Home births on the decline in UK: Midwives protest

By Dr. Ananya Mandal, MDDec 30 2010

According to a leader of Britain’s midwives, more and more women are being discouraged from giving birth at home. Cathy Warwick, general secretary of the Royal College of Midwives said that many GPs are citing harms of a home birth like dangerous bleeding where their midwives may be unable to help. Warwick said, “There are doctors that still tell women scary things that aren’t evidence-based that then put them off having a home birth…

Around the country there are people who feel very strongly that women who are having a home birth are putting their baby at risk. They tell them that if you have a home birth you will have a haemorrhage and the midwife won’t be able to do anything about it. I have heard of that being said to women.” She said she was blaming GPs and not obstetricians and gynaecologists in hospitals. She added, “The implication is that you will be safer if you come into hospital, and that’s not necessarily true. We know that things can go wrong whether women are at home or in hospital.”

She explained that latest research proves the safety of home births. She spoke of GPs imparting this information saying, “It tends to be people who don’t have real information about the evidence. Clearly some doctors aren’t up-to-date with the evidence about home births, and especially the safety of home births, in the UK… I just feel upset that women aren’t being given correct information based on the evidence and that that information is potentially skewing women towards giving birth in hospital.”

In response leader of Britain’s 45,000 GPs, Dr Clare Gerada, chairman of the Royal College of GPs said, “I would be delighted if there were more home deliveries. In my experience GPs are not scaring women out of a home delivery. I don’t recognize that GPs are putting women off from having a home delivery.” She added, “Home deliveries are a bit of a luxury given the shortage of midwife resources. They need two midwives for a home delivery, which is a phenomenal use of resources at a time when resources are tight.”

According to latest NHS figures, 2.7% of the 706,248 births in England and Wales last year were at home, down from 2.9% in 2008. Wales has a higher rate of home births at almost 4%, after ministers made it a priority. In Scotland, 1.5% of women currently give birth at home, while in Northern Ireland the figure is 0.4% of births.

Mary Newburn, head of research and information at the parenting charity the National Childbirth Trust (NCT), lamented women’s “limited” access to home birth in parts of Britain and said it should be “a mainstream option”, along with maternity units for women. She said, “NCT believes women are finding it more difficult to book a home birth… There is no evidence of a reduction in demand, but we know maternity services are additionally stretched due to a rising birth rate and too few midwives. Low midwifery staffing levels can mean home birth is either not offered at all, or is withdrawn at short notice…For those who have had a straightforward pregnancy and like the idea of a home birth, the advantages include greater privacy and comfort in familiar surroundings, more control, one-to-one midwifery support, and the opportunity for the whole family to stay together after the birth.” Warwick however maintains, “We feel that there is a concerted and calculated backlash by sectors of the establishment against homebirth and midwife-led care.”

A Department of Health spokesperson said, “All mothers should expect consistently excellent maternity services… We have made clear that women and their families should be given the information they need to make informed choices about their maternity care… The planned number of midwives in training in 2010/11 is 2,493 - a record level… We expect there will be a sustained increase in the number of new midwives available to the service over the next few years.”