One or two midwives at a homebirth?

[Kess]

I understood there were normally two NHS midwives at a homebirth for the final stages, one for the mother and one for the baby. But talking to my prospective independent midwife last night, she said that started in the 80's when the homebirth revival started (after everyone rushed to the newfangled hospital wards in the 70's) and the second midwife was there mostly for the first midwife's comfort rather than any medical need. She has said she can arrange someone else to be there at the end if I want, but cautioned that it can slow things down right at the important bit as a stranger is arriving into your safe haven. I don't know how much it would be extra for the extra person there.

What are people's opinions on one or two midwives? I'd rather just her, but I'm scared of a situation where both me and baby need immediate attention, say I'm haemorraging and baby needs resusitating, she's only got one pair of hands.

 

[Bournefree]

The only way I can think of this is to relate it back to my own experiences. Sorry, but indulge me for a sec..

We had lots of MWs there for our first baby (4)- though this was unusual and down the circumstances.. Baby was born at 8.30 and there was a change in shifts from day MWs to the night team that happened about 8.. my 2 day MWs stayed on for half hour to see the baby and continue care. If it was more usual timings then I would have had 2. I did feel very reassured that I had 2 MWs.. BUT only on reflection. As I when my second MW arrived I was in full flow of labour, and didn't really care much about who was there! We didn't experience any problems. But if we did.. yes there would have been one for me and one for baby.
But I do think that you can take it too far really in the what if's - or you wouldn't be looking at homebirth at all, you would be too scared and opted for an obstetric unit.. so that all the what if's are covered.
Your risks for things going not quite as planned, such as PPH and baby being distressed or needed resuscitation are so much lower at home. I guessing that faced with a baby to resuscitate and a pph at the same time.. are akin to the odds of winning the lottery. However, i'm sure your MW would prioritise the resus as a greater need. Then give you a shot to stop the bleeding. Ergometrine can work in 45sec to constrict PPH bleeding when given in IV. Also it is worthy to note that PPH more fequestly occurs when the placenta has detached.. which is more usual a little while after birth.
Even though you will have your IndMW there, there is nothing to stop her requesting (or you) for a second MW to come to your home at the same time. Just need to make sure the unit knows your lead MW will be your independent one.
You have to do whatever it is that you feel is best and makes you more comfortable.
Me? - I'd be in two minds.
XxX

 

[louloubabs]

I had one midwife to start with at my homebirth then the second arrived later, just after baby had born as it happened so quickly.

Hope that helps

XxX

 

[Bellie710]

The only way I can think of this is to relate it back to my own experiences. Sorry, but indulge me for a sec..

We had lots of MWs there for our first baby (4)- though this was unusual and down the circumstances.. Baby was born at 8.30 and there was a change in shifts from day MWs to the night team that happened about 8.. my 2 day MWs stayed on for half hour to see the baby and continue care. If it was more usual timings then I would have had 2. I did feel very reassured that I had 2 MWs.. BUT only on reflection. As I when my second MW arrived I was in full flow of labour, and didn't really care much about who was there! We didn't experience any problems. But if we did.. yes there would have been one for me and one for baby.
But I do think that you can take it too far really in the what if's - or you wouldn't be looking at homebirth at all, you would be too scared and opted for an obstetric unit.. so that all the what if's are covered.
Your risks for things going not quite as planned, such as PPH and baby being distressed or needed resuscitation are so much lower at home. I guessing that faced with a baby to resuscitate and a pph at the same time.. are akin to the odds of winning the lottery. However, i'm sure your MW would prioritise the resus as a greater need. Then give you a shot to stop the bleeding. Ergometrine can work in 45sec to constrict PPH bleeding when given in IV. Also it is worthy to note that PPH more fequestly occurs when the placenta has detached.. which is more usual a little while after birth.
Even though you will have your IndMW there, there is nothing to stop her requesting (or you) for a second MW to come to your home at the same time. Just need to make sure the unit knows your lead MW will be your independent one.
You have to do whatever it is that you feel is best and makes you more comfortable.
Me? - I'd be in two minds.
XxX

This is exactly the same as happened with me DD was born at 8.40 and the shift change was 8.30, they tried to phone the new ones to tell them not to come but it was too late. I had 4 MWs and 2 paramedics on standby. i will definitely have 2 Mws for this birth.

