For further information, contact Melissa Maimann at Essential Birth Consulting.
Women who give birth at home with an independent midwife are nearly three times more likely to have a stillbirth than those who give birth in hospital, a study has found.
Many women at high risk of complications choose to give birth outside hospital because the NHS cannot offer the kind of birth they want.
The researchers urged a review of why more babies were stillborn or dying soon after a birth overseen by an independent midwife, but pointed out that many outcomes were “significantly better” for those who gave birth outside the NHS.
For women at low risk of complications, giving birth at home could be as safe as doing so in hospital, they added.
Only 3 per cent of women give birth at home but the Government has pledged to offer women a choice of where and how they give birth by the year’s end.
Campaigners said that the NHS was letting down thousands of women who had to employ an independent midwife because the health service could not offer them a “natural” home birth without painkillers or other medical interventions.
Other women who chose an independent midwife had had a bad experience on the NHS, raising concerns about the quality of childbirth for some women who feel afraid to use the health service again.
Medical leaders say that the health service is unable to provide more home births due to shortages of midwives despite Government promises and the fact that home births could save the NHS money and provide a more natural experience for around 60 per cent of women at low risk of complications.
A report by the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives estimated that if women had “true choice”, between 8-10 per cent of births would be at home. The study, by the University of Dundee, analysed the records of more than 8,600 women who gave birth in Scotland between 2002 and 2005. These included 1,462 who gave birth assisted by a member of the Independent Midwives Association (IMA), and another 7,214 who gave birth on the NHS.
… Nearly nine out of ten women in the IMA group, said they wanted to give birth at home, and two thirds did so. But the researchers noted that women who chose a birth with an IMA member were more likely to have had pre-existing conditions, such as blood pressure or diabetes, or previous obstetric complications.
The risk of stillbirth or neonatal death (within 28 days of birth) was 1.7 per cent in the IMA group compared with 0.6 per cent in those giving birth in the NHS. Once high-risk women were excluded from both groups, the difference — 0.5 per cent versus 0.3 per cent — was not statistically significant.
… Belinda Phipps, chief executive of the National Childbirth Trust, said that many women who opted to pay for an indpendent midwife did so because they wanted “a home birth, or at least a more homely birth”.
“Women at high-risk of complications are still entitled to choose a home birth and I think we have to ask why they are made to feel that their only option is to turn away from the health service.”
Dr Maggie Blott, spokeswoman for the RCOG, said she was not surprised by the higher mortality rate among the IMA group. “Women with an increased risk of complications should be delivered in hospital where obstetricians can spot those complications,” she added. “Independent midwives should not be agreeing to deliver women who are high-risk at home.”
Aaahhh, the debate around high risk home birth and who should decide if it should happen. Should doctors decide where a woman births? By definisition, high risk birth is outside the scope of a midwife’s practice. Maybe midwives should not be taking such women on for home births as it might appear that we’re practicing obstetrics without a license. But where does that leave women? Although this is from the UK, the situation is the same here, except that publicly-funded homebirth is not available in most parts of the country. For the most part, if you want to have a home birth, you need to employ a homebirth midwife (private / independent).
I’d like to say it’s up to the woman to choose where and with whom she births her baby. It’s her body and her baby. But I’d also like to see hospitals providing woman-centered care to women who are “high risk”, and I see this as being possible with private midwifery for hospital birth. It will be a reality after nov 2010, but even now it is possible if the woman wants it to work this way. In my experience, it has worked well. It allows women to labour on their terms, with private midwifery care, and in a safe environment.
Melissa Maimann, Essential Birth Consulting 0400 418 448