It was shortly after a family dinner on the date when doctors had predicted
that her baby would arrive that Angharad Yeo felt the first twinges of
labour.
She had decided early on in her pregnancy that she wanted to give birth at
home. Everything was in place. After telephoning the midwife, the
28-year-old felt sufficiently relaxed to have a nice warm bath.
In the hours and days to come, however, her hopes of having a safe,
straightforward delivery — with her husband, mother and a National Health
Service midwife by her side — were shattered.
In labour for five agonising days, she was attended by a succession of hurried
on-call midwives who were too overstretched to stay with her.
On the fifth day, frightened and exhausted, Yeo finally admitted herself to
hospital — where doctors carried out an emergency caesarean.
“All I hoped for was a straightforward birth, as painless as possible,” said
Yeo, whose daughter, Ophelia, is now eight weeks old. “I didn’t have any
incredible expectations. I didn’t even mind the midwives coming and going,
as long as I was getting along okay by myself.
“But as the days went by and I wasn’t progressing, it was obvious that it
wasn’t a normal labour. I was frightened. I felt abandoned. When I called
the hospital to try to get through to a midwife, I was made to feel a
nuisance.
“I’m not a medic and they were asking me questions I just couldn’t answer. I’d
had no sleep for four nights. I was exhausted and in terrible pain. It got
to breaking point. Once we got to hospital, the care was actually very good.”
As Yeo does her best to get over her traumatic experience of home birth,
Patricia Hewitt, the health secretary, is preparing to announce a new drive
to improve maternity services.
There will be a promise that every woman will have a named midwife to care for
her throughout pregnancy and a guarantee of one-to-one care by a midwife
during labour. How long that promise will take to be delivered is anyone’s
guess.
Since 2004 the government has been promising women “real choice” over where to
give birth. In reality mothers face not a choice but a dilemma: home or
hospital? If Yeo had a bad time at home, hospital horror stories also abound.
Last week the government watchdog Nice (the National Institute for Health and
Clinical Excellence) issued a warning that babies born at home have a higher
risk of dying if serious complications occur. But last week, too, a health
department study found that the NHS is letting down new mothers in hospital,
treating many like “meat on a conveyor belt”.
The home birth industry is booming. Hundreds of small businesses now offer a
“natural” birth in familiar surroundings. Want to make it pain-free? Try
hypno-birthing, the self-hypnosis technique for a drug-free birth that was
recently featured on Channel 4’s Richard & Judy show. Want to have
your baby in a birthing pool? Birthpoolinabox.com will send you just the
thing for £54.95 (a few pounds more for the eco-friendly model).
The National Childbirth Trust (NCT), which has long campaigned for more home
births, has just brought out a DVD starring Davina McCall in which serene
pregnant women get on with the job in the bathroom while their Boden-dressed
husbands do the dishes next door.
“For some reason I think people think blood-spattered walls, but I didn’t see
anything — it was just, like, whoosh!” enthuses McCall on the DVD. “I want
to spread the word, because that’s what every woman deserves. You know, if a
woman wants to have a caesarean, that’s cool; but if a woman wants a natural
birth, let’s try and give her one.”
Despite the publicity, home births are rare. Until 1955 a third of babies born
to married couples were delivered at home. According to official figures,
only 2% of the 601,000 births in England last year were home deliveries. A
further 2,500 women (0.4%) hoped to give birth at home but ended up on
labour wards.
NHS trusts in south Devon, Shrewsbury, Bath and Winchester are leading the way
in offering choice between birth at home or in hospital. Elsewhere, home
birth provision on the NHS is patchy at best.
ACCORDING to official figures, a normal hospital delivery costs the NHS about
£1,351, while a caesarean costs £2,339. Nobody seems to have calculated how
much home births cost, but the NCT insists they are far cheaper.
Wherever women end up, the UK remains one of the safest places to give birth,
with just 5.1 infant deaths per 1,000 births. But the home versus hospital
debate has become highly polarised — and particularly vocal on the “home”
side.
The website of the Birth Trauma Association (BTA), a support group for women
who have suffered hell in hospital, makes shocking reading.
