PARENTS

Home Births And Maternity-Led Birth Units Are 'Best For Mothers'. But Where Are The Midwives?

05/12/2014 10:49 | Updated 20 May 2015

Newborn Baby Boy with his mother and father

Home births can be just as safe as giving birth in a hospital – and even safer in some cases, according to new guidance issued today.

The National Institute for Health and Care Excellence (NICE) says giving birth at home or in a midwife-led unit is safer than the labour ward for many women.

Which is lovely. There's been plenty of research knocking around for a while about how much more effectively we labour in relaxed, safe, loving surroundings which get our oxytocin flowing.

Giving birth is a natural part of life. We should all be doing it in the most natural way possible. Except. I quite like the idea of a safety net. Doctors. Epidurals. Operating theatres.

There's natural birth, and then there's natural birth. After all, the infant mortality rate in England and Wales was around 15 per cent in the 1870s.

Personally, I'd rather have a more 'stressful' birth experience and go home still alive, with a healthy baby. But that's just me. I'm a cautious type.

Yes, I know many people have wonderful, amazing home births, and I'm really delighted for them.

But if you're the kind of personality type that's anxiously always waiting for SOMETHING to go wrong, the idea of a home birth will send you into jitters of terror.

And for many women, if they choose to give birth at home and something does go wrong, they face half an hour or more in an ambulance to get to the nearest hospital.

But then we have the other extreme, which is that currently more than nine out of 10 children in England and Wales are born in obstetric wards, under the care of a consultant. That's obviously not really necessary. And there's more chance of interventions when you give birth in hospital – our C-section rates are through the roof in this country.

Of course, there's a happy medium. The ideal compromise for many women is the maternity-led units inside major hospitals. They have home-from-home rooms, birthing pools, amazing midwives, the works. They've also got all those lovely doctors with their epidurals and their expert life-saving skills, just along the corridor. It's a bloody brilliant idea. So why aren't there more of them?

Kathryn, who gave birth to her first baby recently in one such unit, said: "I love midwives and would much prefer to have a baby delivered by a midwife than a doctor any day. However, I hope these findings aren't an excuse to cut more doctor-led units in the NHS. I was lucky there were doctors just down the corridor from the midwife-led unit where we were, but if we'd faced a 30-mile drive to the nearest specialist, I don't know what would have happened to me and Betts. And I don't seem to know many people who had uncomplicated labours..."

Emma, who had her first baby in 2012, agrees. "This is worrying," she says. "Things went wrong for us quickly and I was so glad to have obstetricians around. Why don't they put money into improving midwife centres in hospitals so doctors are there if needed?"

Only a few hospitals – around 80 across the country - have midwife led units and they're often full. Which means they often put women off coming in until they are literally giving birth in the car park - which means they have to be plonked in a labour ward. Or they have to send women to a different hospital to give birth – in another labour ward.

There are also a number of stand-alone midwife-led units scattered around the country – but many of these are also a fair distance from the nearest hospital, with all those lovely doctors.

The bottom line is, there's a massive shortage of midwives. Earlier this year a committee of MPs said there was a national shortage of 2,300 midwives, potentially putting the safety of pregnant women and their babies at risk.

So who's going to provide this prolonged one to one care for an increased number of home births? Who's going to staff any extra midwife-led units? It turns out, a home birth actually costs the NHS less than a birth in a midwife-led unit or a hospital. (Puts cynical hat on.) But we still need more midwives, and there's no getting away from that. Let's hope this isn't just a way of cutting costs.

The truth is, for many women, there is no real choice. According to NCT research carried out in 2009, only 57.4% of the population of childbearing women had reasonable access to both an obstetric unit and a birth centre.

Since 2010, across England 13 maternity units - including seven midwife-led centres, have been closed, and six consultant-led units have been closed and replaced with units run by midwives.

Cathy Warwick, chief executive of the Royal College of Midwives (RCM), says there need to be more midwife-led units in order to provide that choice for women.

"It is very welcome to see the guidance reflecting the latest evidence around place of birth," she says.

"For low risk women, giving birth in a midwife-led unit or at home is safe and reduces medical interventions.

"We hope that this will focus commissioners' and providers' of maternity services attention on ensuring that women have a real choice about where they give birth, be it in a hospital, a midwife-led unit or at home."

Hear, hear.

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