Disappointed after homebirth mw appt

[Mum2MJ]

After a lot of to-ing & fro-ing as to whether community mw's at my chosen hospital would cover my area... (they do) I had a risk assessment carried out last night and I kind of feel a bit disappointed by it all.
Firstly I'm so glad I'd researched everything so knew what I was talking about as the way the mw's speak, if you didn't know your rights you would assume that what they say is non-negotiable. Most of what we discussed was fine but can I have some personal opinions from you lovely ladies, on what I've been told?

>I won't meet the mw's or have any of my appts with the community mw's before my birth which I'm really disappointed by. Antenatal appts are either by the hosp or GP

>Homebirth only from 37 weeks and not delivering at home past 41+6

>No homebirth if waters break >24hrs and labour hasn't started - I did say I thought that was 72 hours and she said you can go into hosp for delivery at 72 hours?!

>Meconiom stained liquor = transfer to hospital - I queried if baby is overdue it's not necessarily because baby is distressed but gut is mature and she said but how would we know? I pointed out if HB was ok and my blood pressure/temp etc was all ok was that not enough and she said no, only continuous monitoring at hosp could detect baby in distress

>BIG BABY!!! - What I wasn't prepared for was this! my DD was 9lb 2oz (didn't think this was too big as was 10 days overdue) and mw said she was concerned about size of this baby and actually wants me to have a scan between 36-38weeks to confirm presentation and weight estimate and if mw on day thinks baby is big they want me to transfer to hosp because of risk of shoulder dystocia (even though this is rare).
DD did get stuck because she turned at the eleventh hour and came out with the front of her head (f-ing hurt that did) but I managed to push her out after 2 &1/2 hours (2nd degree tear but no interventions) but her shoulder's just slipped out after her head! lol And I know many women give birth to bigger babies at home, I just never imagined it would be an issue?


Thanks for reading, any advice appreciated xx

 

[Jenniflower]

>Homebirth only from 37 weeks and not delivering at home past 41+6

It is your right to give birth even after 41+6. With my midwives I had a bit of an issue because they only do on call at 39-40+12. I ended up having to write a letter regarding the 39 to get it changed to 37. They've informed me they won't be on call after the 40+12 but I told them if it comes to me being overdue at 40 weeks then I'll draft up another letter so as to make sure someone will be there. They HAVE to send someone out to you. Here's a great sample letter:

Dear Supervisor of Midwives,

I am expecting a baby, and my due date was ........ I would like to inform you that I am continuing with my plans to give birth at home. I appreciate that your advice is to give birth in hospital post 42 weeks, but I have made an informed decision to decline this offer of hospital admission at present.

I will of course transfer to hospital if my baby's condition, or my own, makes it necessary, but for the time being I would appreciate your continued support of my informed decision.

Many thanks for your help,

Yours....

>No homebirth if waters break >24hrs and labour hasn't started - I did say I thought that was 72 hours and she said you can go into hosp for delivery at 72 hours?!

The guidelines state they can offer induction after 24 hours but NICE guidelines also state that you have 96 hours. There was a great conversation about this somewhere so maybe some of those girls would be better at explaining it. Interestingly in my area they give you 48 hours which I thought was reasonable enough given I always hear of the 24 hour rule. I think just know your rights in regards to this one and if it comes up and you feel fine, baby is still moving, then just demand to be seen at home. You can have everything checked at home just as you would in the hospital. The only difference is they would do Doppler HB checks as opposed to constant. Which really isn't a big deal. What they need to check for is that you don't have an infection.

Here's a great little excerpt from a story of a lady who refused:
Sunday morning, gentle contractions again, and I call Becky to let her know about my waters. On and off contractions, just gentle ones, lots of dribbling and leaking (yuck).... and so it continues throughout Sunday and Monday. In the meantime, I see Becky. Protocol is that I should have a swab to test as my waters have been broken for 48+ hours by now, with no established labour. We discuss & I decline - I have no signs of infections, no other contraindications and I WANT MY HOMEBIRTH. Time goes by... I talk to Becky on the evening of the 13th - I'm in the middle of a really good run of contractions and Becky advises that if things tail off again, I might want to try nipple stimulation.

