midwife's muse

Homebirth???

I love homebirths, under the right circumstances. I suggest a homebirth as an option to all of my women who a) are considered to have no risk factors (low-risk); b) seem to me to be emotionally, temperamentally a good 'candidate'. Until today I hadn't really acknowledged that I make this judgement call about their emotional 'suitability', perhaps it had never really happened before but then 'Loopy Lou' came into clinic requesting a homebirth. I asked why she was considering a homebirth, I find this a good place to start as from the reply I can usually judge whether this is a well considered choice or them just grabbing hold of political and media hype or 'tree-hugging' stories on homebirth websites. The answer started well, they had attended antenatal classes the previous night where homebirth was mentioned, but then it went a little off, they were making the decision because the hospital was dark when they went there, they had to park, and they had to leave the dog and cats at home. I would see all these points as peripheral to the homebirth choice and certainly not the answer of someone who had really thought about giving birth at home. I continued sounding her out and, just to see if they had thought about everything they would have in the forefront of their minds I asked what they would do with the dog whilst she was giving birth. I explained that dogs may become distressed if their owners are exhibiting signs that they may be in discomfort and could become confused by the odours, particularly blood, which are associated with giving birth. After a momentary pause I received my answer, 'It's alright. Its my husbands dog, I'm not his owner'. There was something not quite right with her whole demeanour, I felt as if I was in a Shakespearean play as she kept making 'asides' to a person who was not in the room and then seemed to be listening to a reply. As we continued chatting I flicked through her notes; minor psychiatric problem in the past; cardiac abnormality at birth, which has since been corrected by surgery. Right, so when is she next going to see the consultant, she's not, whoever booked her considered her low-risk. Now, I'm in a dilemma here. I feel I should ask a Consultant to review her, purely due to her medical history and there is a little voice in my head telling me that this lady is not a good candidate for homebirth. I can advise her that in my personal estimation a homebirth may not be the best option and I have told her I would like her to see the Consultant, but she is now questioning why, in the previous 20 weeks, no other midwife has made that referral. Fair point, why haven't they? Would I have done if she hadn't requested a homebirth? I just don't know, all I know is that I feel uncomfortable with her having baby at home. So I've taken the cowards way out. I've asked my job-share to visit her at home, told her my concerns, admitted I have a strange 'feeling' about this case and said that I will concur with whatever decision she comes to. As it stands though midwives cannot refuse anyone a homebirth, we can advise against it but it is a Health Authority's duty to provide professional care for a woman wishing to have her baby at home. So, if Loopy Lou decides to go ahead with it, all I can do is put on my happy face and go with it. I just wish my gut instinct was not worrying me so much.

Stillbirth rates were is the news this week, they have remained unchanged since the early 90's and unplanned homebirths are mentioned as one of the causes. Do they mean Freebirthing, is that an unplanned homebirth, or a BBA? One is a deliberate decision not to involve professionals, the other a case of events being too rapid to allow professionals to attend. All I know is that any stillbirth is one too many and that any moves to lower the rates should be given huge publicity and support.

28.2.05 17:13