“Mel” tells of an agonising forceps delivery. A doctor “with a rude and
patronising manner, without talking to me, put my legs up in strirrups. What
had been a managable experience up to that point became a nightmare.”
“Rachel”, who did not want to give birth at her local hospital, was told by
midwives that she was “too fat and too old, and therefore too much of a
risk, in those words, to my face” to have a choice.
“They sent my birth partner out of the room, leaving me with no moral support.
The male midwife who did this was rude and completely ignored me when I
asked him to go easy. When I tried to breast feed, the only help I received
was being told ‘to put tit to target and get on with it’.”
Another new mother writes: “The whole catalogue of neglect and shocking
treatment has left myself and my family extremely distressed and
traumatised. Last night we even spoke about the fact that we would never
have children again because we were so saddened. The experience ruined what
should have been the happiest time of our lives.”
Maureen Treadwell, a committee member on the BTA, said: “Communication,
respect for dignity, listening skills — that’s what matters to women.
“They don’t want to be left naked with their legs in stirrups while the
registrar finishes off an instrumental delivery somewhere else. They want
pain relief when they ask for it, not to be told they are too early, too
late or too fat. If they need a caesarean, they want the same kind of
support that anyone who has had major abdominal surgery would receive — not
to be scolded because they find it impossible to breast feed.”
Belinda Phipps, the NCT’s chief executive, said: “Maternity services need a
sea change. We estimate that barely a third [of mothers-to-be] are offered a
choice between hospital and home. We know an awful lot about what makes
birth easier — things like being in warm water, feeling comfortable and
cared for, being looked after by another woman who looks you in the eye.
None of them are high tech, but we’re not doing it. It’s madness.”
Mothers who want to give birth at home but do not trust the NHS can employ an
independent midwife for about £4,000 — although not for much longer. The
small army of private midwives has been without indemnity insurance since
2002, when the last company willing to provide cover pulled out because of
the multi-million-pound awards typically made by the courts to victims of
botched births.
The government has warned independent midwives that they must obtain
professional indemnity insurance within the next 12 to 18 months or quit.
Susan Stephenson, an independent midwife in West Yorkshire, said: “There is no
insurance available to us at all. This means that the UK will lose a small
but crucial element of what pregnant women and their families are offered in
terms of care.”
She insisted that private midwives were not the preserve of the rich: “We
often care for women on low incomes, who spread the cost as much as they can
or budget because of what they regard as a priority.
“Very often we care for women who do not want to be pampered by a private
service but who want to be supported and helped in making decisions and kept
safe from humiliation, degradation, lack of care and excessive
intervention.”
PITTED against the vocal home birthers is the medical establishment. There are
no romantic notions here. Many doctors say giving birth is a dangerous
business, prone to unexpected complications, and the best place to do it is
in hospital.
Who cares if the rooms are a bit cold, the paint is peeling and the wards are
noisy, if there is an operating theatre, a crash team and a state of the art
neonatal unit within a 30-second dash?
Patrick O’Brien, a consultant obstetrician and spokesman for the Royal College
of Obstetricians and Gynaecologists, said: “In a situation where both baby
and woman are low risk, thena home birth is a safe option. But you can’t
always identify which babies are going to have a problem. If you’re in a
hospital and things go wrong, you’ve got everything to hand.
“If you’re somewhere far from the hospital and things go wrong and it’s a real
emergency, it will take a long time for the ambulance to get out and come
back again.”
Helen Westwell, who had two difficult births at the Whittington hospital in
north London, where there is a state-of-the-art neonatal unit and an
operating theatre by the birth ward, said: “At least one of my babies, and
possibly two, could have died if I’d been giving birth at home.
“My son Otto stopped breathing immediately after he was born and had to be
rushed to the intensive care unit. My son Joel had the umbilical cord round
his neck and also needed emergency treatment.I never even considered a home
birth. If I had done, it would have been a very unpleasant experience.”
There are also those who argue passionately that women should have the right
to even more medicalised births. The biggest single trend in childbirth has
been towards delivery by caesarean section, which now accounts for 23% of
births.
