Albany home births suspended?

[sillywoman]

I was told by a neighbour today that The Albany Group of Midwives have been suspended from practicing home-births and are undergoing some kind of investigation. Can anyone verify this, or shed any light at all? if it's true it may have some knock on consequences for Mums registered with other local teams as Brierly, the Lanes etc. may have to pick up some of the albany's planned homebirths.

[kittysailing]

Hi yes its true. I'm booked with them and had a phone call yesterday. It's really sad as they are fantastic. You still have the option of going into hospital with your Albany midwife. Or you can book with one of the other local ones who do homebirths. I'm in a dilemma. Want a homebirth but want the midwife from Albany who I've seen for the last 8 months. Is anyone else in a similar position? If you go to Brielrly or Lanes do you know which midwife it will be in advance?

[Vik]

This is really sad! The Albany Midwives really are fantastic, hope it's just a glitch and it's all sorted very soon, for all the women planning for a homebirth with them.

[ymenik21]

Oh this is so sad news ,they were more than AMAZING.I do really really hope it all get s orted out coz they are so great.

[curlykaren]

hi kittysailing, if you are with the lanes yes you will know the midwife in advance (barr hols and days off) you get to meet a few of the team...the lanes are great x

[bawdy-nan]

anything to do with this?

Seems a terribly sad case of course but the Albany practice have such a good reputation and success rate in acheiving good births it feels like a terrible shame to have them put out of operation even if this is for a short time.

The issue in the article seems to be about whether or not continuos electyrical monitoring is necessary. I can't imagine anything worse during labour.

[Mellors]

How awful for the people involved, but a terrible shame to suspend the practice. I have to say that I was in exactly the same position (previous ceasarean, followed by natural delivery) and I had a non-hospital water birth with only hand held monitoring from time to time, and no internal exams. I had no idea that you are meant to have continual electronic monitoring under the NICE guidelines. If I had know that the consequences could have been so serious I might have thought twice about it though.

[craigy]

it is recommended that you have continuous fetal monitoring in labour if you have had a previous section but you can make an informed choice not to usually with the obstetric team and have intermittent listening in to the heartbeat every 15 mins when in established labour and many women make this decision and go on to have natural, low intervention births.. generally the risk with a vaginal birth after caesarean is more to the mother who is a risk of a ruptured uterus rather that the baby..

[sillywoman]

Have learned a little more. It's not to do with that. It's to do with their stats on new babies having to spend time in SCBU. Apparently their stats in this area are higher than other group practices so they are being investigated. Hence the suspension. Of course this is all anecdotal & could be talking b*$^**cks, but the source is pretty reliable.

It's so rubbish though, they're such a great and dedicated group of midwives, South London has always been so lucky to have them working here. And they take on many women who want a homebirth but who may be considered in a higher risk category (e.g. VBAC's etc) so of course their statistics will be skewed by this.

Ho-hum, I sense little grey men at work. I can only hope that their practice will come through the scrutiny with flying colours and that the greymen will be able to see the wider benefit of the work these fab midwives do.

[buggie]

Having had to work as part of the team in hospital, resusitating a baby who arrested and subsequently died following a planned home delivery, I welcome investigation and scrutiny to ensure that no family goes through having to be told that the baby they haven't even had chance to know yet has died.

Oh bother, a few mum's might have to change their plans, but, if following this better understanding/practice to avoid these situations is implemented thus potentially saving lives/preventing risk of damage during delivery then where is the problem??

[annaj]

Absolutely, buggie.

If any healthcare service has a consistently higher rate of complications than other comparable services, then of course it has to be investigated. In the case of serious complications, such as deaths, then it may be that the service needs to be suspended until an investigation has been carried out. It's not about "grey men", it's about preventing avoidable deaths.

You may well be right, silly woman, that the mortality rate is higher, because of the type of cases that Albany take on, but that can't be assumed it has to be demonstrated and that is what an investigation is for. Also, if their accepting high risk women for home birth is resulting in significantly higher mortality, perhaps they shouldn't be accepting them. This isn't trivia, it is about neonatal deaths which may be avoidable. I can't really believe that anyone would think it shouldn't be investigated.

As for the case linked earlier and continuous monitoring, it's really a question of informed consent. If a woman has the risks of not being monitored clearly explained to her and understands them, but chooses not to be monitored for whatever reason, that's fine. We're all entitled to make our own choices. If, however, the risks are not explained by the person the woman is trusting to guide and advise her, as is alleged in the case linked earlier, then she doesn't have all the information she needs to make that choice. As medical practitioners it is part of our duty of care to fully inform patients, so that they can make informed decisions.

Perhaps I'm a bit senstive, but I often feel there's a bit of an anti-doctor and anti-medicine vibe in this section. I think it's worth pointing out that NICE is not some shadowy, sinister organisation designed to control us all or take away anyones right to choose. The purpose of NICE is to review medical research and produce guidelines based on that research to try to ensure that everyone receives the best possible standard of care and prevent harm. It also helps to eliminate inequalities in care by setting standards to be followed nationwide.

