The right to choose home birth: a debate in the UK

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Clara Ruth’s birth at home: meeting her family!

I am always alarmed, though not surprised, to see press articles such as this questioning the ‘rights’ of women requesting a home birth.  Over a period of 35 years as a midwife, I have cared for scores women who have given birth at home, and those occasions have been some of the most rewarding moments in my career.  We now have clear evidence that home birth is cost effective and safe.

My district nursing sister (who had her babies at home) tells me that when loved ones wish to die at home, the request is always respected. Services are mobilised to ensure those precious end of life moments are as comfortable as possible. To me, this is fundamental stuff, and choice at the beginning and end of life should have equal priority.  Yet in the above article, lawyer Barbara Hewson is quoted as stating that ‘mother’s don’t have a right to choose a home birth’.

I noticed that the Royal College of Midwives is debating this very issue at their forthcoming conference in November.

I was surprised that an obstetrician is speaking on the topic, and we are to hear perspectives from a panel made up of a lawyer, an obstetrician and a journalist. But where’s the midwife? Isn’t the midwife the one who facilitates home birth?

So I thought I would ask some questions to a similar panel, but to include a midwife, to get a debate going…please add your comments and experiences at the end of the post, and add to the conversation.

 The panel:

Professor Soo Downe OBE (Midwife)

Elizabeth Prochaska (Lawyer-Public Law and Human Rights)

Milli Hill (Journalist-Mother-Doula)

First of all, what do you think about the newspaper article, and Barbara Hewson’s stance on the matter?

 

SD: I was rather surprised to see the statement that women don’t have a right to a home birth in the UK. As far as I understand it, the Midwives Act 1902 gives women this right, by virtue of the fact that the midwife must attend a woman in labour if called. So, at the extreme, whatever clinical or social situation she is in, a woman in labour at home can call a midwife to her. Obviously, it is much better if this doesn’t happen at the last minute, and if this right to be attended in labour is translated into a an obligation for the maternity services to provide good antenatal care and planned support for the labour, the home birth right-or-not debate becomes a red herring.

The debate also sets up women in opposition to the fetus, and the midwife as having more obligations to her employer than to her Code of Practice and professional moral standards. Both of these developments are very sinister, and both should be resisted.

MH: Although my first reaction to the newspaper article was negative, on reflection I think the article is interesting.  To me it looks like an editor has given it a very attention seeking headline and chosen a particularly provocative sub heading (sometimes called the ‘sell’), which sadly complies to the popular notion that home birth is dangerous and probably shouldn’t be allowed.

However, the article is not really saying that birth is dangerous – Barbara Hewson balances this statement with the fact that birth can equally go wrong in hospital and that the litigation culture is probably causing unnecessary interventions. Nor is Hewson saying that ‘mothers don’t have the right to a home birth’ – although she is unpicking from the legal angle the question ‘what are mother’s rights when it comes to home birth’ – a subtle difference that the editor perhaps ignored in their search for traffic.

As a mother who has birthed at home twice (once last month!), the article made me very uneasy. When you put it alongside the current situation in Ireland highlighted by the recent case of Aja Teehan – and the current situation for Independent Midwives in the UK – and a similar struggle to save home birth in France – which I understand is also happening in South Africa… and then read details of the RCM conference debate – it really starts to feel almost like a backlash against the movement to reclaim birth.

Home birth – for me – was the place where I felt safest from unnecessary intervention – and I speak as someone who experienced an episiotomy and forceps delivery in hospital for my first birth, purely because the clock dictated I could not have any more time, although myself and baby were well.

In my two home births I have experienced how birth proceeds so normally in a safe and loving environment, and how wonderfully empowering it can be to birth your baby yourself, with nobody taking control or telling you what to do. I wonder why there is such an energy across the western world that seems determined to prevent women birthing like this? Is it really all about safety?

EP: Lawyers often have different views on the right interpretation of the law and there are rarely clear-cut answers to legal questions, especially when the question hasn’t been considered by a court. Nevertheless, when a lawyer purports to explain the law (rather than give their own opinion about it), it is incumbent on them to give a clear and balanced account. It is a shame that the headline to the article suggested that there is no ‘right’ to home birth, as this is not an accurate reflection of the law, and did not reflect the nuance of the article.

What are the mother’s legal rights to a have a home birth, and does it make a difference ‘if things go wrong?’

