Intervention with a midwife monitored home birth

[Floweryfields]

*I wanted to ask this in the actual thread it was raised in but didn't feel it was appropriate, so...
May I ask... I was under the impression that with midwife monitored home birth, you had far more flexibility with the 'rules' ie 24 hours to labour after waters break.
In a members recent birth story, the midwife was insistent that she transferred to hospital as she had not delivered within 24 hours of waters breaking.
I was a bit suprised to read that because I believed part of the reason many women chose to birth at home with independent midwives is to avoid this kind of strictness. Perhaps I am misguided?

[HotI]

Around Australia, there are a few publicly funded homebirth programs. Some of these have stricter guidelines that the midwives have to work within. The midwives are employed by the State, so although they are often more keen on natural birth than many hospital based midwives, they are not independent in that they are working just for the woman.

Secondly, some 'independent' midwives have signed collaboration agreements with Obstetricians, and then have less ability to make their own decisions (without upsetting the collaboration agreement), and their 'independence' may be questionable..

[Floweryfields]

Oh, I see, so even though they are 'independent' they are still 'under the thumb' somewhat?

[HotI]

yep, but its a choice to sign a collaborative agreement (for now).

[Cassius2]

Basically yeah. Particularly with hospital funded programs there is alot of pressure on the midwives to keep things just like hospital or there is risk of the program being stopped . so they are kept to hospital policy (ie failure to progress is not determined by the birthing mum or baby, but by what the hossy determines as 'taking a long time' ITMS).

Hopefully once alot of the trial periods are up, these programs can begin to etch out their own policies that can better reflect the individual care that is inherent with HB, but for now, the rules are pretty strict.

[Jennifer13]

You would not have the same restrictions with a completely independent m/w, but obviously the cost is your alone and not through the public system. You can talk to them about the kind of procedures they follow before a hospital transfer though and come to an understanding beforehand.

[PollyA]

In a hospital things often happen much sooner, so while there are still timelines, they are more flexible and you still have the benefit of being in your own environment with a person that you trust, these kind if guidelines are based on risk of infection etc and not something that midwives disagree with necessarily. Also if you do transfer you take the trusted person who knows you and your preferences who can help keep the interventionists away to a point.

[Cassius2]

these kind if guidelines are based on risk of infection etc and not something that midwives disagree with necessarily.

But again, those (time) guidelines that are based on risk of infection post rupture of membranes are highly subjective. For example, midwives agree that post rupture there is an increased chance of infection, however, there is a much wider window of time of up to 5 days simply because of the kind of one on one care and information to the client that they can provide.

[HotI]

In a hospital things often happen much sooner, so while there are still timelines, they are more flexible and you still have the benefit of being in your own environment with a person that you trust, these kind if guidelines are based on risk of infection etc and not something that midwives disagree with necessarily. Also if you do transfer you take the trusted person who knows you and your preferences who can help keep the interventionists away to a point.

i'm a bit confused by your post. Are you referring to ahospital as akin to 'being in your own environment with a person that you trust'?

[onthefly]

I think polly is saying that while there are rules they have to follow, they have a little more flexibility (in a more comfortable environment) when you're planning a homebirth as opposed to being in the hospital from the start.