 You can't
have a home birth because…
Even though you have decided on a homebirth, you may find that family,
friends and some medical staff are against the idea so it's worth knowing
just what your rights are, how to convince others that you actually really
do know what you want and, if all else fails, what options you're left
with if your powers of persuasion have followed your waist and disappeared.
Your rights
You are perfectly within your rights to have a homebirth if you wish.
Women have a right to a home birth, the Government suppports a home birth
service and the Trust has a responsibility to provide the service.
However, there is a lack of clarity surrounding the legal issues of homebirth
and it is not uncommon for Trusts to suggest that if they are short of
midwives around the time the woman goes into labour she will have to come
into hospital - at this point many women decide not to have a homebirth.
According to The Association for Improvements in Maternity services,"
around 37 weeks is the most common time for telling women this, because
from this time onwards women cannot face confrontation, and as a result
the majority will accept what they are told and change their booking.
" In AIMS' experience women who are determined to give birth at
home, who make it absolutely clear (preferably in writing) that they have
no intention of going into hospital to solve the Trust's staffing problems,
are eventually provided with a midwife. To do otherwise, would leave the
Trust in an indefensible position were a disaster to occur as a result
of their failure to provide a midwife."
If you are faced with this dilemma AIMS recommend that you send a letter
to the Chief Executive of the Maternity Unit. You
can find an example on AIMS' website.
A woman who deliberately decides to give birth at home, without a midwife
or doctor present, and her partner delivers the baby could face the threat
of prosecution because the Law says that only a midwife or doctor can
help deliver a baby in a non-emergency situation. In these circumstances
AIMS advises parents to contact AIMS
immediately. Obviously, this does not apply if your homebirth was not
planned or if it all happens too quickly for a midwife or doctor to arrive.
Wrong reasons - when it doesn't have to rule out
a homebirth
In the UK, figures show that 22 per cent of pregnant women would opt
for a homebirth if given the option and a study by the National Perinatal
Epidemiology Unit in Oxford concluded that, "There is no evidence to support
the claim that the safest policy is for all women to give birth within
hospital."
So why do women still face criticism and negativity when they mention
the words 'home birth'?
Unfortunately many doctors hold the assumption that home births are riskier
than hospital births, despite research to the contrary and automatically
rule out a homebirth if there is any other medical condition present at
all.
Sheila Kitzinger, midwife and author of Homebirth and Other Alternatives
to Hospital, says "It is usually taken for granted that hospitals must
be safe because they have the equipment and skilled staff to deal with
medical emergencies but sometimes they are the cause of these emergencies
in the first place."
And the GPs' professional body, the Royal College of General Practitioners,
have a joint statement with the Royal College of Midwives which says,
"Women wishing to arrange a home birth should be able to do so. General
practitioners who do not wish to provide care for home births should refer
women to a local midwife or the local supervisor of midwives (or to a
general practitioner who does provide full maternity care)."
It's also worth remembering that between 10 and 20 per cent of women
who plan a home birth will end up giving birth in hospital, so it is wise
to make plans that allow for this possibility.
Some of the following are reasons why your GP or hospital may question
whether or not you can have a home birth.
- First baby - Due to the fact that many first births are slow
to progress, some GPs and midwives worry that you may need to be transferred
to hospital. While there is a higher risk for the need for intervention
with first babies, it is rarely a medical emergency, even if you do
need to be transferred.
- Insulin dependant diabetes - Diabetic women need careful monitoring
of their condition and even more so during pregnancy. However, with
discussion with your obstetric and diabetic team, it need not be totally
impossible to have a home birth. For more information visit Diabetes
UK (www.diabetes.org.uk)
- Big baby - Plenty of big babies have been born at home without
problems. It's also worth remembering that working out the size of your
baby is, at best, an educated guess and many women expecting a 'big'
baby actually give birth to a very normal sized baby.
- Overdue - Many medical professionals are concerned about possible
complications if your baby is two weeks overdue. However, it is again
worth remembering that scan dates are not exact so make sure you really
are overdue.
- Too early - The World Health Organisation states the normal
length of pregnancy as 37-42 weeks so delivering a baby at 37 weeks
is not early and it would be worth discussing further with your midwifery
team.
These are just a few reasons why you may be recommended to have a hospital
birth but if you're determined then it's always worth discussing options
with your obstetric team.
Angela Horn, mother to four babies born at home and owner of Homebirth
UK says, "It is not up to me to tell you that home birth is 'too risky'
for you because of your individual circumstances. This is about your baby
and your body - you will live with the memory of this baby's birth for
the rest of your life. Make sure it's the right decision for your family."
Right answers - how to get the homebirth you want
There has been loads of research done on home birth and the key to getting
what you want is to fully arm yourself with some quite persuasive arguments.
- Shorter labour - If you are relaxed during labour it is more
likely to be shorter. Nicky Wesson, author of Home Birth, says being
at home gives you more control over your birth. "Because nothing will
be done to you routinely or against your wishes you are in a far better
position to do exactly as you want."
- Better pain control - Stress can increase pain and lower your
level of tolerance. Being in familiar surroundings during labour has
been shown to reduce pain, or your perception of it. Midwife Caroline
Flint, founder of The Birth Centre, expresses the importance of a woman
being in familiar surroundings. "It is totally unique; there is no other
place the same. She can feel totally uninhibited when she wants to make
a noise or if she wants to remove her clothes; she can be in the bath,
leaning against the worktop in the kitchen, or sitting on a sofa in
front of the TV having a fag and watching the racing-it is her choice,
she is in charge."
- Safety - Ros Claxton from Birth Matters says, "Homebirth has
been given such bad press that there now exists the need to redress
the balance and challenge the widespread myth that hospital is the only
safe place in which to give birth." The National Birthday Trust Study
followed women booked for home births in the UK in 1994. The results
are the most comprehensive achieved through study in the UK.
They recorded the outcomes for 5971 women booked for home births and
compared the results with women who were as similar a match as possible
but booked to deliver in hospital. Reporting their findings in Practical
Midwife, the authors concluded, "In essence it seems that a woman who
is appropriately selected and screened for a home birth is putting herself
and her baby at no greater risk than a mother of a similar low-risk
profile who is hospital booked and delivered."
- Professional backup - In March this year, the governing body
for midwives the NMC (Nursing and Midwifery Council) published guidance
for midwives on home birth. Their recommendations conclude, "All midwives
have a responsibility to ensure that all women receive care that is
based on partnership with women and which respects the individuality
of a woman and her family. Women have the right to make their own decisions
on these issues if they are competent to do so and midwives have a duty
of care to respect a woman's choice."
If all else fails
If you still are having problems getting a home birth and your health
authority continues to refuse you a home birth service, the Secretary
of State wants to know that not all women are being supported in their
childbirth choices.
The Department of Health is compiling evidence that home birth is still
being declined in some areas and Catherine McCormick, who is responsible
for midwifery services, has asked for women having difficulty arranging
a home birth to contact her. She can be written to at the following address;
Catherine McCormick, Department of Health, Room 419, Wellington House,
133-135 Waterloo Road, London, SE1 8UG.
Where to next?
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