Choosing Where to Have a Baby
The latest NICE Guidance on childbirth suggests that straightforward births are safest in a midwife lead unit, and that for ‘low risk’ women having their first baby, there is a ‘small increase’ in the risk of serious medical problems, such as death and brain damage. These occur at home in 9 per 1000 of first time births, compared to 5 per 1000 births in an obstetric unit. The risks are small but the outcome can be catastrophic. So how is a mother supposed to choose?
Many NHS obstetric units are creaking at the seams which is why a home birth sounds so tempting. As one midwife told MD: ‘We know what we could do to give families brilliant care and we desperately want to do it. But we just don’t have the staffing levels. So the service has become a production line where we try to deliver a minimal safe standard of care where mother and baby survive unharmed, but we don’t have time to put into building up meaningful relationships, getting breastfeeding off to a brilliant start, making sure the stitches are okay, etc. You know the parents want to ask you all sorts of questions and they want your time and reassurance, but we have to send them home as quickly as possible. And some end up with episiotomies and C-sections that we may have prevented. Sometimes we have to close the unit and turn mothers away because we’re full.
On the worst days, when there simply aren’t enough bodies on the ground, I wouldn’t want to have a baby on the unit I work on. I love being a midwife but not being able to deliver the standard of care I dreamed of when I was training is the biggest disappointment of this job. That, and the constant fear that we’re going to harm a mother or baby by not spotting their distress in time. And that we’ll be blamed and hung out to dry if things go wrong, and the ‘system’ will get off scot free. 20% of the obstetric budget gets spent on litigation. It’s madness, but if you speak up you worry for your job.’
Obstetric care in the NHS is as safe as it’s ever been, and serious harm to mother or baby is rare. But harm does happen, and most of the NHS litigation spend goes on compensation for birth injuries. It’s also common for women to say they were left alone for long periods during hospital labour. The NHS is short of up to 4000 midwives to provide a safe service, and obesity and older mothers are making childbirth harder and riskier. Homebirth seems very attractive but nearly half of women who start off having their first baby at home end up getting transferred to hospital. And not all mothers are aware of the risks.
As one told MD; ‘I was young and fit for my first pregnancy, and I can remember being strongly encouraged to try a home birth by my midwife. I did hypno-birthing, which was very effective, and the pain was the easy part. The hard part was trying to persuade the two midwives allotted by the NHS to come to help us. It took seven and a half hours from our first call saying I was well into labour and three and a half hours from our call saying we were really in need of assistance from a midwife. They simply wouldn’t believe me when I calmly said I was in labour. But I was. I remember feeling afraid, telling myself they were going to come soon, surely they would. They finally arrived just as I was about to deliver. Our daughter was born 12 minutes later, grey and cold with an Apgar of 2 and was whisked off to hospital. She’s now fine, but we were very, very lucky. If I meet anyone now thinking of a home birth, I say you may not be believed if you call the midwives and tell them calmly that you’re in labour and need help. You need to scream, shout and go into a full One Born Every Minute act. Being relaxed, self-hypnosed and in less pain at home is no use if no one believes you’re about to deliver.’
Home birth can be wonderful with the right support, but only if the risks are fully understood, there are enough midwifes on duty and women in labour are listened to and believed. The NHS needs to address these issues carefully before we encourage more women to give birth at home.