Women want individual care. Women a want good care for all women and babies
Having a baby at home can, if there are no complicating factors, be really good for mother and baby, but even this service is up for privatization. Small scale privatization of home deliveries is already happening on Merseyside and is spreading out.
Our campaigners believe absolutely in a woman’s right to choose home delivery but the midwives involved should be part of the NHS, fully trained, with ongoing professional development opportunities, fully supervised by the NHS and linked to emergency NHS provision if things go wrong, fully insured and not for profit.
If a woman makes a choice to step outside the NHS provision and use an independent midwife that’s her choice, but that is not what has been happening on Merseyside where a privte company has been commissioned to provide some maternity care for home births.. Some women were not aware that the midwife they were using was not employed nor supervised by the NHS. They were not aware that parts of the home birth service had been contracted out.
The concept of “one to one care” in pregnancy and childcare is a national one.It is about knowing your midwives in advance, having the same person or small team providing pre natal care, care during the actualbirth and care to mother and baby after the birth. One to One midwifery care can be provided by the NHS, in NHS hospitals, in Midwife led units and in the community. Many such services do exist.There used to be a serive in Liverpool called Dominoes (domicillary midwives) who would provide care in pregnancy and go into hospital with you, and look after you after the baby ws born and first home. However, in 2016 there is a shortage of resources in the NHS and a shortage of midwives, obstetricians and neonatal doctors and nurses.
Resource pressure can limit a very good idea. This was seen in Birmingham. NHS One to One midwives in Birmingham women’s hospital reported being called in to work in the hospital when the hospital was short of staff, rather than concentrating on their caseload. The core issue is shortage of midwives and the inadequate maternity tariff
Most women still choose to give birth in Hospital, either in consultant led units or in midwife led units This is a conscious choice. There are many reasons for this, often very valid.
“Around half of pregnant women in the UK will have or develop a complicating factor – from high blood pressure to diabetes – that makes a hospital birth advisable. Of the remaining half, he says, about 50% develop a problem during labour that may require an emergency transfer to hospital. “That can be very traumatic, even if things end up well” Philip Steer, emeritus professor in obstetrics and gynaecology at Imperial College London.”
Home births may reduce interventions with lower rates caesarean section, forceps, epidural and episiotomy but the situation for safety for the babies is less clear. The statistics are complicated because the women who give birth at home are likely to be the ones who will not need interventions because more complex cases are referred to hospital.The more complex cases need the interventions. Also interventions can be very effective and necessary. It can be a bit like saying less meat is eaten in vegetarian restaurants
There is a good website for exploring the personal options for someone deciding where to give birth from Which and another from the NHS
Some women see the experience of giving birth as one of the greatest joys and experiences of their lives, and others as a not very pleasant experience, best soon forgotten, but one that produces their much loved baby. Some want personal control over every single aspect and some are happy to hand over control to the experts.
An uncomplicated home delivery of a baby is a joy to the world. The help of a known and trusted midwife can only add to that joy.
Labour for many women is far from simple and, at the extreme, they or their baby, would die without medical intervention. Those interventions prevent huge tragedy and allow thousands of mothers and baby to go home safely to begin their great journeys.
Going into labour at home is exciting and daunting. Calling a professionally qualified and experienced midwife who you already know must reduce any anxiety and fear. All Midwives and support staff should put women in labour at their ease, as best they can, but a trusted, familiar face works wonders. One woman described how she scarcely had to speak, either the midwife or her partner, guessed what she wanted, without words.
Walking into a labour ward, in labour is also exciting and daunting. Being greeted by a familiar and trusted person must reduce anxiety and fear. Midwives and support staff do put women in labour at their ease as best they can but a trusted familiar face works wonders. One woman described how the midwife shared this intensely personal experience” with the knowledge and kindness of a close and very knowledgeable friend, though we had never met before.”
One to One care, in the home or in hospital, is something we believe all women in labour need. And more resources should be put into the NHS to allow more midwives to be trained and employed to make this possible. Its not something that can be used as a money saving opportunity or an opportunity to contract out services.