What is the deal with home births? Is everyone entitled to one and what are your rights?
Last year, the birth rate in England and Wales increased for the fifth consecutive year, with the delivery of 669,531 babies, a four per cent rise from 2005. From 2009, the government has pledged to give every woman a choice over whether to have her baby in hospital, at a midwife-led unit/birthing centre, or in the familiar surroundings of her own home.
But there is no guarantee of extra funds to ensure every woman gets her first choice, and the current staffing crises means there are too few midwives to go around.
According to the Royal College of Midwives (RCM), the number of full-time midwives working in the NHS on 30 September 2006 was equivalent to 18,862, 87 fewer than in 2005. Maternity services are stretched to the limit and at least 40 maternity units are expected to close this year. Antenatal classes are also being cut or reduced, at a time when the birth-rate is on the rise.
Cynics suggest the new government pledges about choice are merely a cost-cutting measure to keep women out of hospital and in their own homes, but the RCM claim another 1000 full-time midwives are needed to make the government's plans work, while another 2000 will be needed by 2012.
Legal rights
You don't have to wait until 2009 if you want a home birth, however. You already have a legal right to give birth at home should you wish, even if it's for your first child. Research suggests that home births are at least as safe as hospital-based births for a healthy woman with a normal pregnancy. It is an attractive idea for many expectant mothers, but surveys suggest that only one in five women are currently given this option and only two per cent of births now take place at home.
NHS Trusts are obliged to provide a qualified attendant should you wish to give birth at home, and your doctor should be willing to refer you to a midwife experienced in carrying out home births. You also have the choice of registering for maternity care with another local GP rather than your usual family doctor if you wish, providing the new doctor is willing to take you on for maternity care alone.
Alternative arrangements
If you find difficulty arranging a home birth through your doctor, you can contact the Director of Midwifery Services at your local hospital and arrange it yourself, or contact the Association for Improvements in Maternity Services (AIMS) and ask for their help and advice.
Their website provides template letters that you can use to book your home delivery, and also one to send to the Chief Executive of the Maternity Unit if you are told in later pregnancy, as often happens, that a home birth is no longer possible due to a lack of staff or excessive demand on their services.
According to AIMS, the chance of successfully getting a midwife to attend you at a home birth depends on your determination to make a fuss about it. You can, of course, pay privately for maternity care and a home birth if you prefer, but expect this to set you back several thousand pounds.
Another popular scheme is the DOMINO (domiciliary, in and out) in which the midwife comes to you when labour starts and then goes to hospital with you to deliver your baby. You can then go home again, assuming all is well with you and the baby, within a few hours of birth.
The government has also pledged that a woman will have the same 'known and trusted' midwife to care for her throughout her pregnancy, or another known member of her team if she is unavailable. This promise does not extend to the time of delivery, however, although this is obviously the ideal.
Women who experience the one-to-one approach to pregnancy and labour appreciate the continuity of care and are more positive and confident about giving birth. They tend to have a shorter stay in hospital, and are more likely to succeed in breastfeeding than those receiving traditional care. Unfortunately, the shortage of midwives makes this ideal increasingly difficult to achieve.
Stay flexible
It is important to remain flexible in your wishes. Different women have different needs during pregnancy and childbirth, and it is not always possible to tell what these will be in advance. Even the best laid plans may have to be abandoned if you are faced with particular circumstances or complications at the time of delivery. An estimated 15 per cent of home births end with the mother or baby needing a transfer to hospital, and this figure doubles for first-time mothers.
If you have your heart set on a natural home delivery, then need a forceps delivery or Caesarean, it is easy to feel you have somehow failed, because you have lost control, or that your birth experience was not as fulfilling as you would have wished.
By all means make plans and fight for your choices and rights if they are really important to you, but try to remain flexible and philosophical, too, if reality gets in the way.