But will there be enough midwives to go around?

By Julie Whel­don
Sci­ence Cor­re­spon­dent
Dai­ly Mail, 15 May 2006, pages 1, 8–9.

Voir la tra­duc­tion de cet arti­cle. Il y est ques­tion de l’accouchement à domi­cile, une option soutenue par le min­istère de la san­té au Roy­aume Uni depuis le rap­port par­lemen­taire Chang­ing Chilbirth en 1992 (voir his­torique). Un rap­port récent a mon­tré que, pour répon­dre à la demande crois­sante d’accouchements à domi­cile et respecter ain­si la lib­erté de choix des usagers du ser­vice de san­té, l’État devrait for­mer env­i­ron 10 000 sages-femmes de plus.

Can the NHS really deliver the choice?

‘It would be a big and a very popular change’

[NHS = Nation­al Health Ser­vice in the Unit­ed Kingdom]

Women who wish to give birth at home will be giv­en every encour­age­ment under Gov­ern­ment plans to shake up mater­ni­ty care.

Min­is­ters want to move away from the long-held assump­tion that hos­pi­tal is always the safest place to deliv­er babies.

Women hop­ing for a home birth often face med­ical oppo­si­tion, espe­cial­ly if they are first­time mothers.

But under the new approach, a home birth would no longer be regard­ed as an excep­tion to the rule.

Although women already tech­ni­cal­ly have the right to ask for a home birth on the Health Ser­vice, in prac­tice many find obsta­cles put in their way. A Depart­ment of Health source last night said the deci­sion to make home births more avail­able rep­re­sent­ed a ‘sig­nif­i­cant’ shift in mater­ni­ty care.

Health Sec­re­tary Patri­cia Hewitt, her­self a moth­er of two, has com­mis­sioned a report to exam­ine the lat­est evi­dence on home births with a view to mak­ing them more available.

Home birth cam­paign­ers wel­comed the news as an impor­tant step for­ward. But crit­ics warned the cur­rent short­age of mid­wives meant the NHS was still a long way from being able to pro­vide such a choice to all preg­nant women.

Only last week the Roy­al Col­lege of Mid­wives warned that half of all health trusts, weighed down by debt, are not replac­ing mid­wives who leave the NHS.

Giv­ing birth in hos­pi­tal as a mat­ter of course is a rel­a­tive­ly recent practice.

Up until 1955, a third of babies born to mar­ried cou­ples were deliv­ered at home.

By 1975 this had plum­met­ed to a mere 3.3 per cent.

The lat­est fig­ures avail­able show that in 2004 more than 15,000 babies were born at home in Britain.

This is a 7 per cent rise on the pre­vi­ous year.

Even so, it still rep­re­sents just 2 per cent of the 716,000 births each year in Britain.

Cam­paign­ers believe women face a ‘post­code lot­tery’ on whether they give birth at home or hospital.

In many areas a lack of mid­wives restricts their choic­es. Although expec­tant moth­ers can ask for a home birth, they often find cash­strapped health trusts which are short of staff can­not pro­vide the ser­vices they would need.

Many first-time moth­ers are also put off home births by hos­pi­tal staff who make them fear they could not cope with­out an epidur­al or could be risk­ing their baby’s safe­ty by fail­ing to have a full med­ical team on hand.

Women who have pre­vi­ous­ly had a nor­mal deliv­ery with­out com­pli­ca­tions tend to be more con­fi­dent in demand­ing a home birth.

In most NHS hos­pi­tals a mid­wife will be respon­si­ble for two or three labour­ing women at the same time.

Dur­ing a home birth, how­ev­er, one-on-one care is guar­an­teed. It is esti­mat­ed the NHS would need an extra 10,000 mid­wives to pro­vide such care for all women giv­ing birth.

Home births also allow women to move around more freely, which has been shown to reduce the risk of need­ing inter­ven­tion, such as for­ceps, to deliv­er the baby.

The woman is also thought to be more relaxed in her own envi­ron­ment. This often results in a short­er labour.

How­ev­er those giv­ing birth at home can­not be giv­en the strongest pain-reliev­ing drugs or an epidural.

