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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 2007 High Impact Actions for Nursing and Midwifery 2009

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Supporting home birth in bradford

Supporting Home Birth In Bradford

Alison Brown – Consultant Midwife & Supervisor of Midwives

November 2013

Better Medicine Better Health

Making home birth a real choice the background to our initiatives
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

Better Medicine Better Health

Working together to make it happen
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 !

Better Medicine Better Health

Strand one midwivestraining
Strand One - MidwivesTraining

  • Skills days

  • Evaluations from community staff

  • Via Supervision

  • Emergency skills for home births

  • Choice agenda

Better Medicine Better Health

Our aim
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.

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The plan for the day
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!

Better Medicine Better Health

The model for feedback
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

Better Medicine Better Health


  • Community Midwives and confidence

  • Communication and documentation

  • Support from Supervisors

  • Wider collaboration – paramedics and IM colleagues

  • Confidence in service provision

Better Medicine Better Health

Strand two home birth workshops
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

Better Medicine Better Health

Creating a forum for information exchange
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……..’

Better Medicine Better Health

The brain tool
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)

Better Medicine Better Health

Concerning risks
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

Better Medicine Better Health

Some scenarios
Some scenarios!

  • Based on examples from recent practise

  • Anonymised

  • Women and families who have shared their experiences

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Woman a
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.

Better Medicine Better Health

Woman b
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.

Better Medicine Better Health

Woman c
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.

Better Medicine Better Health

Woman d
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

Better Medicine Better Health

Top tips for success
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!

Better Medicine Better Health

In summary
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

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In bradford
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.

Better Medicine Better Health

Plans for 2014 include
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!

Better Medicine Better Health