>Meconiom stained liquor = transfer to hospital - I queried if baby is overdue it's not necessarily because baby is distressed but gut is mature and she said but how would we know? I pointed out if HB was ok and my blood pressure/temp etc was all ok was that not enough and she said no, only continuous monitoring at hosp could detect baby in distress

You're absolutely right in everything you said about this. Of course with most midwives everything is such a blanket statement and they don't have any need to make individual cases, which is really annoying. I've spoken to my midwife that in terms of my waters breaking at home before active labour starts and I see the green poo then yes I'll go in because they weren't there to see it and in truth it does freak me out a bit that they could be awhile and my baby is in distress. On the other hand if I'm at home labouring while the midwives are here and they break while I'm quite far along then it's NOT an immediate reaction to call the ambulance and we will assess it when the time comes. I told her it would be more distressing to be going down to an ambulance while I'm about to push than just waiting and checking baby after they've been born. Does that make sense?

>BIG BABY!!! - What I wasn't prepared for was this! my DD was 9lb 2oz (didn't think this was too big as was 10 days overdue) and mw said she was concerned about size of this baby and actually wants me to have a scan between 36-38weeks to confirm presentation and weight estimate and if mw on day thinks baby is big they want me to transfer to hosp because of risk of shoulder dystocia (even though this is rare).
DD did get stuck because she turned at the eleventh hour and came out with the front of her head (f-ing hurt that did) but I managed to push her out after 2 &1/2 hours (2nd degree tear but no interventions) but her shoulder's just slipped out after her head! lol And I know many women give birth to bigger babies at home, I just never imagined it would be an issue?

I would personally decline the scan. There's no need to have it. Not to mention a lot of time they're wrong, especially when there is Bias behind them. My sister gave birth to a 10lb4oz baby boy so they made her go for a scan as well since she was having another boy and they claimed each boy gets bigger. (Where is that statistic I'm wondering) Anyways she was told he was a biggin too and was told to be induced. He wound up under 8lbs. So yea, decline the scan. Tell them you trust you body. And obviously your body knows how to handle large babies considering you managed your other one out just fine. Even if you did have a SD with your other one there's nothing to say this one would turn out the same, nor would they do anything different at home than they would at the hospital.

Welp! I hope any of that helps. With a lot of those situations just get as much information as you can so that on the day you know the risks and your rights. Here's a great website: https://www.homebirth.org.uk/. On there if you click on the "Can I have a homebirth if..." Link and then search around there you'll find great stories about overdue babies, big babies, and meconium stains.

 

[Mum2MJ]

Many thanks for your reply Jenniflower, I was so excited yesterday and then after she left I felt a little low, feeling better again now though

 

[Jenniflower]

Many thanks for your reply Jenniflower, I was so excited yesterday and then after she left I felt a little low, feeling better again now though

I completely understand that. My midwife has a way of being negative about everything. I've finally learned though she just speaks her thoughts out loud. So I just smile and nod, speak up when I have to and now we have a mutual respect for each other

Just out of curiosity how far along are you?

 

[Mum2MJ]

I'm 31 weeks today, chances are I won't see/speak to that mw again anyway as they have a 'pool' of 30 mw's (any of which I may get allocated when I go into labour and who I won't get to meet beforehand either...)

 

[PeanutBean]

The waters going thing has become my pet issue after my previous experience. The NIE guidelines are indeed 24 hours (for induction and no contractions - I've yet to see any about active labour but no delivery which is what happened to me). It used to be 96 hours but someone on here said I think they changed in 2008 to 24 hours. However, these are guidelines not hospital policy. I have found out just this morning that our hospital is still using 96 hours (begs the question of why I was taken in at 18 with apparently no choice in the matter). So your natural enemy is probably whatever is hospital policy so that should be clarified.