Access to surgery in the case of emer­gency is also compromised.

In one study, as many as four in ten first-time moth­ers giv­ing birth at home end­ed up trans­fer­ring to hos­pi­tal to com­plete their labour.

One in ten who had giv­en birth before also had to go to hospital.

The Nation­al Child­birth Trust said women were often dis­cour­aged from even con­sid­er­ing a home birth, even in cas­es in which it was the best option.

Chief exec­u­tive Belin­da Phipps said more Gov­ern­ment sup­port would over­turn the view that began in the 1970s — and was based on flawed sta­tis­ti­cal analy­sis — that home births were unsafe.

‘It would be a very big step for­ward and a sig­nif­i­cant change,’ she said. ‘It would be a very pop­u­lar move.’

She said the Gov­ern­ment would have to recruit more mid­wives, help those who had left to return to the pro­fes­sion and tack­le the prob­lem of NHS man­agers who often wrong­ly believed home births are unsafe.

‘There will be a gap until these things can start to change but it will be the job of organ­i­sa­tions such as ours to stay on top of this to make sure it does hap­pen,’ she said.

Tory health spokesman Andrew Lans­ley ques­tioned how the over­stretched NHS would cope with extra demand for home births.

He said at least three-quar­ters of mater­ni­ty units were short of staff.

In some areas the num­ber of home vis­its mid­wives could make was declining.

‘It seems that the Health Sec­re­tary Patri­cia Hewitt lives in an unre­al world,’ he said. ‘If there are not enough mid­wives this is not going to happen.’

‘Instead of hint­ing about more ini­tia­tives, she should deliv­er what has been the pol­i­cy for decades, which is giv­ing women gen­uine choice.’

A Depart­ment of Health spokesman said: ‘We are com­mit­ted to offer­ing all women choice of how and where they give birth, and what pain relief is available.’

She said the Gov­ern­ment under­lined its com­mit­ment to deliv­er­ing choice in mater­ni­ty ser­vices in its 2005 man­i­festo, through its Nation­al Ser­vice Frame­works and in a recent White Paper.

‘All these ser­vices will be offered with­in the con­text of what is safe and clin­i­cal­ly appro­pri­ate care for each indi­vid­ual woman,’ she said.

She said the NHS had 2,500 more mid­wives than in 1997.

The num­ber of stu­dents enter­ing the pro­fes­sion had risen by 41 per cent in the same period.


So was home birth the best option for these two mothers?


Dar­ja Bran­den­burg-Anto­ry, 32, is a psy­chol­o­gist. She lives in Coven­try with her hus­band David, daugh­ter Dewi, two, and son Damai, three months. She says:

I had had my first child in hos­pi­tal and although I didn’t have a bad expe­ri­ence, I didn’t like the clin­i­cal, soul­less environment.

So when I found out I was preg­nant again, I chose to give birth at home. Hav­ing a baby should be a cel­e­bra­tion and I want­ed my son’s arrival to feel that way — spe­cial to us instead of just anoth­er birth in a mater­ni­ty ward.

Peo­ple often wor­ry that if some­thing goes wrong the baby will be in dan­ger because you aren’t in a hospital.

If you live very far from a hos­pi­tal then this is a con­sid­er­a­tion, but as long as you have a mid­wife with you there shouldn’t be a problem.

She should spot any issues long before they become life-threat­en­ing, which means you have plen­ty of time to call an ambu­lance. Of course there are risks, but child­birth car­ries risks regard­less of where you have the baby.

My hus­band also believed this to be the best option because all the equip­ment nec­es­sary, such as mon­i­tors, can be used at home. He want­ed to be sure the baby and I would be safe.

The only things you can’t have are pain-reliev­ing drugs such as pethi­dine or an epidur­al, and if you need inter­ven­tion such as a cae­sare­an you will have to go into hospital.

I went into labour at […] weeks on Jan­u­ary 29 this year. Imme­di­ate­ly we start­ed to pre­pare the house for the birth, fill­ing a birthing pool, pro­tect­ing the floor with plas­tic sheets and light­ing aro­mather­a­py can­dles to help me relax.