SD: Even in the very rare situations where the choice a woman makes for place of birth might lead to a very real risk to the baby, there is still no legal grounds for denying her her autonomy, as far as I’m aware. Consider, for example, the case of two identical twins. One is terminally ill with kidney failure, and his twin is the only possible donor match. However, for reasons best known to himself, the healthy twin refuses to donate his kidney to save his brother. Is there any conceivable situation when it would be legally and morally acceptable for the healthy brother to be taken against his will to hospital, subjected to necessary drug treatment to prepare him for surgery, be operated on against his will, and have his kidney removed, for the sake of the brother, however much we may struggle to understand the rationale for his refusal?

Why is it different for women who are refusing to go to hospital for the sake of their baby?

MH: Since learning about the case of Ternovsky vs Hungary at the European Court of Human Rights, I have been under the impression that women have a human right to give birth wherever they wish.

What Barbara Hewson seems to be saying is worrying – essentially that, although women may have the ‘right’ to give birth where they like, the state does not have an obligation to provide them with care in any setting, if this is not practical or they deem the birth to be too risky. This is exactly what has just happened to Aja Teehan, and it seems we are only a whisker away from a similar situation in the UK – the whisker being, as Hewson points out, that the NMC states that midwives have a duty of care to attend a woman no matter what.

Some women who are aware of this will currently insist on attendance by a midwife at home even if their local hospital states that they do not have enough staff to provide one.

But it would only take a small change – an insurance issue, for example – for us to be in a situation where it was impractical or even illegal for a midwife to attend a woman at home regardless of their employer’s wishes.

‘Things going wrong’, insurance, and the desire to minimize or even eliminate risk seem to be at the heart of the issue. Having had two ‘uninsured’ home births with Independent Midwives, I think it’s worth reminding ourselves that insurance only pays out in the case of negligence, and that ‘things going wrong’ in birth does not necessarily mean someone was to blame or that we would have been safer in hospital. I also feel that myself and my partner were capable of assessing any risks involved in home birth – exercising our autonomy as we did so, and being prepared to take responsibility for our decision no matter what happened.

Perhaps the most controversial aspect of Hewson’s piece is that she implies that mothers (and fathers) of unborn children may not be the best people to decide where their baby is born. She talks about births at home against medical advice that had tragic consequences. And she finishes by saying that insisting on having a midwife attend you at home against their employer’s wishes may not be ‘wise’.

This, too, is at the crux of the debate – who should decide where a baby is born? Of course, my view is that it should always be the mother, and that she can absolutely be trusted to make the right decision about this. However, this view is not shared by everybody – many still subscribe to a ‘doctor knows best’ attitude and are reluctant to examine the actual facts and figures that underpin medical advice and decisions. As Labour party Counsellor Ronan McManus tweeted in response to AIMS Ireland, “allowing someone untrained and emotionally involved to interpret the evidence is a dangerous trend.”

This breathtakingly misogynistic view sums up the problem that many people have with home birth – it puts the power and autonomy back into the hands of the mother, which is ‘dangerous’.

The voice of a home birth mother – or any mother – also seems conspicuous by its absence at the RCM debate?

Again I’m wondering – is the current backlash against home birth part of a drive towards safer births and better outcomes? Or does it contain an undercurrent of an age-old desire to limit or destroy the power of the birthing woman?

 

EP: We need to start from the basic premise that women are the best and only judge of where they give birth. If we start to question their capacity to make that decision, we undermine centuries of hard-won legal autonomy and we wouldn’t be far from advocating forced c-sections, which Barbara Hewson was instrumental in prohibiting in the 1990s.

The simple legal answer to the question whether a woman has a right to give birth at home is: yes, of course. She has a right to make choices about the circumstances in which she gives birth, including where the birth takes place. This is uncontroversial as a matter of English common law (which respects autonomous decision-making) and under Article 8 of the European Convention on Human Rights (which protects the right to private life and associated right to physical integrity).

A woman cannot be compelled to accept hospital services and she may give birth where she chooses. The real issue is whether this ‘negative’ right translates into a positive right to midwifery assistance at home. The European Court has recognised that the state is required to take steps to enable this positive right, but there will be acceptable limitations that can be placed on it. Barbara Hewson’s article dealt with those potential limitations. She suggested that staffing shortages might be one such limitation. In the absence of a case determining this point, we can only say that there may well be circumstances in which staffing issues would justify a limited service and cases when they would not. There isn’t a blanket rule when it comes to factual conditions that justify limitations on rights. Certainly, government and NMC policy mandating attendance of midwives at home would inform the court’s assessment of hospital decision-making about home birth.

