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Re: Failed Home VBAC after 3 previous C/S - StillbirthFrom: Jane Wines (jane.wines@telus.net)Sun Apr 30 10:58:51 2006
Jane,a few questions: 1)Why would the midwife be obliged to find someone who is competent and not the patient?And this would include waterbirths of twins at home, I assume. 2) What is the local health trust and why should it allow women to attempt high-risk births at home? Or are twins not "high-risk" in your opinion? Robert Modugno MD MBA FACOG Marietta, GA Sorry for the delay. 1) In the UK the woman is supposed to have the right to birth where and how she wants. She can be given all the info that is around, but if she wants to do her twins at home she can *but* the midwife is able to decline to look after her if she feels it is out of her comfort zone. The responsibility is for the trust (hospital) to find her someone willing, or she can get an independent midwife, or the hospital can draft in an independent. I say 'supposed' because it can be very hard or impossible to find someone who is willing or capable of supporting this woman. There is a responsibility to both the woman and midwife. However you can not abandon care, so if you are stuck at home with someone you think should transfer then the supervisor should provide either physical support, or acknowledge that the situation is there and provide support with documentation, or whatever is needed. Although the principle of womans rights are there - it may be hard for her to actually find that support - and various bullying tactics and threats have been used to get women to comply. 2) Yes twins are higher risk, but plenty are born at home. Why should the trust (hospital authority) support her - because it is her body and baby and right to decide in the UK. As I said though - it doesn't mean it will work out in her favor. You would hope that the relationship with her midwife would mean that women are able to process the information and come to an amicable agreement that both her and her midwife agree on. Interestingly, if a high risk woman declines OB care, the midwives are still obliged to look after her! It has been a couple of years since I was in the UK - but don't think anything has changed that drastically in law. Jane RM, Canada
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