These are answers to questions that women frequently ask of AIMS. If you do not find an answer to your particular question or you need more details than the answers below provide, you might find that some of the AIMS publications address your question, please see the publications page or you may find there is an article on our website that addresses the issue, please try the google search below. If you need further information please email email@example.com.
You will also find answers to some caesarean and VBAC questions on www.caesarean.org.uk
A midwife has no authority to allow or not allow a home birth; neither does a GP or an obstetrician. The decision to birth at home is yours and no one else can make that decision. Health professionals are there to advise and whether or not you take that advice is entirely up to you. NHS Trusts have an obligation to provide maternity care. When you decide to stay at home to have your baby, both the midwife's 'duty of care' and government policy clearly set out a woman's right to choose a home birth.
The midwife's duty of care is set out in the NMC Circular 8-2006 and includes the following statement:
"Whilst an employed midwife has a contractual duty to their employer she also has a professional duty to provide midwifery care for women. A midwife would be professionally accountable for any decision to leave a woman in labour at home unattended thus placing her at risk at a time when competent midwifery care is essential."
If you are having difficulty arranging a home birth please see our website article on home birth which contains further information about organising a home birth including sample letters.
Health Professionals often say that you are not allowed a home birth because you have a particular risk factor. For example:
Many women in these situations have chosen to have homebirths. There may be addition risks, but there may also be additional benefits to homebirth in these situations, and the decision remains yours. None of the above conditions necessarily leads to advice to have your baby in hospital and opinion has changed recently and continues to change as women challenge and home birth rates rise. The website www.homebirth.org.uk has a longer list of reasons women have been given for not being able to have a homebirth along with further information on each.
We suggest that you ask for more information about possible risks in your individual case and look at the AIMS website for more information.
AIMS sells the book Home Birth - A Practical Guide by Nicky Wesson, which you may find helpful.
The Trust's staffing problems are not yours and this commonly given excuse is not reasonable. NHS Trusts have an obligation to provide maternity care. When you decide to stay at home to have your baby, both the midwife's 'duty of care' and government policy clearly sets out a woman's right to choose a home birth. (see question 1)
If you are having difficulty arranging a home birth please see the website article on home birth which contains further information about organising a home birth including sample letters. Unless women protest about these excuses there will be no incentive to improve the staffing and make real provision for home birth and carry out government policy.
We would suggest that letters sent to Heads of Midwifery, Consultants and Supervisors of Midwives are also copied to the Chief Executive of the Trust and to AIMS (see contact details).
If the staff persist in suggesting that your home birth depends upon the availability of the midwives on the day, or some similar excuse, we suggest you write to the Chief Executive and inform them of your intention to stay at home, quote the above advice and ask what steps they are going to take to ensure that when you call in labour a midwife will attend.
There is no reason why you cannot have the antibiotic injections at home and if your midwife is not qualified to give them she can make arrangements with the district nurse or your GP for that to be done. However, there may be reluctance to give IV antibiotics at home because of an increased risk of an allergic reaction.
The article The war on group B strep, considers the need for treatment when women are identified as having Group B Strep.
The Summary of the Cochrane Review - Intrapartum antibiotics for known maternal Group B streptococcal colonization  says: Women, men and children of all ages can be colonized with Group B streptococcus (GBS) bacteria without having any symptoms; bacteria are particularly found in the gastrointestinal tract, vagina and urethra. This is the situation in both developed and developing countries. About one in 2000 newborn babies have Group B streptococcus bacterial infections, usually evident as respiratory disease, general sepsis, or meningitis within the first week. The baby contracts the infection from the mother during labor. Giving the mother an antibiotic directly into a vein during labor causes bacterial counts to fall rapidly, which suggests possible benefits but pregnant women need to be screened. Many countries have guidelines on screening for GBS in pregnancy and treatment with antibiotics. Some risk factors for an affected baby are preterm and low birthweight; prolonged labor; prolonged rupture of the membranes (more than 12 hours); severe changes in fetal heart rate during the first stage of labor; and gestational diabetes. Very few of the women in labor who are GBS positive give birth to babies who are infected with GBS and antibiotics can have harmful effects such as severe maternal allergic reactions, increase in drug-resistant organisms and exposure of newborn infants to resistant bacteria, and postnatal maternal and neonatal yeast infections.
