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Promoting Normal Birth Bradford Home Birth Workshops

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Supporting Home Birth In
Alison Brown – Consultant Midwife &
Supervisor of Midwives
November 2013
Better Medicine Better Health
Making Home Birth A Real Choice the background to our initiatives
 National Drivers –
Maternity Matters 2007
High Impact Actions for Nursing and Midwifery 2009
Birth Place Study 2011
Midwifery 2020
 Local Drivers –
Midwives and Mothers
Bradford Choices Group
Airedale Mums
Bradford Community Midwives
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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
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Women and Families !
Strand One - MidwivesTraining
Skills days
Evaluations from community staff
Via Supervision
Emergency skills for home births
Choice agenda
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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
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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
Tea and cakes!
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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
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Community Midwives and confidence
Communication and documentation
Support from Supervisors
Wider collaboration – paramedics and IM
 Confidence in service provision
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Strand Two – Home Birth
 Providing detailed information to enable robust
choices to be made
 Establishing effective relationships with women
and their families
 Creating a culture of partnership working
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Creating a Forum for Information
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……..’
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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)
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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
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Some scenarios!
 Based on examples from recent practise
 Anonymised
 Women and families who have shared their
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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.
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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.
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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.
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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
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Top Tips For Success!
 Support from Head of Midwifery/Management
 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!
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In Summary………
Just about everything is possible if the will is there
All partnerships are important, those with women can be
Develop a service philosophy which women know about
Encourage EVERYONE to use the BRAIN tool
Aim to achieve a measured view of risk
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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
 Women feel we respect their choices and work with them
 Midwives feel prepared and supported to offer birth at
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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!
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