What about staffing shortages?
Women planning a home birth are sometimes told that the local health authority may not be able to provide a midwife on the day, because of staffing problems. If you hold out for a home birth in these circumstances, you may feel guilty that you would be taking midwives away from other women who need them on the labour ward. This is an understandable concern, but it is important to remember that staffing levels are the health authority's responsibility, not yours. You may sympathise with their problems, but remember that where there's a will, there's a way. Trusts which are fully supportive of home birth find a way around this problem; so can yours.
While sympathising with the health authority's staffing problems, you can ask what they are doing to resolve their staffing problems. Advertising vacancies is insufficient - perhaps providing their midwives with more autonomy and job satisfaction, for example with the opportunity to attend births at home, would improve their retention of midwives.
If women are persuaded to abandon their home birth plans on the grounds of staff shortages, the health authority will have no incentive to improve its services for other women - so by holding out for a home birth you are helping to improve choice in your area, and helping to make midwives' jobs more interesting - and you are also saving money for the NHS (see below).
Every health authority has access to what are called 'bank midwives', and most use them regularly when they have staffing problems in the hospital. These are midwives who work on a temporary basis, sometimes for just one shift at a time (a bit like supply teachers). Some will be midwives who are employed by the same health authority, who are taking on extra work - doing overtime - and others will be midwives who want to work part-time but who have not obtained a permanent part-time job, or midwives who are currently taking a career break to look after their own children, but will work occasional shifts, or semi-retired midwives. All 'bank midwives' are all fully-qualified midwives. If there was a genuine shortage of midwives on the labour ward then the health authority should always be able to arrange cover on the ward from a bank midwife, thus freeing up a community midwife to attend home births.
In some areas, independent midwives work as 'bank midwives' when they are not needed by their own clients. On occasion, independent midwives have attended home births on behalf of health authorities who could not arrange cover from their own employees. Sometimes such arrangements are made in advance - when people talk of arranging an 'extra-contractual referral' to an independent midwife, they mean that an independent midwife would be booked to attend you, but would be paid directly by the health authority.
See 'Home Birth Bullying' from AIMS for suggestions on dealing with this situation, and also 'Home Birth Alert' for a sample letter to send to your health authority. If you still have difficulty in arranging your home birth, please contact Beverley Beech of AIMS - she is very experienced in supporting women in this situation, and would far rather that people contacted her, than fought on alone.
What if you phone when you are in labour, and are told no midwives are available?
Many homebirth advocates feel that it is still important to stand your ground in this situation. If the labour ward is really this busy, is it a safe place for you to labour? You do not need to feel guilty about making the labour ward manager's job harder; while she may have a tough job, you are having a baby. She has ward crises every week and, by next week, will have forgotten that you ever existed. You, on the other hand, will remember this baby's birth for the rest of your life.
To the best of my knowledge, and from discussions on the Homebirth UK email group, in every case where a mother has insisted that she is staying at home and that she expects a midwife to be sent, a midwife has indeed been sent out. It is important to make clear that you will not accept a paramedic, nor will you accept transfer to hospital in an ambulance if one is sent out.
Here is some advice from Shawn Walker of the Norwich Home Birth group:
Over the past three years, we have seen this a lot among our group in Norwich / Norfolk. Here's what we recommend if it may happen to you:
Have someone with you who is not your partner or mother or other close, emotionally involved person. This person should have ideally had a successful homebirth herself and at a minimum be entirely supportive of your plans to do so, comfortable advocating for you in a situation where you are being told that there will be no midwife sent, and able to be calm in such a situation.
Prepare your supporter by practicing the 'broken record' technique with her. No matter what they say, your supporter should keep replying that you are going to give birth at home and are expecting a midwife to be sent. When they say they definitely won't send one, she should keep playing the record -- 'Clare is going to give birth at home and we look forward to seeing a midwife.' Needless to say, you should not be involved in this exchange -- you have enough to do! And we recommend that someone other than your partner be the spokesperson, so that your partner can concentrate on you. At no time should your advocate say, 'Okay' or 'I understand' or try to reason with the person on the phone. Just keep playing the record.
Don't think of it as preparing yourself for a fight; think of it as preparing not to fight by being clear about your position and having support to keep strong in that position.
My doula colleague and I have been successful with this technique many times, even when they are absolutely insisting they will not send someone. The only time it wasn't successful was when a close family member did the advocating -- and that person was very concerned about there not being a midwife. None of the couples who chose not to have another supporter with them chose to stay at home when told they had to come to hospital. When you think about it, that's a lot of pressure for a dad-to-be to be under in such a situation.