You can read more about the debate on the Birthrights website: www.birthrights.org.uk

 

How can we ensure that the balance is right, with respect of what the woman wants, and what the care-giver wants and is able to provide, ensuring safe, high quality care?

 EP: The question of service-provision isn’t really about balance, it’s more about what women can reasonably expect from their maternity services. Clinical Commissioning Groups (CCG’s) in England and Health Boards in Scotland and Wales are under an obligation to provide services to meet local needs. Women invariably need to be provided with a variety of options for maternity services, including home birth. CCGs and Health Boards are also under an obligation to have regard to government policy on maternity choices, which requires them to make home birth available as a choice in all areas. In essence, women can expect to be provided with home birth services and should hold their local decision-makers to account if they are not provided, or are unreliable.

Do you think the issue of choice in place of birth influences the relationship between mother and midwife, and if so, why?

 

SD: Good maternity services = skilled and compassionate care in an authentic relationship with the woman. And this includes a stop to the quibbling about facilitating home birth for women, especially when the evidence says it is the most economic and safest place for most low risk women and babies to be;  and a turn towards providing the best possible care for women and babies in the place that suits them best.

EP: All the evidence suggests that choice of place of birth can have a profound effect on women’s experience of their birth experience, measured not only in improved clinical outcomes (and consequent public health savings) but also in terms of long-term emotional consequences for the mother and child. Continuity of carer, generally only achieved when the mother chooses a home birth, has a particularly positive effect for women, presumably because women build a trusting relationship with their midwife that enables better care and support. It is no surprise that the Department of Health seeks to promote home birth as a result.

 

If you have anything else to add….

MH: I don’t think the question should ever be asked, “Do mothers have the right to give birth at home?”, or, “Do women have the right to give birth where, how and with whom they choose?”. A woman’s right to have her baby where and how she chooses seems so fundamental to me and it feels wrong and dangerous to even question that basic right.

However, there are questions about the practicality of home birth in such times of midwife shortages, insurance issues etc, that are worth asking. Why are the RCM, for example, not debating ‘How can we encourage home birth to increase and flourish in the current climate?’, that would seem to make more sense.

We would like to know your thoughts, to start the debate…

More about the contributors

Milli Hill:

Founder Positive Birth Movement Twitter: ‪@birthpositive

Editor Water Birth: stories to inspire and inform Twitter ‪@waterbirthbook

Birth Columnist for Best Mag Daily ‪@BestMagDaily

Blog: the-mule.com Twitter @Millihill

Elizabeth Prochaska:   

Lawyer, Matrix Chambers 

Founder: Birthrights Twitter @birthrightsorg

Professor Soo Downe OBE

Professor of Midwifery University of Central Lancashire 

Previous post interviewing Soo Downe

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29 comments on “The right to choose home birth: a debate in the UK

  1. The perceived power of the medical establishment and the preservation of the status quo has a role in the debate. Since birth has moved into the hospital it has been a paternalist event where you can be ‘allowed’ various request i.e food in labour. I also think finances have a role to play in the argument, although from a societal point of view home birth is the best finial option, it would mean that trusts would lose a revenue stream.

    Just my initial thoughts

  2. I wonder if public perception of women’s rights and choice will ever change all the while the media, and if they are watching, the NMC allow blatant cases of bullying and coercion to be displayed as entertainment on our TV screen, as in the awful case of Audrey on the Midwives programme on Monday 7th October. It resulting in the woman being vilified by the public on social media sites.