A handful of GPs and obstetricians are prepared to help women obtain an
elective caesarean on the NHS, although women who want to go down this
route, even for good reasons, are still derided by natural birth pedagogues
as “too posh to push”.
Into this passionate debate has stepped the calming figure of the “doula”, a
Greek word for a woman who helps other women. She fulfils the role that the
grandmother might take in traditional societies, with emotional and
practical support during childbirth.
From a handful in the early 1990s, the number of doulas in Britain has risen
fast. They are now easily available online for fees of about £600, whether
for home or hospital births. Many NHS trusts are only too eager to embrace
the extra hand that they provide on overstretched maternity units.
Perhaps this is where the solution lies. While ministers sweat over how to
deliver on their promises, an informal public-private partnership between
the NHS and the doulas can alleviate the agony and be alert to the dangers
of childbirth — whether in hospital or at home.
Births by numbers
- There are about 600,000 births a year in England
- Until 1955, a third of babies born to married couples were delivered at
home. By 1975, the home birth rate had plummeted to 3.3%. At present only 2%
of births take place at home
- The vast majority of births take place in NHS hospitals. Only 0.4 per cent
of hospital deliveries were originally intended to take place at home
- Nearly half of all births are normal deliveries, meaning there is no
surgical intervention, use of instruments, induction or epidural or general
anaesthetic
- About 23% of births are caesareans, with most classified as emergencies
- About 11% of births — 66,110 — are by planned caesareans. The
number of caesareans has doubled in 20 years; the rate was just 5% in 1989
- The World Health Organisation has recommended that no hospital should have a
caesarean rate of more than 20%. Many hospitals in the UK have a rate which
exceeds that
- Some 20% of births are induced. A third of women giving birth have an
epidural, general or spinal anaesthetic
- Figures show that 64% of deliveries are by midwives, 36% by hospital doctors
- The majority of women (51%) leave hospital within 24 hours of childbirth and
16% leave the same day
- Just 15% are still in hospital three days after giving birth
- Government guidelines say: “Women in the UK have a right to insist on
staying at home to give birth and should be supported in this decision. NHS
maternity care providers should ensure that the range of antenatal, birth
and postbirth services available locally constitutes a real choice for
women.”
Sources: NHS Maternity Statistics, England 2004-2005, and National Service
Framework for Children, Young People and Maternity Services, 2004
The main report say that the National Institute for Clinical Excellence said that babies born at home have a higher risk of dying if serious complications occur. The report (Draft guidelines on Intrapartum Care) was very careful about what it said - it said the evidence was uncertain, and the quality of evidence available is not as good as it should be for such an important healthcare issue. I'm trying to find out why the report made no reference whatsoever to the Dutch experience where about 30% of babies are born at home with a similar mortality rate to the UK. Surely there must be some conclusions that can be drawn from there about the safety of home births?
mconcerned, Chichester,
I wanted a home birth and as my local NHS Trust could not provide one I decided to use an independent midwife. (cost £2,000 three years ago, we are not rich but our child's birth was a priority for us so we made savings in other areas so we could afford it) It was the best money we have ever spent.
The one to one care recieved from our independent midwife was exceptional, I had a natural drug-free birth in a birthing pool at home and excellent care after the birth.
At the time I was aggrieved that we had to pay to have our choice of birth because the NHS couldn't offer it, now the Governent is planning to take away even my choice to pay for the care I want by insisting independent midwives have indemnity insurance which they can't obtain (incidentally, there have never been any 'botched birth' payments made to women attended by independent midwives).
If the Government grants women the right to elect to have a costly caesarean, why do they want to deny me the right to my birth choice
Linda Green, Todmorden, West Yorkshire
I trained to be a midwife so I could be "with woman" and support her through pregnancy, labour and postnatally. To replace the "with woman" aspect of midwifery with doulas is a disaster. Midwives don`t want to be obstretric nurses running from room to room "delivering" babies from women unknown to them, working machines and assisting in surgery.If we introduce untrained assistants to do the midwifery (ie supporting a woman through labour, supporting her with breastfeeding, doing the postnatal visits etc) I will leave and do something more valued and valuable with my qualifications.
