Shortage of midwives??

[fluffball]

Hello everybody

I am quite upset today about this and I though I'd ask you mums.
How many midwives "on call" (for home births) were there in your area at any one time?
And how big is "your area"?

I had my 16 wk apptmt yesterday and I happily announced to my midwife that I had decided on a home birth.
I spent weeks reading and doing all the research possible as it was an important and difficult choice for me, this being my 1st baby.

She filled in the relevant forms and was happy for me to go ahead, but warned me that I may need to go to hospital anyway because they only have TWO midwives on call at any given time in the WHOLE of the area.
I live in a semi-rural area but it's a bloody big area, and those 2 midwives seem to cover the main city as well.

But before all that, do you think I have any realistic chance of being able to have a home birth at all, given the statistics???

 

[Sherlock]

I think you do. Not many women opt for a homebirth and its highly unlikey you'll be in labour at exactly the same time as another homebirthing woman.

FWIW we have 5 on call MW's to cover our area. 2 are from outside the district and they rotate with the other 3 for night call outs. One MW is attached to my local area and the other 2 within the district cover other towns. But all 5 take it in turns to be on call and on call as back up/2nd call out MW.

When I had my homebirth my MW wasn't on call officially that night. But she gave me her number and said she would come out and be the #1 MW and the on call one would be her back up/2nd MW She also told me she had not had a hombirth for 2 weeks prior to that and was not expecting another one for a few weeks after.

Good way to check out who is having a homebirth in your area is to go to the ante natal classes (esp the labour and pain relief one) Out of 20 or so women at mine I was the only one opting for a homebirth And the women came from a 10 mile radius round the local area and were all due to give birth within weeks of me. Gives you some idea.

Any Q's feel free to drop me a PM

 

[Sherlock]

BTW I live rural on a farm and my main hospital is over a 30 minute drive for the maternity unit.

 

[fluffball]

Thank you so much for your reply, Sherlock!

My hospital is also at about 30 minutes from here, which was my only reservation when deciding on a home birth.

Trouble is, the area covered by this hopital is more like a 30 mile radius. 2 midwives seems just ridiculous to me!

I won't have my ante-natal clases until October, but I'm hoping to join some aqua natal classes in the area next week. Thanks for the suggestion, I'll see what the other women have planned.

If you don't mind, I think I may PM you a bit later on. Thanks again!

 

[LisaJ1986]

Round here home births are not a regular occurance. We're even short on MW in the labour ward. Was talking to my neighbour the other day. His wife was in labour. 8 ladies giving birth at the time with only 3 MW to go round!

 

[fluffball]

That's just terrible!
Call me naive, but this trend towards "patient choice" the NHS is supposed to offer is making me sooo mad
It's all a lot of hot air when in practice not even the basics are covered.

All I seem to hear since I got pregnant is: "in some areas they do this and that but not here". And then it turns out "some areas" is really just 1 out of 30.

 

[moss]

I am planning a homebirth and apparently there will be a team of 8 on call during the few weeks window they will allow me to have one. I think it must be a large area they cover, and I don't know how many are available at any given time, but she didn't let on that it would be difficult to get someone.

Like Sherlock, I am the only one in any of my antenatal classes planning a homebirth.

 

[daftscotslass]

It's especially infuriating because the students midwives I was speaking to had no jobs to apply for when they finished their course.

I'm sure those wanting homebirths will get them, though, as if you insist on it they seem to pull out midwives from nowhere!

 

[Daffodil]

DO NOT ACCEPT THIS!!!!!

This happened to me and I wrote a letter....

Now I have a letter in my possession from the matron of midwives telling me that they WILL provide midwives for me EVEN IF there is another home birth at the same time as mine.

The midwives in the NHS are currently fighting to get more funding and more staffing for home births. If women just accept this and are forced to go into hospital every time there is ONE other home birth in their area things will never change!

Don't accept it.

Here is a copy of the letter I sent. Send one of your own to your Supervisor of Midwives (the local unit will tell you who that is)

LETTER:My name is XXXXX XXXXX and I am due to give birth to my first child on or around XXXX
I have chosen to have a home birth. My pregnancy has no complications at this time.
I attended my local doctors surgery on 3rd June 2008. I saw a midwife named XXXXXX. She informed me of the following:
1. That there are two midwives on call at any one time in the whole of the XXXXXX area (and both are required to attend one home birth at any given time).
2. If I should go into labour at the same time as another woman (who is having a home birth and who made the telephone call before me), I will not be provided with midwife care at home and I will be required to go to hospital to deliver my baby.

I am very concerned indeed about this information. I require a home birth and I believe it is my right to give birth at home. I certainly do not wish to be one of the women who is asked to attend hospital due to one other home birth occurring at the same time as my labour.

It also worries me that when I go into labour, I may have the stress and upset of being told that a midwife is not available to attend me at home.

From my research, I understand that it is Government policy that the NHS should support women who intend to birth at home. In a House of Commons debate (20 Dec, 2000) Lord Hunt of King's Heath stated: 'The Government want (sic) to ensure that, where it is clinically appropriate, if a woman wishes to have a home birth she should receive the appropriate support from the health service. At the end of the day, it must be the woman's choice'.

