy then there is no reason why I can't have a home birth.

My consultant was the only positive one! I found out at last appt I am under consultant care as last LO was low birth weight (5lbs12oz) although it was never expressed as a concern at the time and he soon jumped up the percentiles to be regularly on the 95th!
I haven't seen my community MW as I am seeing the consultant with a couple of growth scans along the way. I don't foresee any problems but it would be nice to be able to get a positive agreement towards having a home birth early on and some info on how it will be handled. I think it's just the constant assumption that a woman will go to hospital to give birth

 

[zoe4eva]

Read the AIMS website, put into google...legalities of a home birth. The aims link will come up. It tells you all the legal side of it and even gives you examples of letters to send to the appropriate people. They can't refuse you a home birth, they can only advise. If you give prior warning to the head of midwives at your care unit then they have to supply you with adequate care when giving birth, to not do so would be putting them at a legal downfall and should anything happen (god forbid) they could be held accountable.
You may get to 37 weeks and they think you won't put up a fight so will then tell you that they are 'short staffed' and you can simply respond 'I have given prior warning and that should be enough, I will not change my plans due to your "staff shortages"'
AIMS also gives you all the contacts you could possibly need to take it higher. But let's not hope it comes to that.
I'm having a home birth after a c-section, but I have managed 3 naturals since the section and have managed to pursuade (sp?) my consultant that a home birth is now my only wish for my last pregnancy. So YAY!

 

[xxembobxx]

a home birth is now my only wish for my last pregnancy. So YAY!

That's exactly the same as me. 5th (and last) baby and I really want a home birth as I don't feel hospital can offer me anything better.
Thank you for the AIMS info. I have been looking up a lot of info (as most HB wannabes do) but it's just the fact that HB is never really offered as an option and I feel I have to keep mentioning it at appts, almost asking for permission!

 

[hes109]

Read the AIMS website, put into google...legalities of a home birth. The aims link will come up. It tells you all the legal side of it and even gives you examples of letters to send to the appropriate people. They can't refuse you a home birth, they can only advise. If you give prior warning to the head of midwives at your care unit then they have to supply you with adequate care when giving birth, to not do so would be putting them at a legal downfall and should anything happen (god forbid) they could be held accountable.

This is really good advice but actually NHS midwives can refuse to come out to a home birth as the relevant act that covers birth says that midwives have a duty to provide maternity care which they will say they are offering in hospital 24/7. I think it's really rare but I have heard of women in labour who have had their midwife refuse to come out and in their case they either transferred to hospital or used an independent midwife as an 'emergency' as some of them offer this service. Obviously if you've not booked with an independent midwife they may have to or be attending their own clients but practices with more than 1 midwife will have more flexibility.

I also really believe in writing a letter of intent to your local midwifery service advising them of your wish to have a home birth and you have a paper record of your wishes. They may have a standard response that they can't guarantee this but you just have to keep calm. When you're in labour and call the midwife to come out its best to have your supporter call them and to not engage in a discussion or compromise about going into hospital and simply state that you've booked a home birth and you would like them there and you'll see them soon! Just don't let them persuade you otherwise and yes, they staffing shortages are not your problem!

embob - if you're local to Harrogate then you will find the Harrogate home birth support group fantastic help. It's the 3rd Sunday of each month and there's a variety of people there with a mass of support. To enquire just google harrogate home birth support group and the lady that organises it is called Jen. I do know her email address but as I've not posted here many times the rules won't let me put email addresses or links on posts yet!

A good book I've just read is called Gentle Birth Method by Sarah Buckley - amazing and inspiring read from a doctor who has had 4 home births.