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Wendy Savage says midwives are capable of overseeing uncomplicated home births |
Midwives have a role to play in home births
Wendy Savage believes that midwives are more than capable of overseeing uncomplicated home births
THE government policy launched last week ‘Maternity Matters’ was greeted with relief by many childbirth campaigners, women and midwives.
The Royal College of Midwives expressed concern that the plan was not achievable without employing another 3000 midwives. The statement by the Secretary of State did, unusually for New Labour health policy, conform with the Labour Party manifesto of 2005 and proposed that “every woman should have the choice of a home birth or birth in a midwifery-led unit by 2009”.
Perhaps the silence of the obstetric establishment in the media is because the Secretary of State omitted the crucial word ‘healthy’ from this pledge to guarantee the choice of birth place to all women. The press statement on the Royal College of Obstetricians and Gynaecologists (RCOG) web site states erroneously that “hospital births are still the safest option for most women”. They are probably the safest option for women with medical problems (although the evidence for this is scanty) but the majority of women are healthy.
They do not need care from obstetricians who are the experts in abnormal pregnancy and birth, but can safely be looked after by a qualified midwife throughout pregnancy, birth and the important period after birth, the puerperium.
Midwives are the experts in normal birth and one of the reasons that we have too few midwives today is because half of those who trained are not practising as midwives.
Many of these have left because they see the whole process of birth as over-medicalised and they do not want to work in a system where they feel they are obstetric handmaidens, not autonomous professionals.
Birth arouses powerful emotions in all of us. The issue of home birth continues to inspire heated debate and passionate arguments. Some women feel strongly that they want to give birth at home.
This is their own place, the centre of family life, it belongs to them, they feel secure and relaxed there. The professionals are visitors.
In hospital the woman is not in charge. The rules and system are imposed upon her, however hard people try. The noise, the interruptions, the bright lights, all interfere with her feeling of being in control and able to surrender her body to the rhythm of birth.
Birth is seen as a natural and profoundly significant part of life which should be part of the community in its truest sense, not taking place in a hospital where people go when they are ill or to die.
The negative emotions and memories associated with hospital may well interfere with the way some women labour, as may travelling once labour has begun.
This may explain why the move from 30% home and 11 per cent GP unit births in 1958 to 1.5 per cent home births and five per cent GP unit births in 1980 was associated with a steady rise in delivery by Caesarean Section (CS).
This has now reached 24 per cent in England when WHO stated in 1985 that 10 per cent was a reasonable figure – a rate with which I agree.
In 1994 RCOG, after many years of vigorously opposing home births on the grounds of safety, agreed that “Home birth is an acceptable option and appropriate information should be provided”. Up to then they had argued that it was unsafe, and the current statement in response to Maternity Matters suggests that some still think this way.
The latest information we have about home birth in the UK comes from a study of Home Births in 1994 carried out by the National Birthday Trust and published in 1997.
The results showed that there was no statistical difference in the number of babies who died (1.1 home booked vs 1.5 hospital booked per 1,000) ie it was equally safe.
But women booked for hospital were twice as likely to have a forceps or vaginal delivery (5.4vs 2.4 per cent) or Caesarean (4.1 vs 2.0 per cent) as those who booked at home (including those who were transferred to hospital for delivery).
Fifty per cent of women at home delivered in bed and half in other positions whereas in hospital 86 per cent of women delivered in bed, suggesting that women were freer to do what their bodies told them to do.
After the Winterton Committee report (1992) and the recommendations in Changing Childbirth (1993) women were hopeful that the system would alter, but as no money was allocated to make the radical changes proposed, little happened.
If the money to employ more midwives reaches the PCTs and is spent as envisaged, we do have enough midwives to change the focus from hospital to community.
However I believe that unless we have midwives separated into community midwives working in small groups and hospital midwives, things will not change sufficiently to achieve the kind of birth that women want and need if they are to be confident mothers.
For once the government has got the policy right but we will have to push hard to ensure that they deliver.
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