  3. If the nhs has an issue with women choosing to give birth at home, perhaps they should ask them why they are doing it. I am pregnant with my second child, 37 weeks, and had my first in hospital in Leeds. I never dreamed of having a home birth the first time as I felt I’d be ‘safer’ in hospital. Like so many women, my birth experience was so utterly horrendous that second time around (and it was a huge decision becoming pregant again for the sole reason that I’d have to give birth again and I was terrified) I had no doubt in my mind that I would not set foot in a maternity ward again, no matter what. I have met so many second time Mums who have exactly the same attitude as me. We have done our research and believe wholeheartedly that our first births were full of totally unnecessary interventions and actions of medical staff that we trusted to look after us that go against all the evidence of what gives women a positive birth experience. The very basic care was not there in the hospital where I had my daughter – it was a hectic, noisy, dirty environment (blood and used sanitary towels on the toilet floor, sitting in my own bloody bed all night, no nurses anywhere near to answer my questions about the newborn I was left with when my partner was sent home for the night) and there was a total lack of privacy and respect. I had my midwife changed three times without explanation and was told ‘if you don’t like how you are being treated, write a letter to complain when you get home, as we are too busy to talk to you now’. All power and control was taken away from me and decisions were made without consulting us – as first timers we were scared, vulnerable and liable to agree to just about anything to have our baby safely. I now know I had choices that I didn’t exercise, and I am full of regret at what a bad start me and my daughter had. I was hospitalised for 3 months with severe PND soon after the birth. A coincidence? I don’t think so. I felt I had ‘failed’ at birth, and it took me a long long time to feel like a woman again. This time, I am staying at home, on my terms, with a doula to support me. Will I be irresponsible with my baby’s life if things go wrong and I need medical intervention? Of course not. But I have had to harden myself to demand better care, and part of this is being on my own turf and calling the shots. So sad that this is the reason so many women opt for home birth – the total paralysing fear of hospital care. I hope more women can experience it for the empowering choice it truly is.

    • Wow Rohan, your story has completely moved me and brought a tear to my eye! Well done you for standing up for your birth rights! It’s your birth, nobody else’s and I sincerely hope that this time it is everything you have dreamed of and that you are fully involved in the decisions made about your care! I am currently training to be a midwife (am a long way off qualifying still) but feel very strongly that women should be supported and empowered throughout their pregnancy and birth experiences and com

  4. If birth is a normal life event and physiological birth is the healthiest option and an outcome which happens most easily and cost effectively at home or in a birth centre then Health Boards, Trusts and all health professionals should rather be asking “Why are healthy women encoraged to expensive resources etc to birth in the most non-physiological, un-economical and least healthy place (hospitals being the cradle of resistant bacteria and iatrogenisis) ?
    Where is the airing and debate about the lack of safety or risks of hospital birth for healthy women??

  5. I’ve been a midwife since 1984, luckily I spent 5 months one-on-one with an Irish CommunityMidwife who saw home birth as being the place to birth normally – even for 1st time mums. I experienced 14 wonderful home births in my time with Pat and she totally shaped my midwifery philosophy, for which I will be eternally grateful.

    I became an independent midwife after emigrating to New Zealand in 1995 and 25% of my work was home birth (or low risk Birthing Centre). I should add that my daughter was born at home in the UK, with 2 midwives and my elderly GP who had birthed all his children at home and I had homebirthed his grandchildren for him – he did not provide any of my care, he just wanted to retire happy and keep my husband calm by drinking vast quantities of tea!

    Home birth is undoubtedly a choice for some women that must be protected in law, and midwives protected both by their professional bodies to do so. It has been proven time and time again to be safer than hospital birth for low risk women. I have conducted many VBACs and waterbirths at home over the years and it takes courage to do so. …midwives are the woman’s advocate and her safety net. Long may we last.

  6. I am a Paediatrician and most of my colleagues were fairly horrified that I had my second and third babies at home. Most of them ask if it was planned!

    Having had my first in hospital and being convinced that the reason it took so long was because going into hospital upset everything. I was well into labour and was perfectly happy at home, it all felt so strange to get into a car (not to mention painful)!
    My second and third labours were so different. I felt totally relaxed and in control in a way I wasn’t first time. In fact the third one I basically deliver my son on my own while the midwives drank tea!!
    I think everyone who has a straightforward pregnancy should not only have the right to a him birth but should be encouraged. Pregnancy and birth are not illnesses, that are normal and should be treated as such!

    • Hi Julie, it’s interesting about your colleagues, though not surprising. Have you read Amali Lokugamage (Consultant Obstetrician) and author of the Heart in the Womb? http://theheartinthewomb.com Think you will find it useful and enjoyable. Thanks so much for sharing your story and views, it will help many others I am sure Sheena x

  7. As a twice home birthing mother, and one hospital birth experienced mother I have seen the two and therefore feel I can comment.
    If you were to ask me where I would want to bring my child into this world, each and every time would be at my home… Very simple, non medical, non insured kind of view.

