When I fell pregnant with my second child, I knew straight away that her birth would happen in our home. After a relatively smooth birth with my firstborn that descended into a week-long hospital stay, due to interventions that saw her being overdosed on precautionary antibiotics which were later discovered to be completely unnecessary, I was keen to avoid a similar situation the second time around. I was pleased to learn that my local trust is very homebirth friendly, with very high rates of home birth, and a lot of supportive care through my pregnancy. I felt prepared, supported and ready to go.
On the evening I went into labour, I quickly learned that the reality of the service provided was far different to what I had been expecting. When they midwives arrived they were obviously tired, just off of a “back shift” they, quite bluntly, informed me. Polite, but by no means warm or friendly, they ignored my requests for quiet, so as not to disturb my labour or my sleeping toddler upstairs. Though I felt I was in true labour, they didn’t feel it was strong or regular enough to be worth staying. I left them alone downstairs for an hour whilst I lay with my partner upstairs, feeling my contractions becoming stronger, longer and closer together. Naturally, when the cool natured midwives produced their files and red tape with expectations of examining me again, the contractions became more erratic in their presence. Apparently they might have stayed if they weren’t so tired but one of them had an hour and a half drive back to her bed, so it was decided they would leave with reassurances that they would return as soon as I felt things had picked up. So, I took a shower, tried to get comfortable and went to bed. When I woke from a fitful sleep a few hours later, unable to doze through contractions any longer, I decided to hop into a warm shower for some relief. From there, things picked up rapidly and I had my partner call the midwives. When we were informed that they would be an hour and a half, I started to panic. I didn’t think it would be that long and I wanted some support, I wanted the midwifery care I had expected and I wanted to birth in my home. So, we called back to press the urgency of the situation upon them only to be told it would be even longer as they were “in the middle of handover” at the hospital. I paced, panicking, contractions on top of each other and the pain becoming unbearable the more tense and anxious I became. It was all going wrong in my most vulnerable moments. I was being expected to make a major judgement call minutes from giving birth, when most women find themselves in the most irrational phase of labour.
My only option was for them to send an ambulance, I was told.
Reluctantly, we agreed. In my mind I was still having a home birth, but the paramedics would at least provide some support, surely? When they arrived, however, the pressure was on to get me into the ambulance. The paramedics looked alarmed, clearly undertrained. As I was ushered out of the living room door, toward the ambulance, my waters broke and I shrugged the paramedics off and turned back to my birth space. Acting on an instinctual, deeply primitive, birthing auto-pilot I removed my clothes and got onto all fours. I don’t know what I was thinking, except that I wasn’t thinking at all. I ignored the paramedic’s requests to turn back to the ambulance and screamed at him to be quiet when he pleaded with me repeatedly to get onto my back to birth my daughter. I birthed her, myself, into the hands of a shaking paramedic and it was the most terrifying and exhilarating feeling of my life.
The midwives, it turns out, had cancelled their “booking” and I was expected to go into hospital as part of ambulance protocol. On a high from having birthed my baby only minutes before, I figured there was no harm as she’d been birthed at home and we were both in great health. I even imagined we’d be back within a few hours. I could not have been more wrong and we, again, wound up with a prolonged drug filled hospital stay that, once again, was proven to be unnecessary. The effects of being separated from my baby, of being forced to hobble an unacceptable distance in my post-partum state to the neo-natal intensive care unit for every breastfeed, of being forcibly separated from my toddler who had never been apart from me before were more emotionally disastrous for me than I could have anticipated. I suffered severe post-partum anxiety, low level depression and the bond between myself and both of my children was damaged. It took me almost a year to come to terms with what happened and to move on.
Though I can now appreciate how truly empowered my daughter’s birth was, despite the failures of my midwives, I spent a great many months feeling deeply confused. We’d had a natural and powerful homebirth experience, so why did it feel so traumatic? Surely homebirths are supposed to be empowering, happy and positive? All of the bad birth stories I had read were of hospital births and intervention. Was I alone with my bad homebirth experience?
Alarmingly, my situation is much more common than anyone realises. With midwives misjudging or simply ignoring the signs of imminent birth, refusing to come out due to staffing issues or putting pressure on women to go in to hospital to be checked over, women are frequently finding themselves in a vulnerable position without midwifery care.
