By Caroline Flint

I delivered a baby at home yesterday, for the first time in almost a year. All the babies I have delivered in the past eleven months have been born in hospital and almost nearly all the women I have looked after in labour have moved around a great deal in labour. Many have spent hours on end in the bath, many have used entonox, most have ended up by delivering in positions other than on a bed and lying down - on their hands and knees, standing up, on a birth chair, on their side or even in the bath.

Being privileged to be with women in labour has shown me the great diversity of the human spirit, the love and affection between a woman and her lover, the excitement of seeing a baby emerging, the pain, the joy, the strength, and the beauty of the human body working at its best.

During the labour at home I sometimes thought about being with women in labour in hospital and there were some things I really missed - the space primarily. The bedroom was much smaller than the delivery rooms in our hospital and the labouring woman had far less room to roam around in than she had when she had her first baby in hospital.

The second thing I really missed were the rubber mats which we have for our floors. They are truly marvellous and really comfortable for pregnant women to crawl on, lie on or sit on; they are also waterproof so that a clean sheet on top of them is the only equipment needed to ensure that the area is clean.

Those were the things I missed. What did I not miss? What was better about delivering a woman at home? First the equipment was all there, I had everything I needed inside the room or just outside the door. I knew I had everything I needed because I pack my own bag ready for home deliveries and it is my responsibility and mine alone to ensure that I have everything.

I didn't reach out for a thermometer, only to find it not there and have to say to Janie `I've just got to pop and get a thermometer', or `I've just got to go and get a spygmomanometer, I won't be long'. Or the syntometrine, or the vaginal examination trolley, or an extra pillow, or the resuscitaire, or a bottle of lotion, or a monitor or some more inco pads.

The other thing that I really appreciated about delivering Janie at home was the privacy. It was her bedroom, in her house; when she looked up there were no prying eyes gazing in at her through a grille in the door. No-one burst into the room to `borrow a sphyg' or to ask `have you got a spare monitor?" No doctors came in to ask why I hadn't ruptured the membranes even though she was eight centimeters.

No one was there to cast any doubts on her ability to handle this situation, no anaesthetist came into to ask her what analgesia she had thought about. In fact the whole labour was conducted in peace and quiet as Janie's husband held her hand and whispered occasional encouraging words. I just sat and waited and listened to the fetal heart occasionally.

Janie's mother was there looking after their little son who I delivered three yeas previously, and whenever I put my head out of the bedroom door to ask for three cups of tea or coffee, they arrived in seconds. Soon Janie's parents-in-law also arrived and throughout the house there was an atmosphere of waiting, caring, thinking of Janie and only her. She was uppermost in everyone's minds, the house was filled with love and concern - everyone was rooting for her.

When Danielle arrived it was into a silent room, into warm and loving arms and into tranquil lighting. Within a few minutes she was looking around wondering where she had come to and then she decided she had come for a good meal and latched on.

It was after the birth that I remembered again what the great beauty of a home delivery is. By now Janie was in bed and Danielle had been inspected by grandparents and big brother, I had scooped all the newspapers and inco pads protecting the floor into a large black polythene bag (and the placenta well wrapped) and I had filled in my notes, register and birth notification. The household ticked on, the birth of this little person had happened and now everyone was getting on with preparing the lunch - the baby had been absorbed into the continuum of life.

Big brother came up to see his mother every now and then, but finding her rather boring because she was in bed and not ready to play, he went downstairs again, Janie sat in bed like a queen - eating a huge steak and drinking a large glass of red wine. She looked relaxed and content and very, very clever. Her husband was tired - he had been up all night and he lay beside her, snoozing in his own bed, next to his beloved woman who he had cherished and supported and next to his baby. He wasn't cut out, sent home, excluded.

Today when I went in to see Janie the feeling had not changed. She was lying in bed and the television had been brought upstairs for her to watch. She lay in bed with her baby snuggled on one side sucking contentedly and her little son snuggled on the other side watching `Thomas the Tank' with his mother.

The whole house is organized around Janie and her baby - meals are brought to her when it is convenient and desired; no one disturbs her sleep except her baby, she is in her own comfortable bed in her own room next to her own dear man. This is how birth was meant to be - custom-built for this woman. Here she is unique, the only one, not one of dozens trying to learn the `ward routine'. Here she is the queen, the pivot, the most important person - the mother.

April 1986