Supporting Home Birth In Bradford

Better Medicine Better Health

Supporting Home Birth In Bradford

Alison Brown – Consultant Midwife & Supervisor of Midwives

November 2013


Making Home Birth A Real Choice -the background to our initiatives

National Drivers – Maternity Matters 2007High Impact Actions for Nursing and Midwifery 2009Birth Place Study 2011Midwifery 2020 Local Drivers –Midwives and MothersMSLCBradford Choices GroupAiredale MumsBradford Community Midwives


Working Together to Make it Happen

Community Midwifery Team Colleagues Professional Development Midwife Childrens Centre Partners Local Support Groups Bradford Community Radio The Trust Publicity Department The Local Evening Paper Women and Families !

Strand One - MidwivesTraining Skills days Evaluations from community staff Via Supervision Emergency skills for home births Choice agenda



Our Aim To facilitate a reflective approach to

emergencies in the home environment, enhancing confidence and improving communication at all levels, in a non-threatening environment.



The Plan for the Day The key to everything – COMMUNICATION Demonstrating skills and practical sessions Updating on new evidence Scenarios and feedback The role of the Supervisor of Midwives Reflection Tea and cakes!



The Model for Feedback What went well, what could be done differently The opportunity to re-run Two things they felt they did well One thing to do differently Reflection and how the Supervisor of Midwives

could contribute



Outcomes Community Midwives and confidence Communication and documentation Support from Supervisors Wider collaboration – paramedics and IM

colleagues Confidence in service provision



Strand Two – Home Birth Workshops

Providing detailed information to enable robust choices to be made

Establishing effective relationships with women and their families

Creating a culture of partnership working



Creating a Forum for Information Exchange

The Home Birth Workshops include: Choices for the place of birth Assessing individual risks using the BRAIN tool Listening to each others stories Practical considerations Working on supportive strategies for labour and birth Coping with the ‘what if’s……..’

The BRAIN Tool Benefits (potential, any supporting information required) Risks (potential or actual, and/or side effects) Alternatives (Some always exist!) Instinct or Intuition (what you feel is right, gut instinct) Nothing – delaying decision making (what will happen if

you wait, take time to think things through)


Concerning Risks…… We work in a risk averse health service Safety assessments Risk discourse reflects medicalised rather than

social/midwifery view of birth Who does risk belong to? Risk as the lens through which choice is filtered


Some scenarios! Based on examples from recent practise Anonymised Women and families who have shared their

experiences


Woman A 35 year old, previous booked home birth, transferred in for delay

during 2nd stage of labour, failed attempt at forceps, baby born by LSCS. Felt traumatised and had PND. Still very tearful.

With second baby requests VBAC at home in the pool. Develops gestational diabetes. Undertaking hypnobirthing course. Supportive partner and family.


Woman B 34 year old G6 P3 (ventouse, home birth with ‘tight fitting

shoulders’, home birth with PPH of 1000 mls). Planning for another home birth. GBS positive. Anaemic prior to pregnancy but now Hb in normal range Obstetrician has advised against.


Woman C 29 year old G5 P2 (2 pregnancy losses, 1 LSCS for undiagnosed

breech, a vaginal birth in hospital) BMI 33, smokes 10 per day, lives in a large shared house.

Planning home water birth. Declines appointment with obstetrician, declines USS. Community midwife feels baby is breech at 36 week appointment. Has detailed birth plan – no specified time limits on labour, no

vaginal examinations, physiological 3rd stage of labour.


Woman D 39 year old primigravida with BMI of 39. Decides to have home birth. 2 weeks before due date, moves house, one

street of area – the community midwives want to keep her on.

She is T plus13 (x1 stretch and sweep) and declines induction



Top Tips For Success! Support from Head of Midwifery/Management

Team/Colleagues/Supervisors Develop a shared vision Be prepared to go the extra mile Collaborate with women and their families Be creative Get some publicity Think about getting support for yourself Keep calm and carry on!


In Summary………Just about everything is possible if the will is there

All partnerships are important, those with women can be crucial

Develop a service philosophy which women know about

Encourage EVERYONE to use the BRAIN tool

Aim to achieve a measured view of risk

In Bradford…. The home birth rate went up to 2% We won an RCM Award in 2011 for promoting normality We were highly commended by the APPG on Maternity for

working with service users in 2011 We have had numerous publications and conference

presentations Women feel we respect their choices and work with them Midwives feel prepared and supported to offer birth at home.



Plans for 2014 include….. A continued programme of home birth workshops Widening the network of women and partners willing to

share their experiences Addressing the information needs of partners A project to explore the views of South East Asian

women in Bradford A review of how community teams work Wider community midwife and MSW involvement!


Supporting Home Birth In Bradford

Documents

home environment

birth coping

birth place study

local drivers midwives

robust choices

brain toollistening

things thr

nonthreatening environment