    The memory of being a mum about to give birth in hospital was one of being patronised, not listened to, rushed along in any fleeting meeting with the nurse/midwife as they had several other ladies to see and a cold sterile environment, which for some ladies, they feel secure in this style of environment. I, however, much prefer to listen to my body, in the comfort of my home, with a dedicated midwife, who then becomes a very important lifelong memory to the start of your little baby’s beginning…. The main part to this is the fact that as a woman, it is our right to birth anywhere (within reason! – hospital/home) and that should not be withdrawn from us. All decisions taken are based on knowing your own body/health/ pregnancy and the desired safe outcome of your baby should be considered before a decision is made and advice can change your decision to move your planned place of birth, but one the medical team should support, not dictate.

  8. Brilliant discussion of the issues. What was missing though was the point that some women are driven to have a home birth because the hospital will not offer them any choices and/or because of appalling experiences in a previous birth. As an independent midwife I have often tried to negotiate a home birth like type of care for women who have more complex obstetric/medical needs. Some of them want to have as physiological a birth as possible in a hospital setting to have ‘immediate’ access to medical help when necessary. It is extremely rare for theses negotiations to succeed. Whilst I respect the woman’s choice in this context and wholeheartedly support her I feel outraged that it is often exactly the people that don’t give her any choice in the hospital setting who want to withdraw her right to a home birth.

  9. Home births, love them,have been a community midwife for 22 years initially having to challenge gps to allow! women to birth at home,in some cases removing them from their practice!!,I have always championed parents rights to have the birth that they wanted,and have always been privileged to attend a wonderful family event,long may they ( and myself) continue .

  10. As a mother of three having experienced two wonderful homebirths, I’m saddened to think that my daughter’s or anyone else may not have the same opportunity in the future. Having my second and third children at home was a massively bonding family experience with midwives facilitating not controlling the births. I had the opportunity to build a lovely relationship with my midwife beforehand for my last birth and the continuity of care made such a difference. My other children and husband knew her and were comfortable. With high expectations and compensation culture I am not surprised that birth is becoming more controlled and more medicalised. As mothers and prospective parents it is our responsibility to learn about and understand birth and our bodies and make our decisions carefully, understanding the risks and unpredictable nature of birth and the decide on our path of care. The government, the law and the medical profession should uphold and respect these decisions and the role of the midwife. I sincerely hope that in future, women will not face the stress of having to fight to birth their babies at home and that midwives receive the respect they deserve.

    • You are so right Laura. And if anything is going to change, parents and grandparents are the ones who’ll make it happen. Change is coming, so I like you want my daughters and their daughters to have autonomy and choice, and for birth to be a social event and joyful.
      Thank you so much for taking time, and join in in the debate. Your perspective is invaluable. Sheena x

  11. Pingback: The right to choose home birth: a debate in the UK By Sheena Byrom - Birth Balance

  12. If we take as a starting point in this debate that, at the moment, in the UK, we have a paltry 2% home birth rate, it seems to me that we need to approach this issue from a different perspective: – as long as homebirth is the ‘choice’ for a few, it is easy for those who, for whatever reason, are not in favour of HB, to imply that it is not a sensible, safe or practical choice for the many.

    Instead of asking women to ‘choose’ whether or not they want a HB – sometimes early in pregnancy when they may have no idea what their preference is going to be once in labour, we should instead offer them caseload midwifery, with one or two midwives they get to know and trust over the course of their pregnancy.

    With this relationship based model of care, women can, if they are not sure, then leave the decision of where to have their baby until labour itself and, since all women will spend a significant part of their labour at home anyway, it is a very simple step to deciding to remain there, with your trusted midwife by your side – or with her support, make an informed decision about when to go in, either to the birth centre down the road or the consultant unit for the area….

    And, hey presto – we would have a 10% HB rate in no time, women would start to hear of and know other women who were having positive and fulfilling birth experiences at home, it would demystify the experience and, before long, we could reach the tipping point where it becomes a reasonable and increasingly sensible choice for low risk women to make – you would then at a stroke also improve the experience for those women needing or wanting to go into hospital.

    The key to this future Utopia? Bringing in new midwifery models, based in the community, working collaboratively and in partnership with the local Trust etc but with the sole purpose of providing caseload midwifery to the women in their community and guess what – we already exist – Neighbourhood Midwives’ vision is exactly what I have just described and, with women and midwives campaigning together we can make it happen

    And, to pre-empt comments that there are not enough midwives to do this – Neighbourhood Midwives is unique in that we are an employee-owned social enterprise and the working environment and culture we offer midwives is very different to the current system. We know that there are 1000’s of qualified midwives out there who have chosen not to work in the medical model but who are interested in a genuinely social model of midwifery care…. we just need to offer them more choices in how they practice

    • Thanks for this perspective Annie, it would be wonderful if all midwives wanted and were able to work in this way, so that all women could receive total continuity of care. Keep shinning the torch for a better future! Sheena x

  13. I am not “low risk” but just this past Monday had my fifth baby (second home birth). One of the midwives who attended told me that this would be the last time I could be “allowed” to birth at home.

