The woman and her partner have spent months planning this baby’s birth. She has attended hypnobirthing, or pregnancy yoga, or NCT. She has hired or bought a birthing pool. The room has been lovingly prepared with soft lighting to encourage oxytocin flow, the hypnobirthing cd is playing in the background, the post-birth nest is ready to receive mother and precious newborn.
The sensations of early labour begin and with a sense of excitement the woman telephones the local maternity unit to let them know that labour has started.
Then the bombshell.
“I’m sorry all the community midwives are out at other births. You will have to come in to the midwife-led unit (or hospital).”
The woman is left with a choice of either freebirthing unattended apart from (possibly) a paramedic – not exactly a relaxing, oxytocin-filled scenario – or coming into the midwife-led unit or hospital.
Now don’t get me wrong. I am a big supporter of midwife-led units and hospitals where the woman wishes to use them and where they are the most appropriate place for the woman to give birth. We are incredibly lucky to have these facilities. And I know that many women across the globe would give their eye teeth to have access to such facilities.
But giving birth in a hospital or midwife-led unit, however pleasant the environment, is simply nothing like giving birth at home. The environment of home allows privacy, intimacy, relaxation, freedom. If we go to a midwife-led unit there are other people’s rules with which to comply. Even getting a cup of tea, or a shower, or using a pool – all these rather basic things are not our automatic right within the clinical environment, they are things that will or will not happen according to how helpful (or otherwise) are the staff in that place. And often the staff are very helpful – and will be wanting to facilitate everything the woman and her partner could need. If it’s where you want to be, that’s great …
but it is not home.
The cups of tea, the showers, the use of a pool – maybe these are relatively trivial things. But the feeling of being comfortable and private, and who accompanies her during her labour, these are not trivial things and they can make a huge difference to the way the labour flows. The mother’s emotional condition should be considered a vital part of the birth process, as it has a huge impact on how the birth progresses. Who is with her, and where she gives birth, are very important to the labour outcomes and for her and her baby’s physical, mental and emotional health for years to come. This really matters, and it is not about being demanding, or a hippy, or spoilt. If you sat, as I do, in a home birth group hearing the dreadful stories of women emotionally (and sometimes physically) scarred by inappropriate medical intervention (or its lack) then you too would think it important to respect the mother’s wishes about where she gives birth.
And if you sat in that home birth group circle and heard again and again of the happiness, strength, love and empowerment of home birth, or birth in hospital if that is where mother’s instinct takes her – you too would think it vital to respect her wishes about where she gives birth.
I realise the maternity services are severely overstretched. But we simply have to address this issue – giving birth is such a significant aspect of life for each woman – and each baby. If you still think it’s reasonable to ask women to change their planned birth setting at the last moment, please consider the situation the other way round.
If the hospital was the planned birth place, and the hospital happened to be at full capacity when the woman went into labour, you would NEVER have a scenario where the staff told the woman to stay at home as there were community midwives but not hospital midwives available! If the worst came to the worst the woman would be asked to attend a different maternity unit. This is far from ideal, but her wish, indeed her right, to give birth in hospital would be respected. Why is it so different for home birth?
As an independent midwife, I work alongside independent midwife colleagues from different areas to ensure that my clients have a home birth if that is what they want. If I was ill, or at another birth, I would ask a colleague to step in. I can trust that my dear independent midwife colleagues would go to any lengths to make sure that the woman had her home birth.
It might sound a bit unrealistic to expect this kind of cooperation from midwives in the NHS maternity services, but when I qualified in 2000 this is exactly what used to happen in the community. There were several midwives on-call overnight in each area and if someone got called out then everyone rallied round the next day and covered her clinic. It was a very satisfying way to work, though of course everyone was still overworked and underpaid. If the service can’t promote this kind of flexibility any more, we have to ask ourselves why not? (*Edit: see footnote.) Are midwives and the maternity service at breaking point? if so, it is intolerable not only for the women but for the midwives. No wonder there is so much sickness, so much stress within the NHS. My argument is not against the horribly overworked and dedicated NHS midwives – far from it. Ways of working need to be introduced that allow midwives to work with women in a way that the needs of both women and midwives are acknowledged and respected. At the moment it feels as if the maternity services are fraying round the edges. It’s both women and midwives who are suffering.
It cannot be beyond the wit of woman to work out a way of ensuring all women have their choice of birth setting respected.
I do NOT blame the NHS managers. They too are in an intolerable position – sometimes under even greater strain than the midwives on the shopfloor if that is possible.
So please don’t take this little rant as being anti-NHS midwives or anti-NHS in any way. I am making the plea though that sending women into hospital when they wish to give birth at home should be off the table, in the same way that telling them they had to stay at home if the hospital was full would be off the table.
The maternity services in different areas need to collaborate in the way that independent midwives collaborate to ensure that women’s right to a home birth is respected. By ‘different areas’ I mean different clinical areas, as well as different geographical areas. More midwives should be trained and competent and confident in home birth so they can cover for their community colleagues when necessary – this flexibility needs to work both ways of course. And maybe some sort of mutual arrangement could be worked out with local independent midwives as our numbers grow.
Please respect the right of women to give birth in the setting of their choice. This is important for women, babies, midwives and families. It really matters.
*Edit 17/09/2016 In responses to this blog published in June, it has been pointed out that many areas in the UK do provide a consistent homebirth service which is not withdrawn because of short-term pressures. I would like to acknowledge the people who have made home birth possible in these Trusts, encourage them to share their expertise widely and ask the Trusts and commissioners who are not managing this to learn from these shining examples. I’m pleased that everyone seemed to take my point that this is an organisational issue rather than one of pure resources or staff willingness. Thanks for reading.