Laura, Bedfordshire,
we must stop focusing on individual stories of horror. We have the evidence that for most women labour will progress to the safe birth of a baby as long as she is confident, well informed and has the constant support of a trained midwife who will overcome or steer around the occasional deviation from normal without disaster or devestation. It is those precautions that the Government are failing to get right. women are not confident as they hear too manny horrer stories they are not well informed as there are too few midwives to spent the time with them both prior to and during the birth. Now the Government want to make the situation even worse by getting rid of independent midwives and thereby making the situation for women even worse. to reply to JK in Liverpool I am a midwife and I had my 4 children in hospital however I was not a midwife then and did not know what I know now. Unless you have experienced a natural home birth you can not compare the two.
virginia howes RM BSc(HONS), kent,
I'm not sure what JK means about 'misleading themselves about home birth'. My highly experienced independent midwife partner, who has also worked for several years in NHS hospitals, will now only take on clients planning home births.
This is based on 'coal face' experience of 100s of births at home, in hospital and where home-hospital transfer was necessary, as well as statistical realities. And her home birth clients have included GPs and other medical professionals.
The best outcome is when the mother has constant attention from someone they know and trust throughout their labour in an environment in which they feel secure.
Being in a hospital introduces so many negative factors and potential for trauma that the availability of a crash C-section - which does not always happen as quickly as many would assume- provides only an illusion of safety.
Anyone who thinks a hospital birth is a guarantee of safety is indeed misleading themselves.
Charlie, London,
The key issue is the chronic mismanagement and underfunding of maternity services. Hiring Doulas is definitely NOT the answer to this basic problem. Women and their babies have the right to high quality, respectful care when giving birth. Sadly this is not happening for many families. The move to criminalise independent midwives via the introduction of professional indemnity insurance is a scandal. The fact that most independent midwives are currently not allowed honorary contracts to provide women with one-to-one care for hospital births is ludicrous, considering the problems with under staffed maternity units.
Alison, Knutsford, Cheshire
I am very concerned about the way the media is colluding in scaring women about the birthing process! We are made to do it! We are good at it and we should be celebrated for it! There are numerous studies that show that home birth is at least as safe as hospital birth. Of course each setting has its individual risks. The proximity to an operating theatre isn't everything! Some people might not be aware that midwives are trained to administer basic resucitation to baby and mother. The vast majority of problems develop slowly and are more likely to be picked up if a midwife can give constant attention to the mother rather than the dominance of machines and the shortage of staff in hospital. I have chosen to attend homebirth with women I know because it is the safest way to support birth. Birth is not a mechanical event it relies on a finely tuned interplay of hormones - stress and fear cause problems for the labour, the mother and the baby - and not surpringly they are interconnected
Elke Heckel, London,
I teach Hypnobirthing and had one of my babies at home, he was born with his cord round his neck not breathing. The midwives were great and quickly got him breathing. I had the choice and knew the risks, but to me there would still have been risks if I had him in hospital. In hospital I could have had a less trained/ less experienced midwife etc and he may not of recovered or he may of got MRSA or something or because I may not of been able to cope so well in hospital I may have need ed painrelief which could of led to further complications. I'm glad I did it the way I did and had the midwives I had. Whether and however you have your baby there are risks. Women and babies die in all methods of birth, c-section, naturally etc. There is no guarnatee. Fortunately during both of my babies births the care I recieved at hospital and for the homebirth the care was fantastic, I wish every woman had the same choice and care.
