Call the Midwife – or call a midwife you know and trust?

I enjoyed reading Sarah Johnson’s recent blog post on call the midwife.  I LOVE call the midwife and read the books when I was student; how I dreamed of working in that way – a local midwife, on her local patch, working with the local women, caring for them in their own homes.   

For most midwives, this way of working is a million miles away from the reality of midwifery care within the NHS; birth at home is no longer the ‘norm’, midwives work in large centralised units, women are very unlikely to be cared for by a midwife they have ever met, normal birth rates are incredibly low and the use of analgesia and the associated risks and side effects high.  Sarah suggests that birth stools are ‘standardised equipment’ in units, and women birth in up-right positions: statistics suggest otherwise, with the NCT citing in their research that less than 40% of women are encouraged to be mobile, upright and off the bed and their backs.  I myself have visited units where birth stools may be quietly gathering dust in the corner, where huge, shiney new units are built with just one ‘token gesture’  birth pool (despite NICE guidance stating that birth pools should be available to all women as an effective form of pain relief) and where one-to-one care is not always achieved for women in labour.   The NHS offers the best it can on a shrinking budget, with a hard working yet disillusioned work force, with a growing population, and with women presenting with more and more complicated pregnancies. 

My dream of practising as a 1950’s midwife might not quite have come to fruition, but I am honoured to have carved a way of working which comes as close as possible: I care for the same woman throughout her pregnancy, birth and postnatal period; I care for women and families in their own home; I attend home births (and follow the woman into hospital if plans change).  I may not have a bike (and am about to invest in a 4x4 to make work life easier), but I do carry my own equipment and have a big ‘Midwife on Call’ sign to hang on my dashboard when I am with a woman in labour! 

When a woman in my care goes into labour, they can call a midwife – they can call a midwife they know and they trust, who will be by their side until their baby is tucked up safely in their arms, who knows all about them and what is important to them.  That is Independent Midwifery – the recognised gold standard of care, a choice for women outside of the NHS.  And it is under threat.  Just as that 1950’s midwife is no longer recognisable, so too, might be Independent Midwives; EU directives, insurance issues, and a government failing to deliver on its promise to really offer choice are seeing to that.

So, women, mothers, midwives, fathers, grandparents – if you LOVE Call the Midwife like me, if you LOVE the idea of calling a midwife you know, if you LOVE the idea of care in the home being the norm, then make sure you make a call to your local MP and tell them that!

You can find out more about this issue by visiting www.northsurreymidwives.co.uk

Home Birth is for Hippies?

This was an original article I wrote a few years ago and felt it was relevant again.....

“I’m planning a Home Birth”. It amazes me that this simple, short statement can evoke such a torrent of emotion and be an area where people feel they have the right to comment on someone else’s choices; the phrase ‘you’re so brave’ springs to mind here. Yet without doubt, the discussions and thoughts around home birth bring to mind many powerful images, not least of ‘danger and emergency’, but for some, the image that the ‘sort of woman’ who may choose home birth, as being a slightly alternative, incense burning, ‘hippie’.

Home birth is not a new concept; home, since the time of (wo)man, has been the place where women birthed their babies. In the beginning, home was most likely to have been a sheltered cave, nestled on a hill-side somewhere, and over time has developed into the style of housing that we now know in the western world. Hospital as a place of birth however, is a fairly recent development in the time line of history and yet it has been culturally accepted as the safe place to give birth, even though study after study, report after report does not uphold this notion. Now, don’t get me wrong here; the advent of technology, obstetrics and the caesarean birth have played a hugely important role in making birth safe for both mother and baby – and we now experience very low rates of maternal and infant mortality and morbidity. However, it is not exclusively through birth taking place in hospital that has lowered these rates so significantly, but the development of excellent antenatal care, drugs for the prevention of haemorrhage and infection, and the development of health professionals’ skills in recognising and managing emergency situations.

In an article in ‘The Times’ newspaper (May 09), journalist Melanie Reid launched a scathing attack on women who had or were planning home births: she labelled them as spoilt and complacent, insinuating that intelligent women choose hospital birth, and only ‘sandal-wearing' women (the hippie word again?) would choose home birth.

True? – far from it;

Factual? – indeed not;

Emotive? – yes and yes again.

Ms Reid is not alone however in voicing her opinion, and this is part of the problem for women who are considering home birth – the emotion that decision causes, the myths around home birth and the presumption of ‘safety’ deter many women from pursuing, what is in fact, a very normal, very safe choice.