    What makes me resentful is the checklist mentality that doctors and midwives seem to have with respect to risk assessment. There isn’t much scope for them to look at me as an individual with my own specific birthing history. I get told time and time again that my risks are higher than normal, but never actual numbers; upon research, it turns out that yes – my risk of previous cesarean scar rupture is double that of a non-scarred uterus rupturing, but that the actual number is still less than 1%.

    On the one hand, I get told that I am “allowed” to make my own birthing choices, but when push comes to shove, it is very clear to me that the midwives are nervous and unhappy about me birthing at home. I try to shrug it off (and hiring a doula surely helped with that) but it still rankles.

    Home birth is not just for the sake of me as a mother (although my mental health is pretty much the foundation for the optimal functioning of my family and that really should be counted as important!) but has been best for my family as a whole – after our newest arrival was born, my older children were able to bond immediately with her and join in with their father and our doula to tidy up, help me get cleaned up and dressed, weigh and measure the baby, etc. The birth was truly a family affair and that is exactly as it should be.

    • I sense your frustrations Sarah, and I know that many midwives dislike the risk assessment and ‘tick box’ activities almost as much as you do. It’s a bureaucratic nightmare to be honest, but is a consequence of the increasing litigious society we live in. It’s a whole topic really, and I could go on. My advice to you would be to ask to speak to a Supervisor of Midwives, and explain that you understand that Guidelines and GUIDELINES. I am so pleased you brought up the topic of how ‘risk’ is presented, I frequently bring this up with health care professions, and highlight the difference and importance of actual and relative risk. Once you have gone through the benefits and risks of each option available to you and your baby, the choice is yours. It’s great that you have commented on here, as it’s so important to get your voice heard. Thank you very much, and congratulations! Sheena x

  14. I agree with Barbara that hospitals have a financial disincentive to encourage home birth, despite the fact that it is safer and more cost effective. The new system of clinical commissioning should make a difference, if it doesn’t, the reorganisation has been a total waste of time. Hospitals should NOT have the final say about care for low risk women, CCGs should be commissioning midwifery-led care in other places. Birth Centres should NOT be satellites of hospitals. Hospitals should NOT have control over the deployment of midwives. The problem is a virtual NHS monopoly of birth and will get even worse if independent midwives are forced out of practice (the government has yet to ratify the insurance solution). State employed midwives could still practise autonomously when at least some of them were employed by local authorities rather than the NHS back in the early 1970s. So we should all be lobbying our CCGs for midwifery-led care (preferably with a known midwife throughout pregnancy, labour and postnatal care. It’s safer and better for mums and babies.

    • Thanks for your comment Margaret, I was lucky enough to be part of an organisation that has MLC as the default, and supports home birth…and has three birth centres. Women have a choice. Midwives work in teams (based on the model proposed in Changing Childbirth) and therefore work in the environments where choice is offered. All maternity services have much to learn from East Lancs. Not perfect, but trying hard 🙂

  15. I have been a midwife for over thirty years The last seventeen years working in the community facilitating birth choices and privelged to attend and support women choosing home births.I will not repeat what has already been said and agree with comments made,especially the concerns made regarding media potrayal of both birth and midwifery.
    Fear of birth has replaced respect for birth and women’s ability in the birthing process.Informed refusal by women of options and choices in their pregnancy and birth continues to cause consternation to some care givers and managers in the UK.

    I suggest midwives need to keep up to date records and stats of the births they attend assisted c/s normal ,their epsiotomy rates ,perineum rates,spontaneous labours and unmedicated births they attend ,water,home and hospital births etc.Each midwife yearly then assesses what skills and update they require.Women they are supporting should be able to ask to see the midwives stats .I know independent midwives have always done this.