 

[Jenniflower]

I would say your midwife is very much right in what she's saying. Not to mention it helps cover the midwives behind to have another one there so they can essentially sign off on each other. I think if I could have my way I would only want one midwife there especially if she was confident enough and has had the experience.

 

[Mervs Mum]

IMs tend to be more trusting and well within their comfort zone to be on their own. My NHS MW rang the 2nd one to come to my home birth and I said 'I think the baby may get here first' and she said 'I dont need anyone or anything else - you have all we need '. Some babies arrive before the first MW never mind the second one (as I have seen first hand! ) so it's really about YOUR comfort levels. My last client had so many MWs in and out it really inhibited her labour at one point so IMO when it comes to birth, on pretty much everything, less is more

 

[crazydiamond]

I fainted after my birth while holding LO and getting out of the birthing pool. I think my MW was very pleased that her colleague had turned up 5 minutes earlier as it was in this case really important to have one MW to look after LO and one to look after me.

Not sure how common this is though - I get a bit funny around the sight of blood anyway and the heat from the room coupled with some blood loss made me feel faint.

Having said this my homebirth was still a brilliant experience.

 

[NaturalMomma]

Where I'm at it's different since I'm in USA. Most women have only 1 Midwife. Sometimes she'll have a Doula or a Montrice as well. I pretty much had 2 Midwives because the assistant was actually in training and finished her studies just a few months after I gave birth. For me it worked out great, and I knew both well before I gave birth because they were both at the appointments.

 

[ypenn]

I had two midwives and it was great. My second midwife was my primary midwife's mentor so they worked well together. I would recommend two midwives during the delivery.

 

[sam#3]

I had 2 midwives at both of y homebirths but the 2nd always arrived after the baby!! I dont really remember taking much notice of the 2nd because by that point i had LO, but if nothing else i thin it helped the 1st to have another pair of hands for writing up the extensive notes, making tea and toast and also clearing up after the birth HTH

 

[Kess]

I'm completely conflicted now. I've pretty much decided to go with this midwife, Jo; we seem to gel well and I like her philosophies, and her huge amount of experience is really comforting. But she generally works alone. She says the chance of both me and baby needing her at exactly the same time are tiny, especially in a home birth with no interventions. I can't get the worry out of my head though - the chances of my losing my first baby at the point in pregnancy that we did was tiny, but it still happened, and the chance of needing the evac were small, and we still did, and the chance that they'd screw up the evac were small, and they still did.

I suggested we could ring an NHS midwife and have them there on standby in the next room, just in case, but she said they generally won't do that - something about their insurance not letting them work under someone outside of their system and not be the lead midwife.

She has suggested that we ask the midwife she introduces me to as her back up (in case she breaks a leg or something and can't attend my birth) what her hourly rate is, and consider asking her to be there just for the last bit to reassure me, but I'm not sure we can afford any more expense, we're stretching things a lot anyway for hiring Jo herself. There is an independent midwife near me that works with another midwife, but neither of them has much experience so I'd not feel as comfortable, and I really like Jo.

I've been reading about PPH. It seems that the drugs they carry can control it really quickly, and it's not something that's going to kill me inside a couple of hours anyway - I only live 15 minutes from the hospital, so Jo could focus on the baby first without my being likely to die while she does so! Sorry to sound so dramatic, I'm trying to think worst case scenario! It seems the risk of a PPH of over 500ml is 2% for a homebirth, and I have no idea what the chance of baby needing resuscitation is, does anyone know?

 

[Bournefree]

I appreciate your honesty and totally understand your concerns and it is ok to look at things in a worse care scenario (sensible in fact).

So going with the worse scenario..

