"Homebirth in North Tyneside"

About: North Tyneside General Hospital / Maternity care North Tyneside PCT

(as the patient),

I discovered I was pregnant with my 5th child in December 2008. I saw my Community midwife (MW) when I was around 8-10 weeks pregnant. The first words she said to me were that I will have to have this baby at the RVI as I was classed as a high risk because it’s my 5th baby.

Well I was shocked and upset by that statement as I had read via homebirth.org.uk and other sites that in some areas, "high risk" is not counted until the 6th pregnancy. I knew that I had the choice to decide where I gave birth, but I thought maybe I was confused and went away feeling annoyed and scared of having to have a baby in hospital again, out of the previous 4, only one was drug/intervention free.

My MW started talking about a child who had a horrific homebirth, and asking me "how will you afford the £300 for that" when I mentioned I was getting a Birth Pool. Then she sighed at my desire to buy a Birth Pool in A Box. I felt like she was just being negative to my desire in the hope I would give up and concede defeat.

I went home and did some more research and found out that no, I was right and that I could have a homebirth if I wanted one, I read that a 5th baby is no reason to not have one.

When I went back to see the MW a month later I felt she was still umming and ahhring over my plans. I had to write a letter to the Supervisor of Midwifery (SOM) at my local hospital to get it in clear writing that I was going to have a homebirth as long as the pregnancy continued well.

The reply made it clear; I felt that my Community Midwife had lied to me and the SOM.

I let it go and continued on with my pregnancy, I had to go see a consultant, so I went and was told that due to 2 previous Post Partum Hemorrhages that I could not have a homebirth. I reiterated to the registrar that as long as the pregnancy was complication free by my 37th week, I was having a homebirth and she agreed.

I asked the registrar why I was given an appointment to see them, she said to me that all pregnant women were referred to them as a matter of course, which was news to me as I had had 3 other children in the same Local Health Authority and had never seen a registrar before.

I went back to my MW and told the MW that the registrar was ok with a homebirth as long as no further complications arose. Other than low iron nothing else happened and I went on to have a lovely, almost stress free home birth.

I felt upset and annoyed by my Community Midwife during the very early stage of labor, while she was at my house just after my waters broke, I felt like she stood around with an impatient air about her, she refused to sit down when I asked her to and she made me feel very uncomfortable. The next day she told me that I had to go for a trace to monitor baby for a bit and that if I had not had baby by 8am the next day I had to go to the RVI for augmentation.

I was so relieved that when labor did kick off (20 hours later) that she did not come to mine. The midwives who did attend I thought were wonderful, unobtrusive, professional, quiet, funny, and most of all I felt like they cared about me and my baby. They stayed out the way and let me get on with it and were there when needed, did what they needed to do, took care of a minor PPH, made sure I was OK and left when the job was done. I later found out my Community Midwife was actually on holiday which I was never told and made me abandoned by her.

I am very happy I got to have a home water birth.

I am not happy at the hoops I had to jump through to fight to get my homebirth.

I think the postcode lottery of when a woman is classed as high risk needs to stop; each pregnancy must be looked at on a case by case basis.

I think all midwives need to be trained in water births, all homebirth kits need to have underwater sonic aids and medications that are still in date (one of the emergency resuscitation meds in the kit brought to my birth was out of date!)

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Responses

Response from Northumbria Healthcare NHS Foundation Trust

It is very difficult to respond to individual cases without more information, however I will give a generalised overview of the service we offer women within Northumbria Healthcare NHS Foundation Trust.

Our service offers a full range of care options. This includes a choice of medical-led care at Wansbeck General Hospital or midwifery-led in one of our four midwifery-led units at: North Tyneside General Hospital, Hexham General Hospital, Alnwick Infirmary and Berwick Infirmary as well as the option for women to choose home birth. We offer continuity of care from a team of midwives to all our women. A woman is allocated a community midwife as her lead professional, but other members of the midwifery team would cover during holidays and days off.

All women attend an early pregnancy appointment which gives them all the information to help them to make an informed choice of where to have their baby. Having a home birth is a choice that we do routinely offer women. As midwives we would support any woman in her chosen place of birth, however for safety of both mother and baby we follow the Royal College of Obstetrics and Gynaecology recommendations and complete a risk assessment of all women to determine whether their pregnancy is classed as high or low risk. If someone has had 2 previous PPH, this would prompt further discussion and planning with medical colleagues.

As identified in the Health Care Commission Review in 2007 we have adequate staffing levels to offer women an excellent standard of care throughout the Trust including midwives allocated to cover home births. We provide midwifery on-call provision for women planning a home birth from the 37th week of pregnancy up to 42 weeks. If more than one lady goes into labour at the same time (which sometimes happens) and a midwife (although this is unusual) had to attend one home birth after the other she would do so within her allocated hours of duty.

All community midwives have had training with water birth, and we do have provision for entonox and underwater sonic aids for all home births without exception.

If you wish to discuss your case in further detail, I would be happy to do so, please do not hesitate to contact me:

Jan Henry, Clinical Lead Midwife

Northumbria Healthcare NHS Foundation Trust

0844 811 8111