Considering a birth choice against medical advice

Context: I developed nocturnal epilepsy when my son was 2 months old, cause unknown. I’ve been under a neurologist and had investigations but ultimately, I only ever had seizures at night, perhaps 1-2 a year and it was deemed unnecessary for me to take medication or be on a treatment plan beyond lifestyle management. I’ve actually been seizure-free for 5 years now, never medicated, never had an awake seizure. However at my booking in apt I was placed on a high-risk pathway and put under the care of a OB consultant. When I met with the dr, she admitted that my particular situation is uniquely low risk comparatively. There’s a 1-2% chance of epileptic mothers having a seizure during birth, which is very low; and that data is based on those who currently have awake seizures. There are risks associated with the meds, but I’m not on any. In essence, the risks for me are no different to someone without epilepsy. However, the official NHS guideline is that you have to be seizure-free for 10 years and med-free for 5 to be considered “low risk”. It’s a blanket recommendation for the condition, not taking any factors into account. So, officially, they can’t class me as low risk and while my birthing choice is still my choice, it would be against medical advice and I’d have to sign something to that effect. Because of this, I don’t fit the criteria for a MW unit, only the consultant-led unit, which I adamantly do not want. My only other option is a home birth, which I’m actually considering and feel v positive about. But there’s a nagging doubt in the back of my mind and I’m very anxious about how the MW is going to react to me stating this is my choice. Is anyone else out there considering going against medical advice for birth? Or has been through this before? I’m currently trying to read medical research and write myself notes on how to handle the conversation, but I’m very anxious about it and could do with some reassurance.

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I've not been in a situation where I have to go against medical advice for birth, but I just want to say, you have every right to choose how you want your birth to be. In your situation I agree with you and think you're low risk and should be able to be in a MW unit! Do whatever research you need to feel comfortable with your decision and be strong, you never know, the midwife might be supportive! But in the case that she's not, you've got this!! It's your body, your decision!!

I’m not in a similar situation but was considering home birth for my first. What’s put me off is that the hospital is a 45 minute drive away for us. If it was like 10 minutes I think I might have gone for it but I worry it would take us too long to get there if we needed to. Also, remember that you can change your mind at any point! You can decide on a home birth and then if on the day your gut tells you to go into hospital you can, or vice versa! In terms of having that conversation, I think you’re preparing in the best possible way. If you know your stuff and stand your ground they can’t argue with you. I think you could even keep pushing to be put back on midwife led, and really push them on providing concrete reasons why they won’t let you do MW led unit.

Ultimately it's your choice and they can't force you to do something you don't want to do so if you're confident in standing your ground, don't be anxious. Playing devil's advocate, I really really wanted a water birth in the birth centre but I gave birth on a consultant lead ward with my first, not realising a home birth could have been an option. Our son was unexpectedly very poorly straight after birth. I was quite glad that all of the necessary professionals were available straight away.

Can I ask why you do not want to give birth in the consultant led unit? I know the risk is so so super small but in the event that it did happen and you were having a home birth that puts you and baby in so much danger❤️

@Kathryn we’re 10 mins drive from our hospital- 8 mins with blue lights! Which is less than the time it would take to prep a theatre, if that was deemed necessary in an emergency (and they’d prep while we’re enroute, so in that respect, it makes no difference). So I feel fairly comfortable with my decision- if anything were to go wrong, we’d be close. @Ellie-May it’s a personal preference. I’ve seen first-hand what the cascade of intervention looks like (I was my sisters birth partner when she went through an induction & ended up with all sorts of medical intervention and issues she didn’t want). I’ve read the studies and I know the risks for intervention & c-section are much higher in a consultant-led unit and I wouldn’t have the option of a pool. I’d be far more stressed, face a lot more pressure from medical professionals and generally it’s the opposite to the type of birth id want. I had a water birth with just gas&air with my son and I’m hopeful I can achieve the same this time!

This is the birthplace study: https://www.npeu.ox.ac.uk/birthplace/results And generally I keep telling myself that giving birth isn’t a medical emergency, and complications are rare, and I can’t live in continuous ‘but what if?!’ fear. I had a beautiful calm empowering birth last time, and I don’t want to be pushed down a different route purely due to blanket guidance. I’ve got to trust my instincts, and my instincts tell me, this is the right thing. If I genuinely felt there was a risk to me or baby of course I’d make a different choice!!

I’m not sure where you’re located so it may differ but home birth is not your only option (though it’s a perfectly lovely one!). You can choose to still give birth on the midwife led unit, even if it’s against advice. Also though, our consultant led unit has a birthing pool. Most will have one pool, so could be worth checking. But either way, it’s always your body and your choice!

@Becki I think follow your gut! My friend wanted a home birth and was labouring at home for ages (no midwife) before she checked herself and realised baby was coming out foot first. She got an ambulance and had an emergency c section. Obviously not as she had planned it but they were both fine! I also know several people who’ve done it at home with a midwife and all has been fine and easy! If you feel strongly that is your instinct that is a good sign!

Pleaseeee join Home Birth Support Group UK - TONNES of info on there and you can put your post in there too, it's judgement free and a lot of useful resources and people willing to help you advocate for yourself 🩷 I've been told I will be outside of guidelines because my bmi is over by one mark which is ridiculous - a lot of it is fear mongering in an over medicalised society of birthing nowadays, wish you luck which ever you choose 🩷

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