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Home Birth Debate
|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|
"Homebirth" by Sheila Kitzinger
A fully revised and updated version of this book became available under the title Birth Your Way in Feb 2002
|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
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.
Official support from midwives for women seeking home birth
Extracts from the UKCC Position statement (July 2000)
The UKCC is the governing body for all nurses, midwives and health visitors in the UK
Supporting women who wish to have a home birth
"The option of home birth should be available.
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 supports women having choice in the method and place of birth."
"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.
The professional responsibility of the midwife
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
The supervisor of midwives must be mindful of the woman's right to choose.
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."
" 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||
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' .....
Children's Books on Birth
Runa's Birth: the day my sister was born
A beautiful children's book available in English about a 4 year old's experience of her sister's home birth.
Some Media Coverage of Home Birth
July/August 2004 See PCCC web
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.
April 29, 2001 The Observer - Improved care for mothers promised.
|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"
7 May 2000
|Midwife crisis puts home births at
Campaigners fear for safety of unsupervised deliveries as staff shortages hit hospitals
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 on 26 August 1999 published
an article by Yasmin Alibhai-Brown's in which she dismissed home births as 'a luxury of
the middle classes'
Mary Newburn, Head of Policy Research at the National Childbirth Trust, responded to this article, an edited version of which was published as a Right of Reply on 30 August 1999.
30 August 1999
|Right of Reply
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?
1 June 1999
seek warmth and intimacy of home birth
By Jeremy Laurance
The growing demand for home births
26 May 1999
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
18 May 1999
||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.
Contents to be added
Debate in the British Medical Journal 1999/2000
|Home Birth References|
|Home Birth is not just a middle class luxury|
International Home Birth Movement
|New Home Birth Video|
|Home Birth Support Groups|