This review finds that giving antibiotics is not supported by conclusive evidence. The review identified four trials involving 852 GBS positive women. Three trials, which were around 20 years old, compared ampicillin or penicillin to no treatment and found no clear differences in newborn deaths although the occurrence of early GBS infection in the newborn was reduced with antibiotics. The antibiotics ampicillin and penicillin were no different from each other in one trial with 352 GBS positive women. All cases of perinatal GBS infections are unlikely to be prevented even if an effective vaccine is developed.There is further information about GBS on the Gentlebirth website and on the Group B Strep Support website that may also be of help.
There was concern that labouring or giving birth in water may increase the risk of a baby being infected with GBS, but recent research (see Water birth: is the water an additional reservoir for group B streptococcus? ) seems to be show that this is not the case, instead labouring or giving birth in water looks as though it reduces the risk for babies. The abstract says:
There is a Practising Midwife Article - Water birth for women with GBS: a pipe dream?  which considers waterbirth for women who are known to have GBS.
This is untrue. Unfortunately many people including midwives believe it is the case. Article 45 of the Nursing and Midwifery Order 2001 states that: "A person other than a registered midwife or a registered medical practitioner shall not attend a woman in childbirth." but this does not apply "where the attention is given in the case of sudden or urgent necessity".
The order is intended to prevent people from pretending that they have midwifery qualification when they do not. It is not designed to prosecute those who are present at a homebirth when the woman decides that she is not going to call a midwife or a doctor. It is not possible to prosecute a woman for birthing her own baby alone - although this decision may be considered unwise, it is not illegal.
As a result of this confusion AIMS lobbied the Department of Health asking for clarification In September 2002. Jacqui Smith Minister of State at the time wrote to Julia Drown MP as follows:
"Attending a woman in childbirth as opposed to general support given by partners and relatives had been an offence against the protected function of midwifery since the Midwives Act 1902 ...By attend we mean assume responsibility for care and this is not intended to outlaw husbands, partners and relatives whose presence and support during childbirth are extremely important.
The NMC also provide advice on this issue. Saying:
"Free or unassisted birth means a woman giving birth without medical or professional help. In Britain where its popularity is growing, it is legal as long as the birth is not attended or the responsibility for care is assumed or undertaken by an unqualified individual. An unqualified individual is a person who is not a registered doctor or midwife but acts in that capacity during birth. The woman assumes responsibility for her birth, but she may and can have her partner, relative or friend present in a supportive role. A midwife has no right to be at a baby's birth and if a woman chooses not to contact or engage a midwife that is her right to do so."
It goes on to give further guidance for those attending in a supportive role and for midwives
A health visitor has no right of entry to your home and you have no obligation to see her if you do not want to. In order to gain entry to your home she would need to obtain a court order. However, we must point out that child protection has generated such fervour that health visitors have occasionally been known to threaten a report to social services if refused admission. In this unlikely event we suggest you seek advice and support immediately, either locally, from your GP for example, or contact AIMS.
Yes, you have a right to refuse to be attended by anyone you do not want near you whether it is a midwife, GP, health visitor, obstetrician or paediatrician. You can ask them, the Head of Midwifery, the Supervisor of Midwives, or the Chief Executive of the Trust to arrange for someone else to attend in their place. This applies whether you are at home or in hospital. Anyone who continues treatment without your consent commits an assault. In the case of a GP you can sign on with another GP the following NHS website page will allow you to find out which other practices are nearby.
