In The Guardian today was an article guaranteed to court fevered discussion, ‘Women have a right to a homebirth’. The authoress, Jemima Kiss, introduces the article with the suggestion that the health service should value natural births and not to allow the loss expertise in these in favour of caesareans, she has my support there. She is also quite correct in her assertion that women have the right to a homebirth, my question is ‘ Is it right that women have the right to a midwife attended homebirth in today’s cash-strapped maternity services?’ Any woman can choose to give birth at home, but NHS Trusts do not have to provide a homebirth service, apparently. It’s all nit-picking though because, if Ms B sent her partner round to my house and he told me that she was in the later stage of labour and they wanted my help, then I would have an obligation to attend and provide care ( NMC Midwives and home birth 2006).
Currently maternity services are incredibly stretched, and it’s not going to get any better. Many maternity units are desperately short of staff, Oxford being just one of them. Low-risk units are closing, Paulton in Somerset, Wycombe in Buckinghamshire and Tiverton in Devon purely because of staff shortages in the obstetric unit they are linked to. A homebirth requires 2 midwives, 2 midwives who will be needed elsewhere. If the homebirth happens at night those midwives will have already worked all that day, who will cover their work the next day? In reality how safe, how ‘on the ball’ will a midwife be when s/he has been working 24 hours? If it happens during the day who covers the work, especially if 2 midwives have already been out at another home birth the previous night? The answer is that clinics may be cancelled, pre-arranged appointments put off and any midwives who are working that day will end up very stressed and going home late. Another factor is, suppose the midwives were called out to homebirth 1 at 6pm and returned home at 2am then another woman wanting a homebirth called them out at 2.30am, it happens, and it is happening more and more frequently due to government initiatives and articles like the one in The Guardian.
I’m sounding negative about homebirth, I love homebirths but I am becoming increasingly concerned about the arrangements and staffing for their provision. Other aspects of community midwifery are really suffering due to cutbacks, childbirth preparation classes are being abbreviated, postnatal home visits are being withdrawn but a small number of women are able to command how the service functions on a 24 hour basis. I am horrified to hear me saying this but ‘ Until the maternity services have enough resources to ensure a safe provision FOR ALL then a homebirth option should be withdrawn’.
What do you think?