The Maternity Alliance on what to do if you want a home birth and can’t get one

Every maternity unit in the country will receive a share of a new £100 million fund for maternity services, announced by the Health Secretary, Alan Milburn at the Royal College of Midwives conference in May. The investment should mean that by the end of 2002, there’ll be an extra 500 midwives, so women all over the country will be able to have personal care from one midwife during labour, and they’ll also have the choice of a safe home birth if that’s what they want.

In 1998, 716,530 babies were born in the UK – but only 2% of them at home. The number is increasing slowly, though a survey for the government funded, Changing Childbirth in the 90s, showed that 16% would have opted for a home birth if they’d had the choice.

At the moment, if you want to have your baby at home, your first port of call is your GP. He or she should refer you to a community midwife (usually working from the surgery or local health centre), who should provide your antenatal care and deliver your baby at home as you want.

Unfortunately, many women do experience problems arranging a home birth via their GP, and if it’s your first child it’s likely to be more difficult.

If you encounter problems

Go straight to the supervisor of midwives or head of midwifery at your local maternity unit (phone the hospital to find out their name and contact details), explain your problem and ask to be given a list of midwives in your area who specialise in home deliveries.

Most GPs give antenatal and postnatal care, but don’t offer care during the birth itself. However, in some areas, particularly rural parts of the country, a few GPs do offer full maternity care, including home births.

If you’d like your GP to be involved but he/she doesn’t offer this as part of the service, you can register with another GP for maternity care. However, it’s worth contacting your local health authority (HA) or your local Community Health Council (CHC) for help and advice because you need to find a GP who’ll offer this and accept you, before you make a move.

If you feel you’re being pressured

If your GP threatens to take you off her/his list for requesting a home birth or puts undue pressure on you to give birth in hospital, contact your local HA and the supervisor of midwives in your area. As the watchdog for the health service in the area, your Community Health Council should help with contacting the right person at the HA and maternity services.

Remember: Most babies are delivered by midwives

You don’t need to have a doctor there. When your midwife undertakes to look after you during pregnancy and birth, she’ll arrange to get advice or assistance from a qualified doctor, if necessary. If at any stage, during pregnancy or labour, you and your midwife agree that you’d be better off in hospital receiving care from a doctor, the midwife will arrange for you to be transferred.

Transfers to hospital during labour are rare but, just in case, talk to your midwife about how she would handle this. Do be aware that sometimes you can plan a home birth but end up in hospital because a problem develops during pregnancy. You have to maintain a degree of flexibility about your plans.

What are my options outside the NHS?

If you have no joy with all this but you still want to have a home birth, you could consider an independent midwife They work on a private basis, alone or in group practices and are committed to providing a service that suits a woman’s individual needs during pregnancy. Private midwifery care can be expensive (in London, most midwives charge £2300 for maternity care, the insured midwives will charge from £4500) and it’s not usually covered by health insurance. Many independent midwives offer schemes, which allow you to spread payments over the antenatal period and afterwards, if necessary.

The Independent Midwives Association can give you details of independent midwives working in your area.

If private options are out of the question, you could consider having your baby in a Community Unit. These small maternity units are run by midwives or family doctors in many parts of the country. They may have a separate building or be part of a larger hospital – check with your local GP or hospital on what services they offer. Community Units may not be as relaxed as home, but they do go some way to providing more intimate and private surroundings for giving birth than a hospital delivery room.

Deciding between home and hospital? See what iVillagers think.

Useful contacts:

AIMS - The Association for Improvements in the Maternity Services provides information, support and advice to parents and health professionals on all aspects of maternity care, particularly focusing on maternity services

NCT – the National Childbirth Trust have a helpline: 0870 4448707 to find out about support groups in your area.

The active birth centre and Homebirth reference site provide information about home birth for parents who think that it might be the right choice for them, and for health professionals looking for facts and ideas.