The decision to be induced is yours and yours alone. You can simply stay at home until you go into labour. You should be offered some sort of monitoring of your baby, however, there is no evidence that this improves outcomes. Your rights to support for the birth at home or in hospital are unchanged no matter how long your pregnancy has been.
It can be difficult refusing when you are under such pressure, however if you do decide to go to the hospital and discuss your decision you may like to press for a clear answer about the relative risks of the likely adverse affects of the procedure on you and your baby so that you can weigh those up against the unlikely potential benefit of preventing an unexplained stillbirth. Asking for such information in writing might be helpful.
The rates of an unexplained still birth is as follows:
(Note that the rate at 37 weeks is almost the same as at 43 weeks)
Cotzia C. et al. Prospective risk of unexplained still birth in singleton pregnancies at term: population based analysis, British Medical Journal, Vol. 319, pp 287-288 1999.
Longer pregnancies are usually a variation of normal and about 5% of pregnancies will go to 42 weeks and 1% to 43 weeks. Often women who have longer pregnancies find other family members have been born at longer gestations too (themselves or their partner, their siblings, parents, cousins, etc.)
Bleeding in early pregnancy is fairly common and does not automatically mean that you are miscarrying or that there is anything wrong, and miscarriage is not the only cause of bleeding.
Such a loss is very upsetting and health services should be sympathetic and explain to you that there is nothing that can be done save such an early pregnancy. Sadly many pregnancies end in miscarriage, probably 1 in 4, and there is little that a midwife or doctor can do that would be helpful in the first 12 weeks, which is why booking-in visits tend to happen from 10-12 weeks. Neither rest nor admission to hospital has been shown to help.
Although sometimes scans are carried out, A and E is not a good place to be when coping with a miscarriage and because there is little that can be offered in terms of medical care you are likely to recover better if you stay at home and let nature take its course. Sometimes the bleeding will stop and the pregnancy will continue without further problems.
However you should have been provided with information about circumstances when you may need to contact a health professional again, for example if the bleeding or the pain becomes excessive or you develop a fever. The main area of concern with bleeding in an early pregnancy would be that the pregnancy might be ectopic, i.e. in the wrong place (see www.ectopic.org.uk and if you were in pain then they should have checked to make sure this was not what was happening.
Carrying out internal examination could make things worse if you are not actually miscarrying and a D and C (Dilation and curettage) where the cervix is stretched open and the contents of the uterus are scraped out, can damage the womb.
There has been research showing that ultrasound scanning can increase miscarriages, however this research was done later in pregnancy. We have no research carried out early in pregnancy to provide information about whether caution should be advise about ultrasound scans at this time.
It might be worth feeding back to the hospital how you feel you could have been treated more sympathetically, and given more information. You can send your letter to the Chief Executive of the hospital Trust.
If you needed someone to sign you off work then your GP should be able to help with this.
It is very, very unlikely that your baby is too big for your pelvis. This was seen in the past in women whose pelvis was damaged by rickets which is now rare (although possible) so unless your pelvis is deformed or damaged (such as from a road accident) you will almost certainly grow a baby of an appropriate size to fit through your pelvis, as we have evolved to give birth and have being doing so for generations.
There is some concern that women who are obese are growing babies that are bigger, but there is no evidence that their size will cause a problem for the birth. Research has shown that assessing the size of a woman's pelvis does not predict who will have a successful VBAC (vaginal birth after caesarean) infact vaginal birth rates were the same for women who had small and large pelves. Interestingly though, the research did show that the act of measuring her pelvis reduced her chance of success, we presume because it undermined women's confidence in their ability to birth. The examination cannot predict how much your pelvis will change in labour (possibly 20% wider as ligaments stretch) and how much the babies head will mould to fit the birth canal.