Danielle , Alfreton, derbyshire
people can mislead themselves about home births but how many home births do you see midwives or doctors taking?
ask the experts
they are only too aware of the deficiences of the health service but you wont find any of them having home births
when things go wrong in labour they go wrong in spectacular fashion
i would rather be in a place of safety if that was to ever happen
JK , liverpool, mersey
I read this article with incredulity. Whilst Miss Oakshotts style of journalism which so to grab the publvis attention it is distorted somewhat with her style and factual content. The maternity services provided by the NHS in the is country are at crisis point. There are too few midwives striving to provide care for women wherever they choose to give birth. Focusing on hospital versus home birth is not helpful and detracts from the real issue of not enough midwives. Patricia Hewitt promises of a named midwife are utterly meaningless if the midwives are not there to deliver care. The additional introduction of 'doula' type trained health care assistants is a dangerous and sinister development f- but a cheaper option for the government. This country is no longer one of the safest places to give birth - the maternal mortality rate is in fact rising and there are two large studies currently underway to find why. In this battle the only casualities will be women and babies.
Kay Hardie, Ashford, Kent
I am a doula and found the article above profoundly moving. As a doula we are there to support the women and their partners we are caring for emotionally, physically and practically in any way they want.
We are not midwives and do not want to practice as such, midwives within the NHS do their jobs to the best of their ability within the parameters around them, more and more obstetricians and doctors are the ones actually 'delivering' the babies in hospital and midwives are taking on the role of obstetric nurses (as is the case in the US) and therefore do not get the opportunity to practice as they would like to do. As a result of this they are not being the opportunity to truly 'be with women' in the way they were trained to be. The very fact that doulas exist tells us a great deal about the maternity services in this country at the moment
mothersmate, Watford, UK
I am a doctor and have just had a 'natural birth' in hospital (NHS). My midwife who I met for the first time that day was outstanding. She stayed with me throughout and encouraged me in having a delivery without medication. No drugs were forced upon me, no one barged in without asking and my care after was great, although I did leave ASAP. I'm not keen on being a patient!
My birth plan was to deliver a healthy baby and whatever happened in between could do so. Every woman is different, I thought that I would definitely have an epidural and even considered an elective c-section (gasp). My birth was very different to how I imagined it but luckily in a positive way.
I could never have a home birth as I have personally witnessed some of the rare but horrific complications of labour, however my cousin had a very positive experience. The only thing that is important is choice, be that home birth or c-section, and that choice should be informed and then available.
Ele, Oxford,
I have to wave the flag for the group of midwives in Crosby, North Liverpool. They perform an unusually high percentage of home births with exemplary professionalism. I gave birth to my daughter at home just 9 weeks ago. My labour was very long in the early stages - days of contractions to little effect. Short of a caesarean, no one could have taken that work from me. However, the local midwives came out to me regularly and reassured me. It may have been coincidence, but after 24 hours of painful but not regular enough contractions, I was advised on specific homeopathic remedies and the rest of the labour took only to 2.5 hours! No one can take away the pain and hardship of birth; they can only act with competency, respect and compassion to deliver a healthy baby and mother with as little trauma as possible - all that one would ask of any health professional. What a shame that not everyone receives the standard of care available here, either at home or in hospital.
Helen Shaw, Liverpool,
There is actually no evidence that hospital birth is safer than home birth for the majority of women. The reduction in perinatal mortality has more to do with improved living conditions and the provision of antenatal care rather than increasing obstetric interventions.
Wannabe, Wakefield, England
The best compromise would be to have enough properly managed birthing suites in hospitals. Places which were appointed like hotel rooms with low lighting and all the atmosphere of a clean and pleasant home but kept scrupulously clean and with all the likely requirements close at hand. If birth at hospital was clean and pleasant many people wouldn't want a home birth.
I decided never to have another child after my son was born, mainly because the hospital was filthy and I suffered a revolting infection and the staff after the birth were unpleasant and unhelpful. The caesarean was the easy bit - and the necessary bit as my son had a birth defect that would have meant permanent disability if he had been born naturally.
Toilets were dirty and 'sanitary' bins overflowing with soiled towels and flies were breeding freely in a hot Summer season.