Even if induction is offered at 24 hours it is an OFFER and not an ultimatum. Alongside this offer they should also discuss with you expectant management. You can then choose what you would prefer depending on the issues and your own circumstances. Expectant management is basically monitoring. So checking all the signs for infection (which you can do yourself) like taking your temp. If in labour then this would naturally include monitoring of the baby by the MW. I think off the top of my head checks should be made on a four-hourly basis.

An added dimension is if you are a group B strep carrier. Waters gone for more than 18 hours increases the risk of GBS in the baby. Unless you've been swabbed you won't be offered the test so you won't know. A positive test doesn't really mean anything anyway except between 35-37 weeks as GBS presence is transient. The usual protocol is to be offered intravenous antibiotics at this point which will generally require transfer to hospital (I am undergoing battle about getting them at home if needed).

I hope that helps a bit. I second Jenni on everything else. And the big baby stuff? MWs all thought I was going to have a big baby as I was massive. Turns out it was all water and he was only 6lb12. There was nevertheless no suggestion of needing to go in or be induced based on a hypothetical weight. Palpation and even scans are notoriously bad for estimating weight.

 

[Bournefree]

It never ceases to amaze me what unjoined up thinking sometimes happens within the NHS.. THAT, and the postcode lottery we all go through!

Why is it so different in so many areas!?

A small team of MWs in my area are associated with a small amount of GP surgeries.. so you see them in the community at your G.P's. Unless my MW is sick or on holiday I didn't see my G.P or any other MW for my regular appointments. Plus for a homebirth in my area, whoever is on your team of MWs, who is on call will come to you first.

Though, I have to tell you this funny little story. When my MW was away and I did have to see my G.P for a routine antinatal appointment, he didn't have a clue bless him! I had to get out a couple of guidelines on what he should be doing.. and checked with me, if he had done everything that I usually have done or talk about with my MW! He was great though.. telling me stories of his wife's labour and birth!

It just seems silly that you might not get to meet a MW in the community, untill you are in labour!? Have I got that right?
XxX

 

[Mum2MJ]

Thanks PeanutBean, the ironic thing is, I had a growth scan with DD1 as I was measuring small (scan showed average weight) and this time I'm also measuring small (no scan booked though) I've heard they can be out by as much as 2lbs too which is worrying! x

 

[Mum2MJ]

Yep Bournefree pretty much.
I only have 1 mw appt booked at 38 weeks at the hospital, the rest is done through my GP (until 40 weeks I think) my booking appt was at the hosp and my 16 week appt was with community midwives - but ones who are at a different hospital and one I refuse to give birth at! (I live in an area covered by the hosp I want to be covered by but my Dr's is with a different area which is why I've had a hard time trying to sort out homebirth/care etc)

 

[PeanutBean]

Our community system is like yours Bourne only when our MW is on holiday or otherwise indisposed we get a different member of the team. Our GPs have absolutely nothing to do with it. I didn't even call them thi time when I got my BFP. Last time they had no clue and just told me to book in with the MW giving me no info whatsoever. Nothing takes place at the hospital either with the exception of the two scans and any peculiarities, for example I think last time I had to get the homebirth signed off by a consultant as I had low B12 and needed shots.

 

[Bournefree]

Yep Bournefree pretty much.
I only have 1 mw appt booked at 38 weeks at the hospital, the rest is done through my GP (until 40 weeks I think) my booking appt was at the hosp and my 16 week appt was with community midwives - but ones who are at a different hospital and one I refuse to give birth at! (I live in an area covered by the hosp I want to be covered by but my Dr's is with a different area which is why I've had a hard time trying to sort out homebirth/care etc)

Hopefully somethings will change for you with a homebirth booking, as your team of MW (which ever have taken on your care ) will arrange a home visit in late pregnancy.. so you get to meet some then ;-) Arranging your HB must be very frustrating - bet you feel like your doing all the leg work! Just remember they have a duty to offer you choice and arrange your care. You can always take it further, if you feel you are not getting anywhere.
XxX