Harriet, a mother of one with another on the way, was denied midwifery care for the birth of her first child due to a lack of staffing and subsequently gave birth to her baby in hospital minutes after arriving. A far cry from her planned homebirth. “I feel let down […] by the lack of resources, let down because at no point did they inform me it was my right to stay at home if we wanted.”. All too often women are not being given accurate information on their rights and frequently report that they have been misled. The consequences of Harriet’s transfer are still with her today, despite the otherwise “smooth” birth. Although she was insisted upon a physiological third stage, her midwife applied traction against her wishes which, she believes, led to a serious post-partum haemorrhage. “The midwife started applying traction (enough to make her knuckles go white according to hubby). I queried this as not physiological. Midwife reassured me it was ok, she was just helping and I was just caught up with my new baby. Placenta was delivered 27 minutes after baby and all seemed fine. Baby started feeding an hour after delivery and I continued to trickle blood. The rest is a bit hazy but from what I can remember and with the help of my notes, at some point I passed out and was violently sick. I ended up with a cocktail of oxytocic drugs as each one didn’t work and so they had to give me more. I had syntocinon almost 2 hours after baby was born, then ergometrine an hour later, half an hour later registrar was called and I was canulated for an IV drip. At some point I had (considerable) fundal pressure applied to expel some clots. I was then given misoprostol before finally being hooked up to a syntocinon infusion and kept in overnight. Estimated loss was 1300ml”. Harriet firmly believes this would not have happened if she had given birth at home, as planned.
Now, she is facing an emotional battle against the system to birth her next baby at home. She is now considered high-risk, under consultant led care, due to her previous post-partum haemorrhage. Despite all of this, Harriet understands the pressures faced by the system itself “I know it’s really just because of understaffing and there are plenty of amazing [midwives] out there who do make a difference.”
But is there any truth in the “no staff” claim so many women have lost their homebirths to?
Chatting with a passionate and proactive NHS Midwife, who wished to remain anonymous, the reasons certainly vary – but understaffing features heavily. With two midwives caring for one woman at home and one caring for several in hospital, the predicament is clear. “The system is strained because of understaffing, generally everywhere. The service, by nature, is unpredictable as we can’t predict labour & birth. We offer a service that sometimes can’t be provided for due to understaffing as two midwives need to go out to a homebirth. So from a coordinators point of view, it’s a “waste” of a midwife”.
Speaking candidly, she revealed how uncommon her relaxed approach to natural childbirth is. Something many natural birth advocates have believed for some time. “It is difficult not to let the “emergency” side of labour and birth creep into your psyche. You are surrounded by it. However, what many midwives fail to grasp is that WE (midwives/docs/HCPs) create these emergencies with interventions.” And it is this ignorance that also shapes the care provided to labouring women “I believe a dedicated homebirth team is the only answer, but this needs to be self-regulated by those who want to be on it and not managers who don’t understand that the concept of homebirth is totally different to hospital birth. If you cannot grasp that concept as a team leader or manager then the service won’t work!”
In the absence of such a service in most areas, what are labouring women to do?
Put pressure on the system. “The message needs to come from the women. The better informed they are, the better they can argue their case […] it is only the service users that can change the service. I have fought to change the service but I am only a small voice in a big crowd. The more women who stand up for their right to birth at home the more the managers and those who hold the purse strings will have to accommodate the changing needs of the service.”
For first time mothers with little knowledge or support, this may prove difficult. Passion for reform is, sadly, all too often borne out of cases like my own and that of Harriet. Even then, finding strength when you are up against the emotional trauma of previous poor care and professional pressure and undermining can become overwhelming. Harriet is currently seeking support outside of the NHS in the form of a doula, she is now educated and passionate enough to fight the system to birth her second child at home but she is sceptical that standing up to it will change anything “I think it would probably make a difference to those that are amenable to change in that direction but for those like the consultant I saw today, who is patently so fixed on procedure, statistics, protocol, etc., I think we would need to wait for them to retire for a significant difference to be seen. Perhaps if midwife training was structured differently, maybe a more Ina Mae Gaskin approach, or at least include aspects of it, then it would eventually get the message home, but I would doubt we could change the world by a few of us standing up for ourselves.”
What is clear is that there needs to be a change to the current homebirth protocols. Too many women are being abandoned when they are expecting support and coerced when they are able to fight against it the least. The information that women receive prior to birth is sorely lacking, with most being unaware that it is their right to refuse to go in to hospital. Perhaps the answer lies in the innovative, personalised service provided by the unique, and highly respected, One to One midwives who work in and around the Wirral area of Liverpool. Working in partnership with the NHS, they offer continuity of care right through to the post-partum weeks. Continuity of care is associated with lower rates of intervention which is a leading cause of complications. One to One midwives recently supported a friend of mine through her pregnancy and birth and the level of support provided was simply staggering, with highly skilled staff believing she could still birth her baby safely at home had her baby remained breech. Empowered is the best way I would describe her birthing experience.
The inescapable truth is that the role of the midwife in birth is powerful, something our anonymous midwife would agree with “Empowering women can, more often than not, mean women can birth their babies with little pain relief and consequently have a much less traumatic labour and birth. This results in better health for women and babies and less birth trauma issues- which never leave most women. I also believe giving birth at home or in hospital is a lottery. Your experience depends upon your care providers. Especially your midwife” and with over 45% of first time homebirths resulting in transfer, something absolutely has to change.