I realise that a lot of people on here have had great experiences with Albany and I don't want to detract at all from that, but to my mind, hypothetically speaking (because we really don't know all the facts here) a midwife who encourages homebirth, without fully explaining the risks, is no better (possibly worse)than a doctor who pushes for intervention.

[Belle]

Think those are really good points annaj. I'm pretty medically clueless and find it helpful to have all the facts - from across the spectrum of views - so hearing from your perspective is really useful.

[sillywoman]

Mmmm,

I agree mostly with the content of what you both say, and (buggie) I have no problem with the practice of any health provider being closely monitored - I don't recall saying that I did?, I find both your responses aggressively defensive in tone. I do understand and agree with the need for scrutiny - I don't think I said that I disagreed with it? Though I can see that if my post was read by someone in defensive frame of mind they could choose to infer that. In attitude I'm very far from anti-doctor or medicine, where either, or both, are needed, but I do think there is an inherent danger in trusting completely to the medical establishment for judgments. The American childbirth model lies at the end of that path. We all know that in reality decisions about what's acceptable and what isn't often come down to the attitudes of a 'few good men' (or women). In that sense decisions regarding public services are always about 'grey men', it's naive to deny that.

The Albany have always practiced slightly outside the bounds of convention, rather like South London's version of Ina May's Farm', and up to now they have been successful in what they do. I can't know the fine details of this suspension, but I would prefer if you didn't infer from my support for them and their difficult situation that I'm a doctor-hating radical with a determination to trivialise the issues this raises. This is far from the truth and you misrepresent me if you do that.

In my line of work my attitudes to the medical establishment often come under close scrutiny, I strive to be balanced and rational whilst encompassing a broader world view. I cannot afford to allow either of you to use the lens of your own attitudes to skew the content of my post thereby suggesting views that were never expressed or held by me.

[annaj]

I'm sorry you feel I've misrepresented you, but I don't think my post was aggresive or defensive. A little sensitive in the last paragraph, perhaps, but I admitted that myself. Your post read as if you were dismissing the need for an investigation, I've just read it back and it still reads like that to me. Phrases like "it's so rubbish" and "little grey men at work" sound dismissive to me, so that is what I responded to.

And I didn't infer that you were I doctor hating radical. I said that I feel there is something of an anti-doctor vibe in this section, which I do. If you read that as referring specifically to you then maybe it's you who's reading "through the lens of your own attitude".

Come to think of it don't we all see everything through the lens of our own attitude?

Anyway, I've been up all night and need to go to bed, so I'll leave this one there I think.

[sillywoman]

Ah well annaj, you say tomato, I say tomato and so on. It's easy to misinterpret without the aid of body language and voice tone for interpretation. These forums are famous for it. Apology accepted and I'll let it go too.

[helena handbasket]

Sorry sillywomen, but I think it was you who took the discussion in that direction. I thought the previous posters made some interesting points, and your following post was the aggressively defensive one. Didn't quite understand the apology but oh well.

Just wondering, what does "the American childbirth model" mean? I hear a version of "American style" used quite often in this country, often to describe something unpalatable. I'm always confused by it. Particularly since Ina May' farm (American) is used as the example for gold standard natural birth here. Hmmmmm.

How would you describe the "British childbirth model"?

And no I'm not American.

[The Nappy Lady]

I believe that Sillywoman was referring to the fact that it is illegal to have a home birth in almost all American States (with 1 or 2 exceptions).

I honestly think this discussion is in danger of going off topic in relation to the comments between Sillywoman and AnnaJ, if we'd been discussing this in a room face to face the confusion would not have arisen, it is the result of that age old problem of reading words without the added context of body language and facial expression.

Molly

[Polmoche]

Actually, america is a real mixed bag when it comes to home birth. It's not actually illegal to have a home birth, its just illegal in about 11 states for a mid-wife to assist the birth, in another handful its legal, while most of the states its sort of legal sort of not legal, and therefore unregulated. The big issue there is that no one knows how to regulate it so its fallen through the cracks. Also the other big issue is insurance--most people in america have private insurance and most insurance companies do not like home births!

[helena handbasket]

Molly I really feel that annaj was completely reasonable and on topic........ until it was made personal. It's a bit much to blame the discussion on "confusion" and certainly too much to blame it on not being face to face and relying on words only to communicate. One person shared their opinion and experience, another shared their own in response. Part of participating on this forum is the understanding that everybody isn't going to love everything you say all the time. Several people are cursing me as they read this! :)

Otherwise I find the discussion to be interesting. And I think that there is some truth to what annaj is saying: I am curious about the anti-medical establishment tone that pops up on here as well. I am interested in the response from the medical community and I often feel that it is not welcome. And there is room on this forum for all sides to discuss.

And no I don't work in the medical community either.