I have to dispel what your IMW is telling you about the Mws from the unit. They may also come to attend you - you have a right under law to be attended by your Primary Healthcare Trust if you request it for emergency situations and not only emergencies but “primary care services” which includes women in labour. So this includes getting a MWs from the local unit, or paramedics on a 999 call. There isn’t a conflict of insurance issues at all. Mws from the unit are covered and your IMW is covered. YOU are the care subject and what you say goes - so if you state that you want your IMW to be the lead, then that is it. So you can call MWs from the unit, at anytime in your labour.
Think of it like this - if you were to transfer into hospital, your IMW would attend you there as well. She can go in, and be the lead MW, and they can come out to you, and be the backup MW.

However in the WCS you are likely to both need to transfer to the hospital and your IMW is going to be calling 999. So the care provided for even if you had 2 MW from the unit is arguably the same. .. And as you have pointed out PPH is very quickly treated, and so it resuscitating baby… they are amazingly robust at term. More so than an adult, and Apgar obs are done at 1min, 5min and 10 mins. So baby starts to get full vitality from breathing sometimes slowly.

You have already increased your chances of having a natural, safe and healthy birth, by simply deciding to have your baby at home.

The choice is yours to have a second MW, but don’t think that you’ll have to pay for it if you need one!
Xxx

 

[smam]

I had the grand total of 4 at my homebirth (2 were students in their 3rd year). The first one turned up, examined me and got her stuff set up and then the 2nd one turned up. They asked if I minded a student and I said no, then theysaid what about 2?! In for a penny in for a pound I thought. I was about 6cm by the time the students arrived and went quickly to 8cm, having made them all tea, run up and down the stairs and had a shower. I'm a shy person but I think knowing they had seen it all before and it was their career meant I was quite at ease with having that many people in my bedroom, not to mention my best friend outside the door, my mum, sister and grandparents were all downstairs too lol!

I had one deliver D and pass him to me, while the other three recorded and did the agpar then another helped me deliver the placenta and got me off the shower curtain and into clean pants etc while the students weighed him and dressed him. They filled out the paperwork and 2 went to do their clinic leaving another 2 behind who went after everything was sorted and they were happy enough with his temperature.

 

[Mervs Mum]

Well I had 2 at my own home birth but I could have had one TBH. The lead MW lead. I have been at births with no MWs and one where we had 7 through the door. I know which ones both my client and I preferred!!

I think BF makes a great point. You could stick with your own IM and when birth is imminent get her to call the community MWs out if you'd feel better with an extra pair of hands. They would hopefully arrive right before or just after you gave birth and your own MW would lead and they would effectively back up.

x

 

[Jenniflower]

I still think one midwife is perfectly sufficient. Especially one that is so confident in her abilities that she doesn't think she needs another one there. My ultimate dream would be to have an unassisted home birth. Just me and my hubby enjoying each others company until LO arrives, but I know that will never happen because neither of us is educated enough to know the ins and outs of complications. So the next goal would be to have just us and one midwife who is as hands off as possible but is there for the just in case.

The more people that start showing up the more some women start to shut down. Now I know each person is different but this is something for you to think about as well. If baby is really needing resuscitated this would most likely be happening after the cord is cut and you're waiting to deliver the placenta. PPH doesn't even begin until after the placenta comes out, that's when the blood loss is counted. So there's plenty of time generally between the two. As well as a worst case scenario you have hubby there to dial 999 if need be but I'm sure your IMW is well aware how to juggle calling if need be. Personally I'd rather have one amazing, well trained, confident in herself midwife than two midwives at my local clinic that haven't even seen a water birth let alone a home birth!

 

[KandyKinz]

Here in Ontario, Canada two midwives attend the births. One comes from the beginning till end and the other one comes closer towards the delivery and stays until everything is settled afterwards.