I vowed never to put myself in such danger to my health again. Caesarean v home birth is not the difficulty - the state of the NHS is
Michele, UK,
My baby was born at home and had the umbilical cord around his neck. The midwife simply slipped the cord over while he was crowning and his apgar scores were 10 and 10. No drama, no ego, no "your baby would have died without me", just calm competence for a common happening that is normally not problem unless heart decels have been detected (in which case you transfer to the hospital, its not like if you choose hb you are handcuffed to the bed). I highly recommend independant midwives for a low risk pregnancy (note to above poster: when labour starts before 37 wks or after 42 wks you go to the hospital even if hb was the plan) and don't be scared by all the "my baby would have died if... " which you will get from 9/10 women, often the babies life was put in danger by the cascade of interventions general incompetence and then the dr rushes in and miraculously "saves" the baby.
AW, Brighton,
Response to Charlotte - in your great-grandmothers time there were many countless other factors which affected infant mortality. To compare homebirth then and now is an absurd argument.
You are also too quick to jump on the hospital birth = horrbly impersonal experience bandwagon. It doesn't have to be bright lights and legs in stirrups.
I'm not a fully paid up member of the home-birth mafia, not by a long shot, but the current system has many limitations, not least the fact that midwives are covering homebirths on top of their normal shifts in some trusts.
In the case of Angarad, the problem is lack of funding for midwives in hsopital trusts. More funding for midwives is essential to accommodate those people who desire a homebirth and also for those who choose hospital birth.
Heather, Glasgow,
"doula" is greek for female slave, btw.
maria, chester,
I have had four children, the first was born in hospital,an unhappy experience.I had attended all the midwife led ante natal classes and on their advice wrote my birth plan which was then ignored during a normal labour. About the same time two neighbours ,who were second time mums ,had home births and said how wonderful it was. So I had the following three at home. The midwives were fantastic. It is far more relaxing an experience for both mum and dad. It is easier to push when you are not doped up to the eyeballs with a drug you expressly said that you did not want. The midwives involved in all of my home deliveries I could not praise highly enough. Huddersfield community midwives you are brilliant.I feel that in making the choice to have a home delivery you psychologically take more of a responsibility in pushing that baby out, knowing that hitech intervention is not at hand. Home births may not suit everyone but for me the positve experiences were the home births not hospital one.
B Benton, Huddersfield, west yorks
My great-grandmother gave birth at home 8 times, assisted by a midwife and a local doctor. Sadly, four of her children died during their birth. My grandmother's own survival (in 1900) was touch and go.
Modern technology has allowed us to forget just how horrific a traditional home birth often was - not an occasion of peaceful rejoicing, but one of pain, death, and bereavement.
I'd rather put up with my legs in stirrups in a brightly lit room with peeling walls, and an unsympathetic registrar, than see half of my babies die before their lives have even begun.
Charlotte, Cameron,
We would all like a a good safe delivery of our baby. The choice of where and how is in the very far distant future for 1000.s of women who deliver, at present virtually alone in NHS units due to under staffing, putting up with curt short remarks from busy midwife's who are often unable to carry out their duties efficiently as they have only one pair of hands and just cannot cope. I have had 3 babies, born in 3 hospitals, one emergency section with no aftercare for myself or my new born, 2 premature deliveries, where my babies were ventilated and their care was 100% excellent, but my care disgraceful, but without the actual hospital facilities and care, all my babies would have died , so in my case a DIY option was choice and like many new mum's I just got on with it. A home birth is great I am sure, but what is the safest option for you and your baby in the long run? I know what mine was and I sincerely thank all those doctors and nurses who have trained to help us all in the NHS.
J Webb, Scarborough, UK
It's not always the case that all 'high risk' labours will inevitably be handled better and more safely in a medicalised environment and a mistake to believe that midwives are incapable of coping with even the most minor of emergencies at birth. I have no doubt that had I given birth in hospital I too would have been saying 'my baby would have died had I been at home' . Having had gestational diabetes in pregnancy I was carrying an 11lb baby that got stuck on the way out (shoulder dystocia) and needed help to be born and to breath after birth. The midwives (both independent) handled both the birth and resucitation with professionalism and calm, extracting my baby and getting him breathing in minutes. What might have been a terrifying scenario in hospital with buzzers going off and panicking staff thundering into the room was managed at home with the minimum fuss and hysteria. I was left happy and untraumatised by the experience, with a healthy baby and an intact perineum.
Dora Explora, London,