[linzkg]

home birth vs hospital births are a tricky one and always will be i guess .. in the "old days" ladies were giving birth to babies in bushes and it quite scary to think that nowadays, with all the medical intervention and support, babies are still lost.

i recently gave birth to my son - at home, in water. when he was born there was no heart beat and he wasn't breathing, so still born, but because my midwives had been constantly monitoring his heart rate with that funny little machine the whole time they knew it wasn't long that he'd been without air so they cut the umbilical cord immediately and begun bagging him, 2 mins later called an ambulance, 2 minutes later our front room had 10 paramedics in it and 5 ambulances outside! needless to say he received the medical support he required and after being rushed to hospital has survived after some time on life support and in ICU.

but then i've since heard of stories (i have been fishing as we are definitely considering our own legal case against the hospital for various reasons) but of ladies recently who have actually been in hospital to give birth and the baby has got into trouble but yet they were not able to get to the baby in time and the baby has not survived, or have had long term damage.

so was i completely lucky or is there something to be said for being at home and completely relaxed and everyone remaining calm and in control (as much as we all could of coz!) and having 911 on call with ambulances to drop everything to get to us? due to the way my midwives conducted themselves and how quickly they responded we have our gorgeous son with us today .. as much as i am furious i was left at home to go through what we did i often wonder what would have been so different in a crowded hospital?

i think as long as midwives are left to guide us through pregnancy they will encourage home births won't they? i guess a solution would be to have a obstetrician / or doc that would favour a hospital birth at your disposal to have these discussions with so that you're more educated ..

[linzkg]

ps, i was with brierley and found them to be great .. if anyone's still looking for a midwife

[Ann]

Linkg.

Brierly midwives look after women who have specifically requested home birth. They are employed by Kings. You cannot take legal action against the hospital without implicating the midwives who were responsible for you through-out your pregnancy. If you're implying you shoudn't have given birth at home then you should have been advised by your midwives at he time. Your post doesn't make sense.

[linzkg]

I simply looked them up after finding out I was pregnant and asked after local midwife teams .. I can't even remember if they told me they'd only support home delivery but I was interested in home delivery any way so I guess it was never an issue at the time ..

You're probably right, if I had to take action against the doctor at the hospital it would probably mean bringing in the midwives in one way or another but my issue is specifically with a doctor who's care I was under.

[helena handbasket]

linzkg you are right about women giving birth in bushes, in many places they still do. But I rarely hear anyone mention that some of these places have incredibly high infant and/or mother mortality rates (for a variety of reasons of course). I have a feeling that the women who have no option but to go alone into a bush would have trouble understanding a culture that has the luxury of ignoring the preventative measures modern medicine provides for us. Or our access to knowledge.

When I was pregnant I saw the movie The Constant Gardener. The main character is an aid worker in Africa and decides to give birth in the African hut hospital instead of a modern English hospital because she doesn't want to have special treatment above that of the women she is working with. Her baby dies in childbirth. And all I could think was how insulting it was to the other women in that hut who would have done anything to have the option she had access to. In a funny way it formed a lot of my attitudes towards the politics of birth.

Sadly, there will always be a terrible outcome for someone until mortality rates are zero, which is not possible. But they are very low. I think home births are wonderful and fantastic, hard not to, and I read Ina May like everyone else. But after my doctors said I should have a c-section it took me about three seconds to decide to put my faith in them and accept that as my new plan. I'm certainly not suggesting that everyone should jump on the medical intervention bandwagon, far from it, but I also sometimes felt (and still do) that birth has become a competitive sport and the challenge is to prove how tough you can be (85 hours! no drugs! baby came out sideways! on the roof of our house! top that!)

linzkg I am so happy your little guy is well, what an incredible story. I hope you get the answers you are looking for.

[Fuschia]

Typing one handed as sick baby on lap.

With regard to the substantive issue, hope it is resolved soon. Hard to have a view about an increased no of babies in scbu for albany without knowing a lot more about the stats. remember they cover peckham, much poorer area than ed. that in itself would increase complicatiions for the newborns compared with the demographic here that chooses homebirth.

With regard to the broader issue of homebirth vs intervention, opinions will always be strongly felt. women who feel having a medicalised birth resulted in un-necessary intervention... the occasional rare case where complications arose in a midwife led or homebirth that might have been avoided via more intervention.

but if you think about induction, you need to induce hundreds of babies to "save" just one. and many of those inductions will fail and end in instrumenta; delivery, cs, extended hospital stay, possible difficulties with breastfeeding or bonding...it all depends what measure you look as evidence of success.

i declined continuous monitoring for my twins, and also left twin ii for a couple of hours to see if she would turn an be born without help. that was my informed choice. it was reassuring to be in hospital where assistance was availabe if needed .. but that didn't mean i wanted to go the route of epidural, cfm etc etc.. "just in case"

birth is a natural process, not an illness. in most cases we are best left alone to get on with it. occasionally it goes wrong, and we are lucky to have the facilites we do.