A letter to my head of midwifery

Hi HOM, 

As mentioned, I am writing to you regarding my birth choices and preferences. I want to ensure these are addressed prior to my estimated due date so we can work together effectively from a place of understanding.

Human rights law gives individuals the right to enjoy a private and family life. This means I have the right to choose who supports me during pregnancy and birth, and in the days following birth and my chosen birth place.

Firstly my perceived risk is due to having a caesarean birth previously. Due to PROM I was induced which resulted in a caesarean. Prior to the cascade of interventions my waters were clear and I was fit and well showing no signs of infection or concerns for babies welfare. Had I been presented with the research at the time to make an informed choice I would have chosen to stay at home and wait, unless concerns arose.

For this pregnancy, all is currently well with the pregnancy and no other perceived risks other than the previous caesarean and a perceived risk of scar rupture. It was a lower transverse incision, the evidence suggests the risk of this is 0.22% and so I am willing to take the 99.78% chance that this won’t happen to me. My background in tissue viability assures me that I have a healed well and allowed enough recovery minimise the risk further again. I discussed this with the obstetrician and I understood him to respect my choices and has hopefully emailed you with the outcome of our discussion. I have asked that unless something comes up in the pregnancy that this is not revisited as I feel there is nothing more to say. 

As a Trust I feel you need to consider the harm the restrictions of the home birth policy may cause as I appreciate restrictions can be put in place, especially around winter pressures. Research in this area has repeatedly demonstrated the benefits of being supported by loved ones and companions of choice during pregnancy and birth. I appreciate staffing may not facilitate a home birth however should no one be available I will be remaining at home with the support of my husband, family and Doula unless I feel the need to come into hospital due to any concerns that I may encounter.

I know questions will be raised around my preferences to not be monitored in labour and declining Vaginal examinations. I would like to make it clear I am informed in my choices and that to achieve the birth that I need to heal from my previous experience these choices need to be respected.

There is no research to date examining whether the practice of fetal heart rate auscultation improves outcomes, or the optimal frequency of auscultation and therefore unless I request it, I do not want to be pressured into monitoring of any kind.

Also to add, the idea that the cervix can tell a midwife about my progress in labour is underpinned by an incorrect understanding of birth physiology. Childbirth physiology is complex and I strongly believe that being left undisturbed optimises my birth experience, mentally, physically and spiritually. I've done a lot of Dr Rachel Reeds lessons in reclaiming childbirth and witnessed firsthand birth unfold beautifully without interruption so the belief that my instinct will prevail is strong and this is what we should be guided by.

I understand that I may need to make alternative decisions during my birth. I want us to work together to make sure I fully understand my options so I can make an informed decision however understanding my above preferences will make this easier and as a result I am confident that my birth will progress without complication.

A lot of self discovery and research has gone into creating my birth preferences which is why I know this is the best chance for me having a birth without trauma or complication.

It is also important to note that once baby has arrived, I do not want the immediate time to be disturbed unless I request it. The only hands touching the baby will be that of my own, my husband and possibly my daughter if she is awake. I do not require active management of the placenta and it is through my own experience that I wish for patience with its arrival as it often seems to come at approximately 90minutes after birth of baby, of course each individual is different. I would also like to keep my placenta. We will be using a cord tie and cutting the cord as a family once the cord is white and non pulsating.

I appreciate their is a lot here that your policy’s may not be supportive of however I am hoping that any midwives involved will be excited about the prospect of a true physiological birth and supporting me by hopefully having to do nothing but sit, listen and wait. I will have refreshments readily available. I also hope that having all of this documented on my health care record can facilitate this further again and reduce any anxieties around protecting NMC registration. I want the midwives to feel relaxed in supporting these choices that do not fall within their usual practice. 

I look forward to your response and chatting through this with you.

Yours sincerely,

Leanne