My waters broke in the evening and for the next 12 hours my con­trac­tions were light. The next day I was able to go for a walk and have a love­ly break­fast with my hus­band and daugh­ter Dewi. There was no sense of pan­ic or stress.

David and I both want­ed Dewi to be present through­out. I had explained to her what would hap­pen and she was very excit­ed about it all.

Child­birth is an amaz­ing, nat­ur­al thing that chil­dren should be allowed to see. There is no rea­son why kids should be left out.

Dewi loved being there. She didn’t see the baby com­ing out but she was in the room the whole time, being looked after by my friend and my hus­band, while the mid­wife attend­ed to me.

As with my first baby, I didn’t suf­fer any ter­ri­ble pain and had a very easy deliv­ery. At 1.30pm I gave birth to a healthy baby boy, Damai, who weighed 6lb 4oz.

I used gas and air, but had no need for any oth­er pain relief. The mid­wife told me it was a text­book home delivery.

I was much more relaxed than dur­ing my first labour, part­ly because I knew what to expect and because I was at home.

The mid­wife ran me a bath and after­wards we opened a bot­tle of cham­pagne and sat on the couch cel­e­brat­ing our new arrival.

We sat there for hours just hold­ing him, and it was won­der­ful to be able to put the baby straight into his cot in his own bed­room. It was the per­fect day.


Angela Howard, 34, is a house­wife in Lon­don. She lives with her part­ner Col­in Howard, 34, who runs his own busi­ness, and their son Luca, 20 months. She says:

A home birth seemed like the per­fect way to bring my first baby into the world.

I thought it would be much more relax­ing to have him in the com­fort of my own house than in hos­pi­tal, which had always seemed like an unnat­ur­al envi­ron­ment to me.

My part­ner Col­in and I weighed up the pros and cons of stay­ing at home.

Our main con­cern was what would hap­pen if some­thing went wrong, but our local hos­pi­tal is just round the cor­ner so we knew that if there were any com­pli­ca­tions we could get there quickly.

After con­sult­ing my GP and mid­wife, I decid­ed to have a pool set up in my front room as the water can help ease the pain of contractions.

By the time my con­trac­tions start­ed on the Thurs­day evening every­thing was in place for me to have the per­fect home birth.

We called the mid­wife, who came round and gave me an inter­nal exam­i­na­tion. She said I was in the very ear­ly stages and that she would pop back the next day.

By the morn­ing I was in com­plete agony, but my con­trac­tions were still irreg­u­lar, any­thing between two and sev­en min­utes apart, and my waters had still not broken.

When the mid­wife came back at 6pm my cervix was still only 1cm dilated.

Thank­ful­ly, my waters final­ly broke a few hours lat­er, but the pain was get­ting worse.

Col­in filled the pool late on the Fri­day night, but it didn’t make the slight­est dif­fer­ence to the pain.

Had I been in hos­pi­tal I could have been giv­en pethi­dine, a drug sim­i­lar to mor­phine, to ease the pain, but you can’t have it at home.

All I had was gas and air, but after fin­ish­ing off two can­is­ters of gas, I was beg­ging for some­thing stronger.

By Sat­ur­day after­noon I was com­plete­ly exhaust­ed and my dream of hav­ing the per­fect home deliv­ery had been shattered.

Emo­tion­al­ly I was com­plete­ly drained. Forty-eight hours lat­er and still only 3 cm dilat­ed, I knew it was time to go to hos­pi­tal. I thought I was going to die.

An hour lat­er I was in hos­pi­tal, where they gave me an epidur­al which enabled me to grab a cou­ple of hours’ sleep. I was also giv­en a drug to help speed up the contractions.

When I woke up I was ready to push. I was so relieved that It would be over.

At 11.56 pm Luca was born, weigh­ing 7Ib 4oz. I was delight­ed he was safe and well, but too tired to appre­ci­ate what should have been a won­der­ful moment.

Two years on I am still scarred by the expe­ri­ence. Now I would seri­ous­ly con­sid­er adop­tion because I’m not sure I could go through that again.