    Thank you for facilitating this discussion Sheena
    lesley price

    • Thank you Lesley. You have wise advice and midwives learn so much from you. A great idea to keep statistics and records of training and share when discussing choice. I also think true evidence based information sharing should include the results of the Birthplace study on hospital birth. x

  16. From personal experience I have found it’s very black and white if you’re deemed as high risk: CLU or HB against medical advice. Yet when push comes to shove there is a rather large middle ground. I pushed for a HB with my 3rd and ended up “brokering a deal” (exact words my cons used!) to get the type of birth I wanted and keep him happy at the same time. I was genuinely happy with the plan put in place, as had my own risk niggles and what ifs that it resolved, but am still very unhappy that one man felt he could in essence treat MY labour and birth as a business contract 😦 As it happens my daughter had her own plan on that one LOL

    Until women are given ALL their options and the evidence presented in an unbiased way, how on earth can they be expected to make a truly informed decision. Telling an expectant mum that she doubles the chance of stillbirth if she’s not induced for going over her EDD is the perfect example of an accurate statistic being presented with bias. Yes it’s doubled, but from 1 to 2 in 100, so 98% chance of not happening AND it is never presented with the risks of induction resulting in section and said risks of section etc etc AND while such stats are presented to the general public in the same way, there’s always going to be that general consensus of “why would you risk your baby”.

  17. Thank you for facilitating this discussion Sheena. Good question why a midwife is not of the panel for the debate on Homebirths! Mary Nolan, recently challenged individual midwives and the midwifery profession for not contributing to let alone leading on the debate on homebirths. This is one of the reason I chose to contribute to and edit a book entitled ‘Supporting women to give birth at home: a practical guide for midwives. I’m finding that is is not only some women who now have a fear of giving birth at home but also some midwives who have limited experience of attending home births. There is much work to do to alleviate this fear around the choice of home birth and bringing back the joy of birthing at home. I believe you are an excellent advocate to take this forward, all the best Mary x

  18. I live in Canada, and I have 5 children (pregnant with my 6th), all of whom were born at home. My first pregnancy at age 19 ended in a hospital miscarriage, and it was such a vile, horrendous experience, I decided never to step foot in the hospital again. During my first pregnancy, I hired a registered, midwife, who worked for the government and the newly minted college of midwives (province of British Columbia). I fired her a couple of months into my pregnancy because she clearly did not work for ME, the mother, but for her governing institution. There was no way I was going to accept being pushed into submitting to ultrasounds, or allowing anyone to coerce me into accepting an induction if my pregnancy happened to proceed past 42 weeks (all of my babies are born at around 43 weeks, incidentally). I ended up hiring an independent birth attendant, and paying her out of my own pocket, a vast sum, to support me as the full authority of my pregnancy and birth. Best money I have ever spent. The same woman attended me during my second birth, and I went on to have 3 beautiful unassisted births. The answer to the problem of access to homebirth is very simple: a realization that birth is inherently unmedical, and that being in possession of a uterus grants us the “option” of giving birth wherever we feel like. Sharing stories of joyful family birth, and realizing that if we don’t want a medicalized birth experience, it is probably best not to hire a medical practitioner–and this includes medically-trained “midwives” who work for medical institutions. Unfortunately in Canadian provinces (as in many other countries), the midwifery act legislation automatically criminalizes independent birth attendants. This is discrimination, it is illegal, and it is another example of the way in which pregnant and birthing women are infantilized during pregnancy. If women do not have the fundamental right to choose where, how, and with whom she gives birth, ALL of the great strides feminism has made mean absolutely nothing. Birth is the very definition of our humanity. Here is an article I wrote on the subject called “Who Gave You Permission to Give Birth? http://bauhauswife.ca/?p=1793

  19. The trust where I work has had to temporarily suspend home birth service due to staff shorages. We have had to put the safety of the majority (hospital births) before the requests of the few (home births.)
    Several women have complained and cant seem to understand that it was a very difficult decision for managers to make.
    As a midwife we want to support womens decisions in their chosen place to give birth but at times of extreme staff shortages women need to be understanding in this difficult time.

    • I totally understand Louise, as I was a senior midwife manager too for many years, faced with crippling resources. I’ve had to make those decisions too in my time. It’s a travesty however, especially now that we have the evidence to support HB, and it can’t install much confidence in the women we serve. Also, when we say ‘safety of the majority’-how safe are hospital services for low risk women, when there is greater potential for them to have unnecessary intervention going birth there? (Birthplace)

      How would it be if we suspended epidural services in busy times, or when staffing was dire? I still feel it’s unacceptable, but understand the pressure.
      Thanks so much for commenting, it’s great to be in communication and share views. I appreciate it Sheena x

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