NHS 'scaring' women out of home births, top midwife says

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Too many pregnant women are being treated as though they are “abnormal,” and told their age or weight could put their child in danger, one of Britain’s leading midwives has said.

Samantha Green had been looking forward to giving birth amid the comfort of her home, where she hoped the familiar surroundings would provide a perfect setting for the arrival her first child.

But when she told her hospital consultant of her plans she received a response which shocked her.

He informed her she was too overweight and that a home birth would lead to such difficulties that both her and the baby's life would be at risk.

"I was so terrified by what he was saying. I was made to feel I had no choice, simply because I'm a slightly larger girl than many," said Miss Green. "I felt I was being discriminated against."

Her experience is far from unique. In fact the leader of Britain's midwives is warning that too many pregnant women are being treated as though they are "abnormal," and told their age or weight could put their child in danger.

Prof Cathy Warwick, general secretary of the Royal College of Midwives (RCM), says risks are being exaggerated, so that mothers-to-be who want to give birth at home or in a midwife-led unit, are being frightened into going to hospital.

So many women were now classed as "high risk" by the NHS – because they were young, old, or considered overweight – that it was becoming the norm ...

Failure to meet the physical ideals set out in NHS guidelines left many mothers-to-be feeling "terrified" about the dangers they posed to their own baby, and "demonised" if they chose to give birth outside of a hospital.

... "It seems more and more we have got into a situation where it is actually unusual to be treated as a normal woman. It makes no sense at all."

Latest figures suggest that half of all women of childbearing age are overweight or obese, while more than 40 per cent of those who become pregnant have a body mass index (BMI) above the range defined as normal.

Meanwhile, the number of births to women aged 40 and over has trebled in two decades.

Obesity and older age in pregnancy are associated with a number of risks – including miscarriage, foetal abnormalities and stillbirth.

Miss Green, 25, admits some people regard her as a 'large girl', but says there was no reason for her not to go ahead with a home birth.

At the time of her pregnancy she weighed 16 stone and had a BMI of 34, but she was fit and healthy with no history of high blood pressure.

When her consultant first saw her, however, he asked her if ate excessively and suggested she halve her portions.

Miss Green, a part-time receptionist who lives with her partner David, said: "He said he was against (a home birth) because he was concerned I was going to produce a big baby and its shoulders would get stuck on coming out.

"He also said my blood pressure would go through the roof because of my weight.

"The midwives had been encouraging about me having a home birth, but they said that once the consultant said something that was it.

"Basically I was terrified into not having a home birth. I didn't feel I could insist on it because he had scared me so much."

The consultant's concerns about Miss Green's weight led to her being admitted to Northampton General Hospital for her baby to be induced a week early.

"He had been predicting the it would weigh as much as 10lbs, but in the end Miss Green gave birth to a healthy baby girl, Charlotte, weighing 7lbs 8oz.

The hospital said it encouraged home births where it was safe to do so, and pointed out its home birth rate is one of the highest in the country.

... NHS guidance says all mothers-to-be with a BMI above 35 should be cared for in consultant-led units.

For women aged 40 and above, and those with a BMI above 30 – the lower threshold of obesity – weight and age factors should be taken account in deciding where the birth is planned.

The most recent advice says even a rise of one BMI point – around half a stone for most women – between pregnancies can increase the risks of diabetes and high blood pressure, even among those who are not overweight.

I'm not disputing that a higher BMI makes high BP and diabetes more likely than if the BMI were normal, but what is wrong with planning a homebirth and then changing to hospital birth if BP rises or the gestational diabetes is poorly controlled? Planning a homebirth doesn't commit a woman to birthing at home: place of birth remains flexible until the birth of the baby.

Prof Warwick said the cumulative effect of all the guidance put midwives under pressure to restrict the options for many women.

"There is a danger that only a very small number of women are left believing that childbirth for them can be a normal and fulfilling experience," she said.

... guidance, combined with an increasing culture of defensiveness, risked turning midwives into "unthinking automatons," she warned.

Disputes involving maternity failures account for almost two-thirds of the £800 million NHS medical litigation bill.

Guidelines published earlier this year say babies born to obese mothers are 50 per cent more likely to be admitted to neonatal intensive care, while one third of deaths of mothers in childbirth involved women who were obese.

Sally Russell from Netmums, a website for mothers, said pregnant women needed to feel in control of their experience.

"If people are feeling under pressure to make choices, rather than feeling cared for, then the system is letting them down," she said ...

Melissa Maimann, Essential Birth Consulting 0400 418 448