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More and more women want to have their babies at home away from an institutional environment. But, says Caroline Flint, midwives are still pushing mothers into hospital confinements for no good reason I was talking to three women who all live in the same district of London. They had all had a baby in the past few months - at home - with an independent midwife. Why hadn't any of them had a community midwife I asked. Mary looked angry. `You have to be joking', she said. `I asked for a home birth week after week, and every midwife I saw said that you couldn't have a baby at home if it was your first-baby. Finally, I got through to the midwife in charge of the community midwives. She said that it was possible to have your first baby at home, but that you had to be checked by a consultant obstetrician. When I saw him he said that he didn't agree with first-time mothers having babies at home. I had so much hassle that in the end I decided to have my baby at home with just my husband and not to call anyone. Then I heard about Becky (an independent midwife) and rang her. We found it difficult to pay even though she brought her fees right down.' Angie had been expecting her second baby and the reason that she had been refused a home birth was that she had had high blood pressure during her first pregnancy (not repeated at all during her second pregnancy except on the day she had waited for hours in the antenatal clinic). Claudia had been refused a home birth because she had had a forceps delivery during her first pregnancy. I discussed these three women with the independent midwife. She told me that many women in her area were being strongly discouraged from having a baby at home. It was really too far away from her home for her to take on cases there, but she couldn't bear to refuse after the stories the women told her. What made me so sad was that these women had approached members of my own profession, and instead of receiving support and guidance, they had been flung into a system resembling a type of Chinese torture. They were being told: `To have a baby at home you must comply with this - and now this - and now this - and so on. On what evidence was this done?Where to be born? The debate and the evidence, a report recently published by the National Perinatal Epidemiology Unit', looks at the results of delivering women in different places over the past century and comes up with several conclusions. Perhaps the most significant is that: `There is no evidence to support the claim that the safest policy is for all women to give birth in hospital'. It also concludes that: `The policy of closing down small obstetric units on the grounds of safety is not supported by the available evidence'. It goes on to suggest that `there is some evidence, although not conclusive, that morbidity is higher among mothers and babies cared for in an institutional setting. For some women, the iatrogenic risk associated with institutional delivery may be greater than any benefit conferred, but this has yet to be proven'. As midwives we should remember our name, mid-wife - with woman. We should be by her side, supporting and strengthening her, and preparing her for the job of motherhood. This is reflected in the latest publication from the Royal College of Midwives, Towards a healthy nation - a policy for the maternity services', which comes up with several refreshingly flexible models on which midwives could base their case of pregnant women. `The college now recognizes the fact that there is some doubt about the assumption that the safest place for delivery of all women is invariably a consultant unit', it states. It also recommends that `a recognized home confinement service should exist in all health authorities, and that maternity units should provide a range of delivery facilities to meet the various needs of all women through the spectrum of low to high risk.' Women and midwives are getting together. What women say is being heard at long last. But is everyone hearing it? I have read recently about the Royal College of Gynaecologists' document on delivering women in this age of AIDS which suggests that the midwife should wear a visor, a plastic apron, full length gown, and boots (I had never realised that you could catch AIDS via your feet, or abdomen and thighs for that matter).; I would have thought that a more relevant conclusion would be that we need to protect ourselves and the baby against needlestick injuries. This means that we need to be thinking twice before artificially rupturing membranes, applying fetal scalp electrodes and performing fetal blood sampling. That is much more relevant than wearing a gown from head to foot. References1. Campbell, R. and Macfarlane, A. (1987). Where to be born? The debate and the evidence. National Perinatal Epidemiology Unit, Radcliffe Infirmary, Oxford. 2. The Royal College of Midwives. Towards a healthy nation -a policy for the maternity services. London: RCM. 3. Hodgkinson, N. (1987). `AIDS alert in maternity wards.' Sunday Times, May 31. June 17, 1987 |
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