Homebirth

Please click a subject below to jump to different parts of this Home Birth page.	Home Birth	Home Birth Debate Listen to BBC Radio 4 Woman's Hour Friday 28th Aug
Photograph by Marcia May	Extract from "Homebirth" by Sheila Kitzinger	Photograph by Marcia May
	Peterborough Campaign for Choice in Childbirth
	Official support from midwives for women seeking home birth
	Children's books on Birth
	Some Media Coverage of Home Birth

Whether birth is difficult or easy, painful or pain-free, long-drawn-out or brief, it need not be a medical event. It should never be conducted as if it were no more than a tooth extraction. For childbirth has much deeper significance than the removal of a baby like a decaying molar from a woman's body. The dawning of consciousness in a human being who is opening eyes for the first time on our world is packed with meaning for the mother and father, and can be also for everyone who shares in this greatest adventure of all.
There are many women who hope for child- birth in which they, not the doctors, are in control. They want to have the information that will enable them to make their own decisions, to prepare themselves for an experience in which they participate fully, and do not wish labour and birth to be taken over by managers.
They know that it is easier to do this on their own ground, in a place to which the doctors and midwives who are their care-

givers come as guests. They would like to give birth outside a hospital. This may be either in their own home, or in a birth centre in which the rhythms of a labouring woman's body are honoured and waited on, and where birth is non- interventionist and centered on people instead of on mechanical processes.
Hospitals exist where all members of staff share this attitude, but they are few and far between. You need only one person who is out of tune with such ideas, who believes in the aggressive management of labour, who, instead of being client- oriented, sees a woman as a patient who must obey hospital protocols, one person who is anxious and afraid, and who cannot trust women's bodies, for the environment in which birth takes place to be poisoned, and completely unsuitable for the focused concentration and inner confidence that is needed for a good birth.

The UKCC is the governing body for all nurses, midwives and health visitors in the UK

The Council recognises its responsibility for enabling midwives to provide midwifery care and support for women in childbirth, whatever choice they make about the method and place of birth.

Employed midwives have identified problems...when the trust employing them says that it is unable to provide a planned home birth service.....the hospital service has taken priority and women who wish to have a home birth are asked to come to the hospital ....It has caused concern and distress for women to be told at a late stage of pregnancy that they cannot have the kind of birth which they have chosen, booked and planned. "

The Council's position regarding home birth

The maternity services policies across the United Kingdom

"The maternity services were the subject of review in each of the four countries of the United Kingdom during the 1990s....The key recommendations common to the four policy documents were that maternity care should be woman-centred and that choice should be offered to women in the types of services available. The Council fully supports these policies and seeks to provide support to enable midwives to provide high quality care.

Midwives' rules and code of practice describes the responsibility and sphere of practice of the midwife: “A practising midwife is responsible for providing midwifery care to a mother and baby during the antenatal, intranatal and postnatal periods.”....The midwife should not refuse to continue to provide care for a woman on the basis of where the woman wishes the birth to take place.

The midwife should discuss the situation fully with her supervisor of midwives to obtain further professional advice. In the interests of developing relationships based on trust and openness, the woman should be included in the discussions. If mutually acceptable alternative arrangements cannot be agreed, the midwife should not withdraw care.

If her (the woman's) decision is to continue with the planned home birth, the midwife should not withdraw care

Midwives' rules and code of practice states: “It is the duty of the supervisor of midwives to ensure that agreed local policies are easily available to all practising midwives within their jurisdiction. The local policy should provide you with support in all settings, including home births and the availability of emergency services, to enable the best possible arrangements to be made for the care of the mother and baby."

Conclusion

" Women should be supported in the choices they make about the birth. When difficulties arise, it is hoped that services which put women and babies at the forefront and which are mutually acceptable can be agreed through negotiation and co-operation between all those who are involved. "

British Journal of Midwifery 9.1

January 2001

Individual trusts are impeding home births, not the UKCC

Since the UKCC released it's position statement 'supporting women who wish to have a home birth' .....
In effect, any attempt by NHS trusts to deny women a home birth service has the status of a bluff, depending on intimidated women not calling it...
When it is clear from literature, and when it is also clear from the UKCC's statement and Midwives' Rules that midwives may not withdraw care from a woman on the basis of place of birth, we must conclude that although NHS trusts can tell women that they can not be attended by a midwife in their employ, they are in no position to carry out that threat, and midwives are in no position to enforce it themselves...

May 2, 2001, More midwives and more money for maternity.
A National Service Framework is to be established for children and maternity services to raise standards.
This will ensure that women will have access to a midwife dedicated to them when in established labour 100 per cent of the time. And those women who want to go ahead with a safe home birth will be supported wherever they live in the country.

April 29, 2001, The Independent on Sunday - 'Family -friendly' Labour backs home births.

In summer 1999 there was lively discussion of home birth in the British media. Strong feelings were expressed about the dangers of home birth. Research evidence has been ignored. But see the following for a more informed approach.

