There are often situations in a birth space where snap decisions must be made, where deviations from ‘the plan’ are recommended and interventions take place. Usually these situations feel highly fraught, the care team can appear extremely concerned and you are swept into agreeing to all of the recommendations for the sake of you, your partner or your baby.
In rarer cases people may be left feeling they have no say, no option, no control. Their care team are either incorrectly telling them what they must do or they are coercing interventions which a birthing person may not want or fully understand.
In either situation you have a wonderful tool you can use:
Ask “Am I / Is my partner or is our baby in immediate danger?”
This question is an effective way of assessing exactly how much of an emergency the situation at hand is.
There are, of course, two potential answers. Lets take the first:
In this instance its pretty clear that the health care provider deems you, your partner or your baby to be in a highly risky situation. Their medical opinion is that immediate intervention is suitable.
Regardless, you deserve to understand exactly what their concern is, why, what they are advising you do, why and what the risks & benefits are. This can be a very swift conversation but understand that you have every right to this information and that the ultimate decision on how to proceed is STILL YOURS.
Only with the appropriate information can you and your partner make an informed decision. Make no apologies for asking.
I would also suggest asking that they immediately note down the discussion which has taken place and they they sign their recommendation. You may wish to read this over to ensure it sums up the conversation. If you are unhappy with their opinion, notes or anything else you can ALWAYS request a second opinion.
The alternative is of course - No.
Feel the urgency & tension lift from your body as you realise that this situation is not the ‘life or death’ it may have felt seconds ago.
From here you can breath a little slower, feel yourself settle back down. You have time to consider all options and discuss them fully with your care team and then again with your partner.
I recommend using the acronym BRAIN to assist you in these conversations.
B - Benefits
What are you suggesting & what are the benefits to this.
R - Risks
What are ALL the risks to what you are suggesting? (Dont let them only tell you about the risks of NOT following their advice). Most interventions carry some level of risk, I would be very sceptical if my care provider were telling me something is risk free. (Consider doing your own research or calling the AIMs helpline - they’re open late and will happily chat to you even if you’re in labour).
A - Alternatives
What are all the alternatives to what you are suggesting. There are usually other pathways (e.g. Intermittent monitoring as opposed to continual. Observing maternal behaviour rather than multiple vaginal examinations) the most commonly used method isn’t always the evidence based one.
I - Intuition
What does your intuition tell you? Do you feel that all is well? Or are you concerned about something and you dont feel youre being listened to? Take time to check in with yourself and make your voice heard. Your decision is final.
N - Nothing
Is doing absolutely nothing a reasonable option? Is giving yourself a little more time with no interference, fuss, pressure something you’d welcome? If so, youre more than entitled to decline all of the offered care and proceed.
I also suggest you ask for time alone (with your own partner/s) to come to your decision on how best to proceed without any pressure or coercion.
Having the presence of a doula with you in these situations can make the communication must clearer, calmer and less tense. You have an advocate there who can communicate your decision, ask relevant questions and encourage you to speak your wishes with confidence. Usually doulas have enough knowledge in where to access reliable evidence based information that they can support you as you research your care too. You will feel the benefit of an independent professional by you and your teams side.
If you would like 121 support from Jen please email firstname.lastname@example.org
‘Sure! We will be more than happy to support your homebirth!’ (A common response to a request for a home birth! Yey!)
However, it is usually followed with:
‘Unless, of course, there are not enough staff on that day. In that case you will have to come into the unit.’ (Not so yey…)
Fortunately its very simple, repeat after me…
‘NOT MY PROBLEM.’
It is not your job to consider the staffing logistics of your local trust when you are deciding on your place of birth. Wether you are assigned to a busy city centre unit or you live rurally and your local trust is practically a long weekend trip away you simply don’t have to concern yourself with this particular issue.
Fundamentally it is your right to choose where to birth.
“All people* should have an appropriate level of choice in relation to place of birth and there are a number of choices that should be available to all people in Scotland including birth at home, birth in an alongside or freestanding midwifery unit, and hospital birth.” (Gov.Scot - https://www.gov.scot/publications/best-start-five-year-forward-plan-maternity-neonatal-care-scotland-9781786527646/)
The factors you take into consideration as you make this decision are yours to choose. You are free to research as much or as little as you wish. My personal belief is that knowledge is power and the more you understand your rights and choices in birth the more confident you will feel in your interactions with your care team. However, in short - you are always in control.
If during your care you are told that you ‘will not be allowed’ a home birth due to staffing levels you are well within your rights to contest this. To support your case you may firstly like to draw your trust’s attention to their National Institute for Health and Care Excellence (NICE) guidelines which state:
“they may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support them in their choice of setting wherever they choose to give birth”
(NICE - https://www.nice.org.uk/guidance/cg190/chapter/recommendations)
You may then consider highlighting the complaint of Mrs Jane Reeve. Mrs Reeve was forced to hire independent care when her trust refused to provide home birth services to her. Her complaint was upheld and it was found that the suspension of home birth services was unreasonable.
It is also helpful to understand that the NMC code itself states
“You put the interests of people using or needing nursing or midwifery services first. You make their care and safety your main concern and make sure that their dignity is preserved and their needs are recognised, assessed and responded to. You make sure that those receiving care are treated with respect, that their rights are upheld and that any discriminatory attitudes and behaviours towards those receiving care are challenged.”
(NMC - https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf)
Is refusing home birth support a breach of the NMC code? When multiple contingency possibilities are ignored then I believe that it is indeed a breach & grounds for a complaint.
Ultimately though this is not your concern, you are simply not the one being paid to consider staffing logistics. We have people in our system with the means to do this.
I would strongly urge anyone who is currently experiencing issues with home birth provision to contact the following people/organisations:
*I have amended this for inclusivity reasons.