Once I was with a woman in labour. She was labouring at home. It took quite a while for this particular labour to reach boiling point. We were lucky enough to see 6 midwives in that time. All smiling, patient, understanding of her birthwishes and really, really wanting her to get what she wanted. They were tired, and juggling other jobs, but unfailingly loving, gentle and kind.
So what’s the big deal about homebirth services anyway? I can understand that many may think that, in this age of underfunding, limited resources and wholesale devastation of the NHS that it would be pretty selfish of mothers to demand one or two whole midwives to themselves, at home, let alone 6. Whilst their sisters in hospital may share their midwife with one or even two other mothers, homebirthers get focused, one on one attention.
Others may wonder at the safety of homebirth. Wondering why on earth these crazy, hippy women should be ALLOWED to put themselves and their babies at risk, using up even more scant resources when the ambulance is inevitably called.
Thing is, these are opinions. Widely held ones, but opinions nonetheless. The…you know…actual facts…tell another story entirely.
Fifteen years ago the Nursing and Midwifery Council issued a statement:
…it is understood that a blanket policy of ‘no home births’ would not be acceptable to the maternity services in England, Northern Ireland, Scotland and Wales.
In other words, they take a dim view of any hospital suspending its homebirth service.
Why’s that then?
Well, we could find lots of reasons: Because it’s safe (yes, a recent study* of over 60,000 women found that homebirth is an appropriate choice for vast swathes of low risk and not-so-low risk women, resulting in better outcomes according to a number of different measures, than both Midwifery-Led Birth Centres and doctor-led Obstetric Units.
Because it saves money. The same study (and other past research) proves that homebirth is a cost effective means of providing maternity care.
Because women like it. It makes birth pleasurable, less scary, negates the need to be separated from family, other children and social support networks.
There are some women who could not think of leaving their familiar home environment to give birth and they have the right to make this choice. Janet Balaskas
If we are to build a maternity service that is fit for purpose, we all need to agree what that purpose is. At the moment, society seems happy with a service that has the most basic definition of purpose: alive mothers and babies. If we are to build a society that is less spiritually empty, psychologically and physically healthy, we need to focus on the wellbeing of the motherbaby dyad. Whole and healthy motherbaby equates to a strong, healthy society which benefits us all and costs us less.
And the simple beginnings of this healthy system is continuity of carer – that’s a posh phrase for midwives being able to build trusting relationships with the women they serve. When we get to see the same midwife all through pregnancy she’s less likely to miss something if we or our babies need some medical help. When she supports us in labour the relaxing, trusting atmosphere she creates enables our hormones to flow and labour to progress as it should. And when she visits us in the early days of motherhood, we are more likely to disclose our deepest fears or problems and welcome her helping us with breastfeeding. This relationship creates happy, healthy pregnancies, safe and satisfying births and loving, joyful postpartum periods…and that’s not just my opinion; every piece of research into maternity care has proved continuity of carer increases straightforward birth rates, reduces morbidity in mother and child and just as importantly, increases women’s choice, control and joy in childbirth.
The more one learns about the way a friendly, familiar face, caring for you in your own home improves outcomes, the more unethical it seems to restrict families’ access to this kind of maternity care. As Soo Downe so rightly points out, if homebirth were a drug with such brilliant effects, there would be an outcry if it weren’t being offered to everyone.
If there was a pill that could be given to pregnant and labouring women that decreased the risk of late miscarriage, low birth weight, prematurity, and maternal infection, increased their chance of successfully breastfeeding their baby, and of completing labour and birth without experiencing an episiotomy, caesarean section, haemorrhage, while saving the NHS money, and without excess risk to the baby (except at a very low level and in very specific circumstances)… I am fairly sure that doctors, midwives, and health service providers would be clamouring for women to have the opportunity to have that drug, and, indeed, insisting that it is unethical to withhold it. Prof Soo Downe
Last night we all sat and smiled and shed a tear as one of our favourite characters in Call the Midwife had the unstinting one to one devoted care from a midwife she chose. What irony it is that this storyline plays out at a time when our right to such care is being systematically dismantled.
So tell me, in the face of an avalanche of evidence, why the Nursing and Midwifery Council think it at all logical to prevent women from choosing their midwife? What purpose does it serve to stop independent midwives – fully trained and insured health professionals – from supporting their clients in labour? What purpose does it serve to tell NHS midwives they can’t care for a friend or family member? How do these decisions make us safer? I have borne witness to the incredible devotion both independent and NHS midwives can show to birthing families. I can tell you, in no uncertain terms, that there are women who are at huge risk when they cannot access a named midwife with whom they can form a bond.
It is a fundamental human right to choose where and with whom to give birth. Our caregivers have a duty of care to support women in their birth choices. Any management system or political landscape that does not facilitate a service that prioritises choice and continuity of carer is letting down both mothers and midwives, disenfranchises families, diminishes our faith in the health service and makes a mockery of what that health service originally stood for.
If you care about birth. If you care about choice. If you believe a respectful, trusting relationship with one or two midwives throughout your journey to motherhood isn’t just nicer, but actually safer, I urge you to stand up for midwifery. Write to your MP, write to the NMC, join the Save Independent Midwifery facebook group, march and shout and generally make a noise about the erosion of true midwifery care.