THE INDEPENDENT

30 August 1999

Right of Reply

Choice/Home Birth
From Mary Newburn (Head of Policy Research for the National Childbirth Trust)

Women who choose a home birth or question the need for a caesarean are not all airheads who, in Yasmin Alibhai-Brown's words, `want to dance in the meadows with daisies in their hair” (Give me hospital birth any day, 26 August) but normal people who want to weigh the pros and cons of different ways of giving birth and decide what's right for them and their baby. The trouble is that where you live and who you go to see when you're pregnant, is as likely to determine the choices you're offered as your health and the details of your pregnancy. This is not just an accident of geography, it is the result of different beliefs about birth.

The `midwifery model” is based on the belief that childbirth is a normal physiological process, for which women's bodies are well designed. Midwives and doctors educated within this framework believe it is important for women to feel confident about their body and their ability to give birth. They believe the environment and the things done to women can help labour go smoothly or interrupt the flow.

The `medical model' is based on the belief that evolution has done childbearing women no favours – the human brain is now big and our pelvises are narrow – and birth is only normal in retrospect. Doctors and midwives who have been educated in this frame of reference tend to relate to pregnant women as cases with the potential for complications which must be managed to avoid disaster.

We're all influenced to some extent by these beliefs. Alibhai-Brown demonstrated which mast her flag is nailed to: `childbirth is a difficult and dangerous process and we need all the help we can get'. Marina Baker (Deliver me from hospitals, 26 August) was equally clear; `If you're uptight which is often the case in hospital, it slows down your contractions. At home you're more relaxed which really does mean less pain and a faster labour.'

We need the best of both approaches. We should protect and promote normal labour though a greater understanding of the midwifery model and embrace evidence-based medical care when it is needed. Differences in beliefs and their consequences should be actively debated to help us achieve the right balance in the UK. On the face of it women may appear to have more choice in childbirth but official statistics show fewer and fewer women are defined as normal throughout their maternity care. Just 25 years ago only one in twenty women had their baby by caesarean, now one in six do, despite improved health and smaller families. Is this really necessary or is our fear of complications producing a different kind of disaster?

THE TIMES

26 May 1999

Birth Risks

From Dr Gavin Young

Sir, I am surprised at Professor Drife's letter (May 20) in which he states “hospital birth is three times safer than home”.

The Fifth Annual Report of CESDI (Confidential Enquiry into Stillbirths and Deaths in Infancy) 1998 contained a report from a focus group on “Place of Delivery”.

I was a member of that group. We were unable to make a fair comparison between home and hospital for several reasons: the number of deaths in either setting is, mercifully, very small; not all women who choose home birth are “low risk” — some choose home against professional advice, and some at “low risk” reject advice when complications arise.

For women who fit accepted criteria and continue to accept their carers' advice, it is not possible to say whether home or hospital is safer.

The continued argument over this is futile — only a randomised, controlled trial can answer the question and it is now impractical to recruit the very large number of women needed for such a trial. We will never know. Doctors and midwives would be better employed making home and hospital safer.

Yours sincerely. GAVIN YOUNG
The Surgery
Barn Croft,
Temple Sowerby,
Penrith, Cumbria CA10 1RZ

THE TIMES

18 May 1999

Luke Zander with two-year-old Max Kindersley
Photograph by Richard Pohle

New NHS proposals radically alter the traditional role of doctors - and for some patients this means losing a friend. Sue Fox reports.
... For Anabel Kindersley, the 27-year-old mother of two-year-old Max, who was able to have the home birth that she wanted with Dr Luke Zander's support, the news that she will now have to register with another GP is devastating.
“Although I'm a relatively new patient, he has been my husband's GP since he was a baby,” she says. “When I was pregnant - and as a new mother - he gave me the confidence to allow me to make my own choices about healthcare. I can't imagine that anyone else could be as supportive and encouraging - all of which I believe are important in any relationship with a GP. If I wanted to try homeopathic remedies before taking antibiotics, I could discuss it with him.”

Zander is particularly interested in maternity issues, medical ethics and the changing thinking about complementary medicine. Of Anabel's home birth, he says: “if you allow people to do what they want in life, it creates a confidence and self-reliance that helps them to take on other challenges and to feel better about themselves. Being patient-centred - as opposed to disease-centred - has nothing to do with having a good bedside manner, or with kindness or politeness, which are important. It is about being prepared to base your health-care decisions on the individual patient rather than on the disease process. Equally, establishing a good rapport with patients does not necessarily depend on the amount of time spent with them.”

THE TIMES 2	26 September 2000
Home comfort. A new report suggests that home birth can be the safest option. by Justine Hancock "Women are brainwashed into thinking birth outside hospital is unsafe"

THE OBSERVER	7 May 2000
Midwife crisis puts home births at risk. Campaigners fear for safety of unsupervised deliveries as staff shortages hit hospitals http://www.guardianunlimited.co.uk/Archive/Article/0,4273,4015635,00.html

THE INDEPENDENT	1 June 1999
Women seek warmth and intimacy of home birth By Jeremy Laurance The growing demand for home births By Jeremy Laurance