By Caroline Flint

Caroline Flint describes the new independent midwife practice that she has set up with fellow midwife Valerie Taylor

We believe that women will not gain control over their births until more women give birth at home. At the moment there really is no choice of birth at home for the majority of women. The one per cent of women in the UK who end up having their baby at home are frequently unusually assertive and determined women who have sought out a midwife and /or doctor for their home birth and have delivered at home following a pregnancy during which many battles have been waged. Apart from these determined women, there are occasional pockets of continuing home births where either the GP or the local midwives have gone on delivering babies at home over the years and women really do have a valid choice.

The reasons for setting up Special Delivery Midwifery Practice are to make home births more `mainstream', to increase the profile of birth at home, to make it something to which well motivated middle class women aspire, so that eventually it becomes something that all women consider.

By practising the midwife's role to the full the midwives also want to try to provide a role model of excellent midwifery practice - to this end they are committed to writing about and publishing the way in which they work, thus giving midwives a view of the full role of the midwife. Our personal aims also include earning a good living in a satisfying way.

This is little different from other independent midwives' practice - one difference is that the blood tests and ultrasound scan are all done privately so that the midwives do not rely at all on the services of the NHS. Another difference is the provision of a Mother's Help for two weeks following the birth, for women delivering in London, (where the practice is based). The charge we make for the service is £1,950. For women who do not require a mother's help, the cost is £1,600 and for those living outside London, the cost is £1,450.

Special Delivery Midwifery Practice has advertised nationally in order to let women know about the service. Every day women from all over the UK telephone asking for further information. These women are sent an Information Pack which comprises an introduction to the concept of having a baby at home. It gives Special Delivery Midwifery Practice's own statistics - based on our previous independent practice and advises women to find out the statistics of wherever they decide to give birth or whoever they decide to have as their midwife or obstetrician.

In order to provide a service to women all over the country, we are compiling a list of midwives who are interested in carrying out the occasional home birth. Special Delivery Midwifery Practice has purchased several sets of up-to-date equipment for these midwives. They will introduce a midwife to interested women and will supply all equipment. This includes notes, blood tests and sample letters to GPs and supervisors of midwifery. As the aim is to increase the number and availability of home births, we feel that every time a midwife attends a home birth she sees birth for what it is, and gains a concept of the politics surrounding birth.

The expectant parents pay Special Delivery Midwifery practice for arranging this service and Special Delivery Midwifery Practice pay the midwife on the return of their equipment - thus enabling midwives to do the occasional independent birth with the support of two experienced home birth midwives, and without having the expense of buying all the equipment.

Most of the women contacting Special Delivery Midwifery Practice could not afford to pay for a private midwife - they are shown how to go about getting a home birth under the National Health Service and they are referred to the Society to Support Home Confinements or AIMS. Women going through this process feel able to telephone Special Delivery Midwifery Practice for further advice and ammunition in their quest for a birth at home. Their midwives are also encouraged to ring and discuss such topics as delivering a baby in water or when the woman is standing up.

The service is more expensive than other independent midwifery services. The promotional literature and advertising costs have been greater than the costs incurred by most independent midwives, likewise the purchase of equipment. The legal costs of setting up a partnership and the cost of an accountant have been included, and during the writing up of the business plan the true costs of providing such a service have been calculated.

Hopefully everyone will benefit from this service. Home birth should achieve a higher profile, so that more women will be able to have one both inside and outside the NHS. Independent midwives should find more women coming to them to book, midwives wanting to `test the water' will be able to carry out an independent home birth without the expense and anxiety usually associated with such a move. And hopefully, we will earn our living and increase our service until eventually we have several midwives working in Special Delivery Midwifery Practice. We will then be able to set up Birth Centres and ultimately, a Special Delivery Midwifery Training School.