Home births are in the news today. New figures released yesterday by the Office for National Statistics (ONS) showed a small drop in the home birth rates, from 2.3% to 2.1% over the last year.
There is a lot of speculation about why the rate has fallen, and the simple answer to that is that we simply don't know, though we can make some educated guesses based on what women and RCM members tell us.
One thing we do know is that too often women are denied the choice of a home birth because of midwifery staffing shortages and this is the case particularly in England. We know this because every year the Royal College of Midwives (RCM) surveys heads of midwifery across the UK. They tell us that community services, such as home births, are often suspended because they have to pull community midwives back into the hospitals to cover labour wards. This is understandable because they have to ensure that they provide the safest possible care for women in labour. However, this is often and understandably a deep disappointment to those women who had planned for a home birth. This is perhaps not likely to improve while England remains 3500 full-time midwives short of the numbers needed to deliver the safest possible personalised care, and choice as recommended in Better Births.
There may also be other factors affecting home birth rates. Our maternity services are seeing women with more complicated pregnancies than we have had before. Factors including rising levels of obesity and higher numbers of older women giving birth all mean that our services need to ensure these women get the safest possible care and attention. More complicated pregnancies (not always) can mean that a home birth may not be advised. The development of midwifery units, either (alongside) within a hospital or in the community, (freestanding) may also mean some women choose this option instead of a home birth.
What is not in doubt is the evidence around home birth (The Birthplace Study published in 2011) and the policy of governments in UK countries to offer it to women. The evidence shows for women without complications who are having second or subsequent pregnancies, home birth is as safe as birth in a midwife unit or indeed as the more 'traditional' birth option of a hospital birth.
Two major government policies, in Scotland "Best Start" and in England "Better Births" also state that home birth should be a true choice for women. . Baroness Cumberledge, who chaired England's National Maternity Review, wrote that 'I heard women and their partners telling me of life affirming births in their own homes - the place where they felt most confident, in charge'. It's so important that we listen to women.
The key issue at the heart of all this is "choice"; choice for women about where they want to give birth. What our maternity services providers across the UK have to do is ensure that women have this choice. Midwives need to be with women to discuss these options, give them the information and evidence about home birth, and then support women to make the choice that is right for them. Politicians in their turn must support their policies and ensure our maternity services are adequately staffed and resourced. Women should, and must have real choices not ones that are denied them because of the vagaries of staffing and funding.