Uncomfortable conversation with MW re staffing levels and HB.

Kess

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I'm 37 weeks and have just had my homebirth assessment. All went fine apart from the warning from my MW (reading from the form she was filling in) that "If the trust cannot provide two midwives to attend a homebirth at peak activity times you may be asked to come into the Midwife Birthing Centre to deliver your baby" (actually written in capitals on the form!).

I said that in the nicest possible way my answer would be "No." I said that although I don't want to be awkward or combative, they've known since my booking in appt (at about 6 weeks) so for 31 weeks that I intend a HB, and their staffing problems are not my concern. I have anxiety issues with hospitals, and although I will transfer in case of actual medical need, I do not consider their staffing problems a reason to transfer (nor "failure to progress", prolonged SROM or more pain relief). I really like my CMW so I found it excruciating to be so awkward, but I know going to hospital would slow labour, increase my pain, and increase risk of unnecessary interventions, all of which will increase risk to me and baby, and my risk of PND would be much higher (already have some risk factors).

MW argued they don't have staffing issues, it just depends on how many women go into labour at once (apparently nights are worse as fewer MWs available).

MW asked if I would prefer to have an unassisted birth rather than go into hospital, and I said no I would prefer they send someone, even if that's a paramedic. She explained paramedics will "scoop and go", so they're not going to stay here to attend. I said I knew some trusts have solved the issue by hiring at their expense an Independent MW, but obviously my MW couldn't comment on that. She's said she will get the Supervisor of MWs to contact me.

How do I handle this? This threat was what made me hire an IMW last time, but it was made at 8 weeks last time, this time is too late and anyway we now cannot afford it.
 
It's a difficult one.
I completely back you 100%, you have every right to a home birth and their staffing issues is not your problem. I'm actually shocked she suggested an unassisted birth to you (or do you think this was a scare tactic?)
I'm pleased you never let the matter stop and hope a solution can be found.
I do understand that they can't predict how many women are going to be in labour, is this not what bank/relief staff come into play?
 
I assume you are in the UK. I have a good book called Home birth: a practical guide (by Nicky Wesson). It covers a lot about the legal and practical side of having a HB with the NHS and has a whole section about the excuses they can come up with and how to deal with it. That is a common one. It is still their responsibility to send someone though. Although lots of women have been told there was no one available, even when they are in labour it is actually quite unusual for them not to send someone when it comes to it. An unasisted birth is actually more of a threat to them because they have a legal responsibility. Its the same thing as them saying if you come to hospital and we don't have enough staff, you could die, of course it can happen but not something they want to boast about. I think the book sugested writing a letter to say you are planning a home birth and expect them to have MWs available, like that they can't claim they didn't have time to find a solution. I saw very simmilar info online somewhere too. Usually it is just a tactic to try and put you off, or to cover themselves. It is unlikely they won't have someone available if you just stay at home.
 
You might find this page helpful:
https://www.aims.org.uk/homebirthUpdated.htm
 
I think they have to say it and if you'd not said anything and if there are staffing issues when you're in labour they will find a midwife to send. When I was in labour there were two other women in labour the same night and they told me at my homebirth visit that they have 4 midwives on call at night. When I called there was no mention of going into hospital and one of the midwives was from a different area so they must have had to arrange for her to cover the staffing shortage.
 
Keeping an eye on this thread.. It's worrying me already and I'm only 10 weeks tomorrow with my booking in appointment tomorrow. Unless it's life or death me or baby I've no intention of going into hospital- I'm already worried about having that conversation
 
I had an unplanned home birth with paramedics and 2 midwives. So if they managed to get 2 midwives to me (albeit one turned up after the birth) as an unplanned I am sure they will handle a planned HB. Sounds like a scare tactic, I'd ignore it.
 
For my first pregnancy I got told I might get turned away from the birthing centre if they ran out of space on the day. They say it just in case to cover themselves. I asked if they'd had to do that before and they said only once or twice since opening the place a few years ago. It wasn't a problem on the day.

Perhaps ask your midwife if they've had to resort to that before and if so how often? Might be a non issue, as nerve racking as them putting it out there is.
 

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