In the unlikely event of your baby truly being too large for your pelvis labouring is still beneficial for you and your baby, preparing both of you for the birth. During the labour the baby will descend so far, and no further, and which point a caesarean can be carried out. However, in most cases lack of descent is not caused by the pelvis being too small or the baby too big, but by other factors such as lying on a bed which compresses the pelvis and means gravity is acting in the wrong direction, or because the baby is in an awkward position. If lack of descent occurs you will need to discuss with the midwife how you feel, what can be done about it and, providing your baby is not distressed, whether or not you wish to wait a further length of time and await events.
The AIMS publication Making a Complaint about Maternity Care provides a guide to making a complaint, including procedures, pitfalls and the regulations. It is available as a printed booklet or as a free pdf, for details please see the publications page.
AIMS provides information on many aspects of maternity care, so if you have any questions about your plans for the birth, midwifery care etc. then we will be very happy to answer those.
We are not, however able to deal with issues around maternity pay, leave, benefits or employment rights. We would suggest that you contact any of the organisations listed below. They should be able to help you.
There is no simple answer to this question. In principle, the present government policy gives everyone the right to choose which hospital they want to have treatment in. However, maternity is a more complicated issue than booking in for a procedure that can be timetabled in advance.
You will be asked to book your place of birth, probably early in your pregnancy when you first make contact with the maternity service either through your GP, or (preferably, in our view) through your community midwives. However in some areas of the country you will not be asked to make a final decision about where to give birth until much later.
Women who are lucky enough to get to know their midwife during their pregnancy and whose pregnancies progress without complications are often very comfortable to make the decision to stay at home for the birth. Other women will make a decision to seek midwifery support for a homebirth.
If you wish to avoid going to a particular hospital then you can refuse care from that institution. In this case you should be offered care somewhere else. Many women who have had traumatic experiences in a hospital, maternity or otherwise, do refuse to go back to that hospital.
Booking into a particular hospital, or birth centre or a home birth does not guarantee that you will give birth there. Complications arising or disappearing during the course of your pregnancy may cause you to change the planned place of birth or you may need an emergency admission (and if you are transferred by ambulance you will be taken to the nearest obstetric unit). Hospitals may also close their doors because they are full, in which case you will be advised to go to another unit.
A birth centre, or midwife led unit (MLU), will have guidelines restricting which women will be able to use their services; usually this will only allow those who are judged to be low risk to give birth there. You cannot insist on booking in to an MLU if you do not fit the criteria, although it is still worth trying to negotiate. You do have a right to choose a home birth (see Question1), and sometimes you may find that opting for a home birth may cause the guidelines for the MLU to be interpreted more flexibly.
In our experience women who ask politely but firmly for what they want often get agreement. Your GP is unlikely to help you to book into the hospital of your choice if it is not the one they normally deal with, but your written request direct to that hospital may work. You may also find that the Head of Midwifery at the unit may be able to help you. Alternatively, you may get help from one of the local Supervisors of midwives (see http://www.nmc-uk.org/Nurses-and-midwives/Midwifery/Supervisor-of-midwives/ for an explanation of the role of a SoM).
Unfortunately, if a hospital is oversubscribed they may refuse to accept responsibility for your care on that basis, but perseverance can still pay off.
Should you turn up at a hospital in labour (and many women do so when they find themselves in labour and away from home) a hospital will have an obligation to provide care; this is considered an emergency situation for which they will be responsible.
Finally, on the day, the quality of care you receive will depend on the particular staff who take on your care rather than the institution, so we would recommend that you consider carefully the kind of care you want, what are your priorities and whether you can attempt to find out about and get to know the midwives who are likely to look after you when you give birth.
The following page on the NHS direct site implies that women have a choice of which hospital a women can have her baby: http://www.nhs.uk/Planners/pregnancycareplanner/Pages/choosingwhere.aspx
Although the NHS charter pages http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Documents/nhs-constitution-interactive-version-march-2010.pdf seem to list maternity as an exception to being able to chose which hospital you can have your baby. This exception was required in order to cover services such as homebirth and community midwifery which only provided care within a geographic area.
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