I had my third baby at home; it was a well-researched, informed, intelligent decision. I met some opposition along the way, but on the whole felt well supported and confident in this decision. No, it was not my ‘first baby’, but how I wish it had been! I had never truly considered home birth an option, after all I did not know anyone who had given birth at home. I had been born in hospital and I was not a sandal-wearing hippie. Why on earth would I want a home birth? Well after experiencing two less than positive hospital births, I felt instinctively that there had to be another way. And there was, and it was fantastic – hard work – but empowering, positive, and ‘uniquely normal’.

The home birth rate in the UK is around 2%, but in parts of the UK the home birth rate is a staggering 50%! In areas where the home birth rate exceeds the average, there are some telling trends in the way maternity care is delivered: midwives actively offer home birth throughout pregnancy and discuss it in an open, friendly manner; women share positive stories of their home birth experiences - giving other women confidence in their own ability to give birth; and women are attended at home, in labour, by a midwife (they often know) and make the final decision on the big day itself! This gives them the freedom to see how they are feeling and coping, knowing that they will be well supported by the midwife, by family and birth supporters, whatever their decision. I would challenge anyone to categorise all those women as hippies.

The DoH has aims to increase the home birth rates for women to experience real choice within maternity services; of course this is still to be delivered and is an ongoing issue for most women.   Following the inception of the NHS it took national campaigns to persuade women to give birth in hospital, needing continual reassurances of cleanliness (hospitals were previously associated with mortality due to infection – very different from now?), and the influential offer of 10 days rest and food. The stark reality in the UK at present is that hospital birth no longer comes with the benefit of complete rest – women are encouraged to leave as quickly as possible due to the high demand for beds (at home you get your own bed); NHS trusts are stretched to capacity with midwife shortages on the labour ward (at home you get your own midwife); and the caesarean section rate is spiralling out of control (planning a home birth halves the chance of you needing a caesarean section).

Hospital is the perfect place for giving birth for the woman who may need additional obstetric care, who may need paediatric care for her new baby or who may not have the support in place to have her baby at home – and no one ever seems to feel the need to comment on those decisions. Next time someone says to you “I’m planning a home birth”, take a closer look; I expect you will find a normal woman, making a normal choice, planning to have a normal birth in the perfect place for her. And not a ‘hippie’ in sight!

Celebrating Normal Birth

I am off-call!  After attending and supporting 8 beautiful, strong, wonderful mothers since April, I am now due a short break.  I have learnt so much and had the immense honour of attending:

• a home 'land' birth
• a home VBAC in water
• a breech hospital birth
• a caesarean birth
• 4 home water births

I am taking my short sabbatical from being on-call in order to rest, reflect and regather my energy.  

In the mean-time, I am planning a workshop for Student midwives and doulas on Physiological Birth: birth is a normal process, a part of life and something that women should be well supported through.  Marsden Wagner writes eloquently and honestly about the dehumanisation of birth here - food for thought indeed. 

Mothers and midwives we need to reclaim birth, we need to honour the strength and courage of all women and we need to do it now.  A fantastic new website has been created for women to share their experiences of birth and midwifery - and to campaign to improve the care that women receive.  Take the time to visit the site and make your own entry....   birth is 'uniquely normal' and we need to celebrate this!

Is having a home birth selfish?

This was a question posted on the popular 'Mumsnet' website and caused a lot of response. I have thought about this question a lot (insomnia gives you time to think!), and I guess my response to that would be that there are many decisions we have to make as parents that are life changing, for example:

• is it selfish to vaccinate / not-vaccinate?
• is it selfish to place a child in full-time nursery care / be a full-time parent?
• is it selfish to home-educate / use state schooling?
• is it selfish to have one child / have 4+ children?

All of the decisions we make as parents are difficult ones: all we can hope to do is make the best decision, based on the information and evidence we have, at that time. Choosing to give birth at home does involve risks, but so does choosing to give birth in hospital and contrary to popular belief; hospital does not guarantee a safe outcome.

Planning a home birth based on the evidence available, is shown to be a safe, normal choice and is nothing new; Women have birthed, and will continue to birth in the place that feels right for them. The question of being selfish is therefore an unnecessary and judgemental one to pose. We are all individuals who have to make choices - as with the examples above they may not be the same choices that other parents may make, but they are no less valuable or 'right'. Birth and parenting is not 'black & white' but is made up of many shades, and every day brings new challenges and choices. I know I don't always get it right, but when it comes to important, life influencing decisions, I try to make the best decision I can at that time!

Selfishness aside, having a baby is a unique, life-changing experience; for some women they will need all the interventions that high-tech birth can offer, for some women they will choose to give birth in their local hospital, and for some women they will choose to give birth in the comfort of their own home. All choices should be respected, all women should receive the best care they can, and all women should feel supported in the decision they have made, rather than bullied, coerced or belittled into doing something that is not right for them.