I have no intention of taking the additional risk and distress of a hospital birth in order to alleviate staffing problems, although I am prepared to transfer to hospital should a medical complication arise.

The birth of my baby is a very important time for me and this is of course why I am approaching this issue seriously. Please could you confirm for me whether I will receive the midwife support I require at home for the birth of my baby.
Yours sincerely,

 

[Daffodil]

Other resources

www.aims.org.uk which says:
To make sure that your experience does not go unrecorded, and for more advice on obtaining the maternity care you need, telephone the AIMS helpline on 0870 765 1433 or email [email protected]

on the AIMS website, on the left hand side there is a link which links to "if you are having problems booking a home birth". Click that link then click the link "home birth" on the page which appears. Here are sample letters you can send to your supervisor of midwives.

Also see

http://www.homebirth.org.uk/

A section on this site says

What about staffing shortages?
Women planning a home birth are sometimes told that the local health authority may not be able to provide a midwife on the day, because of staffing problems. If you hold out for a home birth in these circumstances, you may feel guilty that you would be taking midwives away from other women who need them on the labour ward. This is an understandable concern, but it is important to remember that staffing levels are the health authority's responsibility, not yours. You may sympathise with their problems, but remember that “where there's a will, there's a way”. Trusts which are fully supportive of home birth find a way around this problem; so can yours.

While sympathising with the health authority's staffing problems, you can ask what they are doing to resolve their staffing problems. Advertising vacancies is insufficient - perhaps providing their midwives with more autonomy and job satisfaction, for example with the opportunity to attend births at home, would improve their retention of midwives.

If women are persuaded to abandon their home birth plans on the grounds of staff shortages, the health authority will have no incentive to improve its services for other women - so by holding out for a home birth you are helping to improve choice in your area, and helping to make midwives' jobs more interesting - and you are also saving money for the NHS (see below).

Every health authority has access to what are called 'bank midwives', and most use them regularly when they have staffing problems in the hospital. These are midwives who work on a temporary basis, sometimes for just one shift at a time (a bit like supply teachers). Some will be midwives who are employed by the same health authority, who are taking on extra work - doing overtime - and others will be midwives who want to work part-time but who have not obtained a permanent part-time job, or midwives who are currently taking a career break to look after their own children, but will work occasional shifts, or semi-retired midwives. All 'bank midwives' are all fully-qualified midwives. If there was a genuine shortage of midwives on the labour ward then the health authority should always be able to arrange cover on the ward from a bank midwife, thus freeing up a community midwife to attend home births.

In some areas, independent midwives work as 'bank midwives' when they are not needed by their own clients. On occasion, independent midwives have attended home births on behalf of health authorities who could not arrange cover from their own employees. Sometimes such arrangements are made in advance - when people talk of arranging an 'extra-contractual referral' to an independent midwife, they mean that an independent midwife would be booked to attend you, but would be paid directly by the health authority.

See 'Home Birth Bullying' from AIMS for suggestions on dealing with this situation, and also 'Home Birth Alert' for a sample letter to send to your health authority. If you still have difficulty in arranging your home birth, please contact Beverley Beech of AIMS - she is very experienced in supporting women in this situation, and would far rather that people contacted her, than fought on alone.

 

[fluffball]

Moss, I am so jealous! . But very happy for you that you have a good chance of having the birth you want.
I just can't see how they can justify the differences between areas.

Scotslass, that's exactly what I've heard, that they are there but there's no jobs for them. But clearly there are!

Daffodil, thanks very much for your sample letter and the links. I will definitely be writing one.
I think I'll call my midwife and tell her what I intend to do.

I feel bad because I know the midwives are doing a sterling job, and I'd certaily feel like crap dragging someone who is not on call as "a favour" if I beg. But to be honest, I'm sure I already have a reputation in my surgery as the "difficult one", as I had to really insist and pretty much haggle with my doctor to have my rubella immunity test done.

To be honest, when I wrote the original post all I felt like was, in that order:
- having a cry
- punching the health minister on the nose
- kicking the local NHS trust on the shins
- writing to someone to make a formal complaint

I just don't think I can cope without knowing whether I'll be able to have a homebirth or not until the last minute (other than because of an emergency)
I feel a bit better now, like there is something I can do about it.

Thanks all!

 

[Daffodil]

Hi

I feel bad because I know the midwives are doing a sterling job, and I'd certaily feel like crap dragging someone who is not on call as "a favour" if I beg.

Well what you need to bear in mind is that the NHS midwives are trying to improve their staffing levels. The Matron of midwives I spoke to thanked me for writing and said that if more women took a stand then it would make it easier for them to offer home births!

The guys at the top refuse to provide more home birth midwives because they say that there is no demand. What we need to do is make them aware that there IS a demand.

So don't feel bad.

It actually costs the NHS less overall for home birthing because its been scientifically proven that home births require less interventions and less aftercare. You don't take up a bed in a ward, etc.

In my case, they're not taking anyone off a maternity ward to attend me. They are just having another midwife on call in case I go into labour at the same time as someone else.

I strongly believe that if women who want home births speak up, things will improve in the NHS services.

Dawn