Politics of Home births


 “Nothing about me without me” is the slogan used about  women’s rights in childbirth.

Most of us consider the choice as to where we give birth so far away fron government policy that its odd to think of the two at the same time. But now in 2016 we have to consider what is going on, for all our mothers, sisters, daughters, friends, lovers and for he babies.

Nationally there seem to be two big threads in discussions, one about where women should give birth and the other about how that should be funded. From the Government there are warm words and wonderful suggestions based around home births, midwife units and moving away from Consultant led care.

The government is concerned to  reduce the number of women going into hospital to have a baby. Maternity is the most common reason for first hospital admission.

Then in contrast to the rosy world of the maternity review there are descriptions from those who work in the front line, or those using the NHS, and those who have become campaigners for the NHS, of real risks and shortages in day-to-day provision. One in four mothers nationally reporting being left alone during some of their  labour when they wanted help. Midwives reported as being overtired and stressed.

In Liverpool, in the engagement around the future of Liverpool Women’s Hospital, Home Births seemed to be a big part of the plan in 2015 but that was little mentioned in 2016. This, though, is an important area of spending and an important area for privatisation. Liverpool is a Vanguard area for the Maternity review and its privatisation plans.

In August 2016 there was  a change to NICE guidance which removed a criticism of Caseload Midwife lead care. This is the model used by private contractors in this area. This will open the way for the private  provider model of maternity care.

The latest NICE guidance makes clear that births in midwife-led units (both freestanding and alongside consultant led obstetric-units) and homebirths can be as safe, for low risk pregnancies, as those in consultant led obstetric units, and that these result in less intervention“.

Private providers are paid by the NHS, make a profit from the NHS, but provide a free  service to the patient who will often not be aware that it is not the NHS. We believe though lower levels  of service  are available through them than that provided in the NHS. We will provide evidence for this in another post.

Amongst our campaigners there is a range ofopinion on home births but all of us support the right of a woman to choose to have a home birth or choose to have a baby in hospital.

It is our belief that the Maternity Review’s emphasis on home births and minimum interventions  happens to be helpful to the  development of private providers but not helpful for the safety of those women who might need emergency interventions in giving birth.

August 2016’s national publication stresses again the role of private providers. They are looking for an area to trial private providers. Liverpool is a pioneer area in the Maternity review

“Testing novel payment models

 We want to work with at least one site where there is willingness to design and implement new local payment models, or trial any new payment system model(s) with the support of both NHS England and NHS Improvement

Please describe how you would involve wider partners (including clinicians and women and their families, independent midwifery practices and the voluntary sector as appropriate) to design and support delivery of your vision for transforming maternity services”


“Supporting Local Transformation: this work stream will work in tandem with STP processes, and through the Maternity Clinical Networks, to provide targeted support to local maternity systems.  In addition, we will support a small group of early adopters to harness enthusiasm for change and test the model of care described in Better Births. “https://www.england.nhs.uk/ourwork/futurenhs/mat-transformatio/

The real plans will not be revealed for a while. It is still not quite acceptable to be discussing, too openly, using for profit contractors to provide such personal services.It will take time to develop private provision so the discussion at meetings and  in documents, is that Maternity be relocated to an acute hospital

“It is likely that proposals will include moving at least some of the care currently delivered at Crown Street to a different location or locations.” Healthy Liverpool



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