I would not at all feel comfortable with just one midwife present. As a former midwifery student I have to say that there is certainly alot of benefits to having that extra set of hands. For example, if there's a shoulder dystocia it's very beneficial to have more then one care provider present. One to provide supra pubic pressure and one to maneuver the baby out. And then there's the risk that baby will come out flat. A solo midwife can provide resus but if chest compressions are required it is so so so much easier when two midwives are present. Same with maternal hemorrhage. Care is much more efficient when there's more then one midwife present. There's so much that needs to be done, like getting and administering anti-hemorrhagic drugs, inserting an IV, continually monitoring vital signs, staying sterile while checking for lacerations, potentially clamping or suturing lacerations which are causing excessive bleeding, uterine massage, inserting a catheter, bimanual compression.... A midwife really can't do to much else when a bimanual compression is necessary! Then if there's a situation when more then one thing goes wrong eg a simultaneous flat baby and postpartum hemorrhage then having just one midwife there would be just a nightmare!

And while thankfully most births are uncomplicated and normal and the second really doesn't do much more then puts the sheets in the wash and makes a cup of tea they're IMO a very important just in case component of ensuring a safe homebirth. Just like that $$$$$$ Ergot in the fridge that you pray you never have to use.

 

[Mervs Mum]

I still think one midwife is perfectly sufficient. Especially one that is so confident in her abilities that she doesn't think she needs another one there. My ultimate dream would be to have an unassisted home birth. Just me and my hubby enjoying each others company until LO arrives, but I know that will never happen because neither of us is educated enough to know the ins and outs of complications. So the next goal would be to have just us and one midwife who is as hands off as possible but is there for the just in case.

The more people that start showing up the more some women start to shut down. Now I know each person is different but this is something for you to think about as well. If baby is really needing resuscitated this would most likely be happening after the cord is cut and you're waiting to deliver the placenta. PPH doesn't even begin until after the placenta comes out, that's when the blood loss is counted. So there's plenty of time generally between the two. As well as a worst case scenario you have hubby there to dial 999 if need be but I'm sure your IMW is well aware how to juggle calling if need be. Personally I'd rather have one amazing, well trained, confident in herself midwife than two midwives at my local clinic that haven't even seen a water birth let alone a home birth!

Even as a doula I have to admit I never truly understood why people would plan a free / unassisted birth....that was until I witnessed one and also had a birth where we had a challenging time protecting the space. I have to say I totally get it now and I'd seriously consider UC IF (and it's BIG if!) we had anymore.

 

[Kess]

I appreciate your honesty and totally understand your concerns and it is ok to look at things in a worse care scenario (sensible in fact).

So going with the worse scenario..

I have to dispel what your IMW is telling you about the Mws from the unit. They may also come to attend you - you have a right under law to be attended by your Primary Healthcare Trust if you request it for emergency situations and not only emergencies but “primary care services” which includes women in labour. So this includes getting a MWs from the local unit, or paramedics on a 999 call. There isn’t a conflict of insurance issues at all. Mws from the unit are covered and your IMW is covered. YOU are the care subject and what you say goes - so if you state that you want your IMW to be the lead, then that is it. So you can call MWs from the unit, at anytime in your labour.
Think of it like this - if you were to transfer into hospital, your IMW would attend you there as well. She can go in, and be the lead MW, and they can come out to you, and be the backup MW.

However in the WCS you are likely to both need to transfer to the hospital and your IMW is going to be calling 999. So the care provided for even if you had 2 MW from the unit is arguably the same. .. And as you have pointed out PPH is very quickly treated, and so it resuscitating baby… they are amazingly robust at term. More so than an adult, and Apgar obs are done at 1min, 5min and 10 mins. So baby starts to get full vitality from breathing sometimes slowly.

You have already increased your chances of having a natural, safe and healthy birth, by simply deciding to have your baby at home.

The choice is yours to have a second MW, but don’t think that you’ll have to pay for it if you need one!
Xxx

I'm afraid the bolded isn't true. IMW aren't covered by insurance at all, they can't get it because no insurance company provides it - there's a FAQ including the issue here - https://www.independentmidwives.org.uk/?node=750. It is also uncommon for IMW to be allowed to practise in the hospital in the case of transfer. My IMW has a good relationship with our local hospital, having given talks and so on there before, but they still won't let her actually act as a midwife there. If I transferred in, she'd stay with me as an advocate and support, but couldn't actually be my MW.

Thank you for the reassurance about the worst case scenario though.