What follows is a copy of an entry I made in a previous life, blog. I have reproduced it here as I saw the woman ‘Loopy Lou’ again today and am feeling really ambivalent now toward her, and even more worried about her choice of a homebirth.
I love homebirths, under the right circumstances. I suggest a homebirth as an option to all of my women who a) are considered to have no risk factors (low-risk); b) seem to me to be emotionally, temperamentally a good ‘candidate’. Until today I hadn’t really acknowledged that I make this judgement call about their emotional ‘suitability’, perhaps it had never really happened before but then ‘Loopy Lou’ came into clinic requesting a homebirth. I asked why she was considering a homebirth, I find this a good place to start as from the reply I can usually judge whether this is a well considered choice or them just grabbing hold of political and media hype or ‘tree-hugging’ stories on homebirthwebsites. The answer started well, they had attended antenatal classes the previous night where homebirth was mentioned, but then it went a little off, they were making the decision because the hospital was dark when they went there, they had to park, and they had to leave the dog and cats at home. I would see all these points as peripheral to the homebirth choice and certainly not the answer of someone who had really thought about giving birth at home. I continued sounding her out and, just to see if they had thought about everything they would have in the forefront of their minds I asked what they would do with the dog whilst she was giving birth. I explained that dogs may become distressed if their owners are exhibiting signs that they may be in discomfort and could become confused by the odours, particularly blood, which are associated with giving birth. After a momentary pause I received my answer, ‘It’s alright. Its my husbands dog, I’m not his owner’. There was something not quite right with her whole demeanour, I felt as if I was in a Shakespearean play as she kept making ‘asides’ to a person who was not in the room and then seemed to be listening to a reply. As we continued chatting I flicked through her notes; minor psychiatric problem in the past; cardiac abnormality at birth, which has since been corrected by surgery. Right, so when is she next going to see the consultant, she’s not, whoever booked her considered her low-risk. Now, I’m in a dilemma here. I feel I should ask a Consultant to review her, purely due to her medical history and there is a little voice in my head telling me that this lady is not a good candidate for homebirth. I can advise her that in my personal estimation a homebirth may not be the best option and I have told her I would like her to see the Consultant, but she is now questioning why, in the previous 20 weeks, no other midwife has made that referral. Fair point, why haven’t they? Would I have done if she hadn’t requested a homebirth? I just don’t know, all I know is that I feel uncomfortable with her having baby at home. So I’ve taken the cowards way out. I’ve asked my job-share to visit her at home, told her my concerns, admitted I have a strange ‘feeling’ about this case and said that I will concur with whatever decision she comes to. As it stands though midwives cannot refuse anyone a homebirth, we can advise against it but it is a Health Authority’s duty to provide professional care for a woman wishing to have her baby at home. So, if Loopy Lou decides to go ahead with it, all I can do is put on my happy face and go with it. I just wish my gut instinct was not worrying me so much.
Between that entry and today my job-share booked her for her homebirth. She agreed that LL was dotty, not enough for her to question her homebirth, but reported back that the house was filthy and stunk of cats, she added that she hoped she wasn’t called for the birth as she didn’t think it would go well. Either my job-share is thick skinned or I’m losing the plot. Then last week my manager left a message saying that she didn’t think that LL was a good candidate for a homebirth because of her cardiac history and her OCD (obsessive compulsive disorder), I was happy, understatement. That was the day that I should have been seeing her at clinic but I was called to a homebirth so a colleague covered it instead. The following day I discussed LL with the colleague who had seen her at clinic, she agreed with me that LL was not the most stable person, mentally, that she had ever met. Then the bombshell, manager had reviewed Loopy Lou’s hospital records, spoken to one of the consultants and decided that a homebirth would be fine ‘with 2 midwives sooner rather than later’.
I saw LL today at clinic. Tomorrow is her due date and obstetrically all is well and there were no conversations with invisible third parties so I began to feel slightly more positive, until I talked to her about a stretch and sweep next week if she hasn’t gone into labour. As I began to explain what it involves she asked if it was like a smear, ‘Well, not really. We don’t use an instrument, we use our fingers.’ She looked uncomfortable, don’t blame her really, and then she explained that she always bleeds after a smear. I changed tack and talked to her about raspberry leaf tea, under ripe pineapple and other alternative methods that may encourage labour including making love. Then the flood gates to her psyche opened. Making love is always painful, I asked if she bleeds then, no she doesn’t but it always hurts ‘ Conception was not a pleasant experience’. I wondered if she had sought help, she has seen the G.P and she was told to use plenty of lubrication, that doesn’t help her. She reverted back to the stretch and sweep, she doesn’t want one, she finds people touching her painful, touching her anywhere painful. The conversation meandered around, without me asking she volunteered a lot of personal, very personal information. I suggested to her that perhaps a homebirth is not the best idea, supposing she needs stitching after the birth will she be able to tolerate that sort of touching without the aid of something more than a local anaesthetic, she said she could but then in the next breath asked me to book her for an induction of labour next week, I think that she is having second thoughts.
I’m going to see her at home next week, I have promised not to mention stretch and sweeps and she seemed really pleased that I would be going round. I’m feeling like a two-faced old c*w. I’m trying to turn her off a home birth, I still think that she is a poor candidate for one. She obviously has major psychological hang-ups and I do worry that having the baby at home, with all the touching that involves may tie baby, home and painful, unpleasant experiences together. I’m not a psychologist so have no idea if that could be a reality, or what the outcome could be but I would really like to avoid finding out. I’m going to make her an offer, go into hospital to have the baby and I’ll go with you. She will probably turn me down flat, I may be entirely mis-reading things but I do think that today we hit it off and I believe a ‘domino’ birth could be the best answer for old Loopy Lou.