ER - I'm really pleased that you have decided to "crack on" - hopefully it will just mean that you get some really good help, brilliant mws and good advice in your final 10weeks. Plus hopefully some excellent mws in attendance on the day.
Here for you, anytime.
Make a list of things that you would like to say at the meeting and questions you have. It will help to keep you focused.. as I know how easy it is (esp when pregnant) to get emotional, and break down. You want to have a successful meeting - and remind him, the meeting is to inform of risks, and to make your plans for a HB viable. (that was his words!).. So try to look at it in this light, and not get too stressed or down about it - you are planning a homebirth, and they have all planned this meeting to help you achieve it!
Plan of Action:
>Make a list of potential health risks:
First make a list of all the potential problems that may arise in birth that the consultant potentially might bring up. (it doesn’t have to be long - your not indicated for too many risks) Research them thoroughly. Make sure you know the definitions of them, and how they are treated. If you can - find your consultant on the internet, when they graduated, and when they started being a registrar in their speciality - it’s great to start a sentence; “since you started your specialisation in 19**, I’m sure that medical technology has moved on significantly in obstetrics… but, as you have been in this environment for X years, you have to concede you have little experience of natural labour (gets them every time! - he will sit up and listen to you)
>Draft agenda: It's your meeting after all - take the lead, it‘s all about you! I have added a suggested agenda for you - I hope you don’t mind. Keep it formal and friendly. You need them to know you are an informed, intelligent, and self-assured.
*Thank yous and intros
>Make sure you get everyone’s name and who they are - your support should do this for you. You can instigate this by saying “.. well I’m guessing that everyone knows who I am, because of the bump, but if you wouldn’t mind telling me who you are, that would be great”
>Thank everyone for coming, and for taking the time to support and help you to plan your homebirth. (it just gets it off on the right footing - and flattery can go a very long way!)
> First, make sure you thank the mws. Tell them, there support, attendance and experience are central in your plans for a homebirth. (always do the mw’s first - you might be in the Obst office.. But these are the pros who are going to help you, and be your support)
> Then thank your Obst (sorry you might not want to - but keep your enemies close and all that! - seriously, he is there to help you.. they are all there taking the time to help you)
*Case Orientation
> Ask if everyone is familiar with your case history and medical results. It helps to keep it focussed on evidence. (it is important, that you don’t give up your notes unless you have to, before your meeting - you will then get to see who knows you, and who doesn’t. Plus is stops them having a “side meeting” to discuss you without you being present)
>Then invite everyone to read your notes first. To familiarise themselves with your case history, so they can all make and give informed opinions.
>Tell them they can ask any questions of you, to help them to help you. Stick to - “as you can see for my notes, my baby isn’t presenting with macrosomia (tech word for large babies), I don’t have high blood pressure, My urines have been clear. My booking weight taken at x gestation was xxx, at present I have gained xxxx (in Lbs or Kg) (this because you know BMI is the only issue you have.)
* Safety of birth - It’s the main issue, there is no avoiding it
> inform them, and they will want to hear it: that you wouldn't do anything that you perceive to be a posed significant or even imminent risk to you or your babies health.
> Invite the Obst to talk about what risk factors he feels might apply to YOU based on your presenting clinical evidence, and not just policy, in your HB, one by one. Hopefully it will be short. (you don’t have GD, you are not measuring big, your BP is within norms etc)
> explain that for each factor, you would like a full description and explanation of what each risk is, what it can lead to, and what if anything would be able to be done in a hospital environment. Let him finish going through all problems - and make a list of them.
> then ask the mw's if they can comment on each risk, and ask if they feel the risk applies to you based on your notes, and how they feel that you would be treated in the home environment, should any such risk occur.
>Thank everyone for there input, then go through what ones if any, YOU feel apply to you, (point out, that because you are in a relaxed environment, you will labour slower, and naturally, and have fewer problems because of it etc) and say that you are confident with the mw's experience to treat these problems, or to transfer if you feel necessary, if anything unforeseen occurs that couldn't be safety treated by the community mws.
*Information
> Start by saying what you have found out about stats for HB in your area. (this lets them know you are well informed)
> Ask the Midwifery team, how many on-call mws they have at anyone time. (excluding sickness, and holidays)
> experience - how many mws are trained on attending a HB and how many in there current team have attended a HB.
> Ask what drugs are available to you and your baby?
* synthetic oxytocin, vit K injection, or oral administration etc.
*Medical pain relief; .gas and air, can you have a pethidine or diamorphine, script on hand, if you want it, and if it is available, and how to organise it?
>Ask what equipment they will bring? For you and for baby?
* For you:
Thermometers, BP machines, Dopler (will it be waterproof; if you decide on a water birth?) Suturing equipment - inc dissolvable stitches, how many are carried. What are transfers if 2 degree tear and 3 degree tear? Also Oxygen, canellas - for fast admin of IV drugs, Breast pads, maternity pads, absorbent bed pads…. etc
* for baby:
suction cups for clearing babies airways (if necessary), re-sus equipment, Oxygen (with appropriate masks for baby) , clamps for cord; what type are they - unless you decide on another method, scales of measuring babies weight - some have hanging scales, others digital flat-bed ones.
>Any thing else you can think of, you want answers to.
Thank everybody, for helping and supporting you in your HB plans.
Make it a reality. You can do it!
Sorry for yet another mammoth post from me! - off to bed I go (sorry for any typos, I keep doing loads, and then having to edit. I have to type fast whilst the LO is asleep!!!)
xxx
I havent recieved a call back from them yet to confirm this appointment. I will give them till Tuesday afternoon as I know thats when he has clinic. 
