Birthing Story

Title: Birthing Story.

Description:

As Yeo does her best to get over her traumatic experience of home birth, Patricia Hewitt, the health secretary, is preparing to announce a new drive to improve maternity services.

Content:

It was shortly after a family dinner on the date when doctors had predicted that her baby would arrive that Angharad Yeo felt the first twinges of labour. She had decided early on in her pregnancy that she wanted to give birth at home. Everything was in place. After telephoning the midwife, the 28-year-old felt sufficiently relaxed to have a nice warm bath. In the hours and days to come, however, her hopes of having a safe, straightforward delivery — with her husband, mother and a National Health Service midwife by her side — were shattered. In labour for five agonising days, she was attended by a succession of hurried on-call midwives who were too overstretched to stay with her. On the fifth day, frightened and exhausted, Yeo finally admitted herself to hospital — where doctors carried out an emergency caesarean. “All I hoped for was a straightforward birth, as painless as possible,” said Yeo, whose daughter, Ophelia, is now eight weeks old. “I didn’t have any incredible expectations. I didn’t even mind the midwives coming and going, as long as I was getting along okay by myself. “But as the days went by and I wasn’t progressing, it was obvious that it wasn’t a normal labour. I was frightened. I felt abandoned. When I called the hospital to try to get through to a midwife, I was made to feel a nuisance. “I’m not a medic and they were asking me questions I just couldn’t answer. I’d had no sleep for four nights. I was exhausted and in terrible pain. It got to breaking point. Once we got to hospital, the care was actually very good.” As Yeo does her best to get over her traumatic experience of home birth, Patricia Hewitt, the health secretary, is preparing to announce a new drive to improve maternity services. There will be a promise that every woman will have a named midwife to care for her throughout pregnancy and a guarantee of one-to-one care by a midwife during labour. How long that promise will take to be delivered is anyone’s guess. Since 2004 the government has been promising women “real choice” over where to give birth. In reality mothers face not a choice but a dilemma: home or hospital? If Yeo had a bad time at home, hospital horror stories also abound. Last week the government watchdog Nice (the National Institute for Health and Clinical Excellence) issued a warning that babies born at home have a higher risk of dying if serious complications occur. But last week, too, a health department study found that the NHS is letting down new mothers in hospital, treating many like “meat on a conveyor belt”. The home birth industry is booming. Hundreds of small businesses now offer a “natural” birth in familiar surroundings. Want to make it pain-free?

Try hypno-birthing, the self-hypnosis technique for a drug-free birth that was recently featured on Channel 4’s Richard & Judy show. Want to have your baby in a birthing pool? The National Childbirth Trust (NCT), which has long campaigned for more home births, has just brought out a DVD starring Davina McCall in which serene pregnant women get on with the job in the bathroom while their Boden-dressed husbands do the dishes next door. “For some reason I think people think blood-spattered walls, but I didn’t see anything — it was just, like, whoosh!” enthuses McCall on the DVD. “I want to spread the word, because that’s what every woman deserves. You know, if a woman wants to have a caesarean, that’s cool; but if a woman wants a natural birth, let’s try and give her one.” Despite the publicity, home births are rare. Until 1955 a third of babies born to married couples were delivered at home. According to official figures, only 2% of the 601,000 births in England last year were home deliveries. A further 2,500 women (0.4%) hoped to give birth at home but ended up on labour wards. NHS trusts in south Devon, Shrewsbury, Bath and Winchester are leading the way in offering choice between birth at home or in hospital. Elsewhere, home birth provision on the NHS is patchy at best. According to official figures, a normal hospital delivery costs the NHS about £1,351, while a caesarean costs £2,339. Nobody seems to have calculated how much home births cost, but the NCT insists they are far cheaper. Wherever women end up, the UK remains one of the safest places to give birth, with just 5.1 infant deaths per 1,000 births. But the home versus hospital debate has become highly polarised — and particularly vocal on the “home” side. The website of the Birth Trauma Association (BTA), a support group for women who have suffered hell in hospital, makes shocking reading. “Mel” tells of an agonising forceps delivery. A doctor “with a rude and patronising manner, without talking to me, put my legs up in strirrups. What had been a managable experience up to that point became a nightmare.” “Rachel”, who did not want to give birth at her local hospital, was told by midwives that she was “too fat and too old, and therefore too much of a risk, in those words, to my face” to have a choice. “They sent my birth partner out of the room, leaving me with no moral support. The male midwife who did this was rude and completely ignored me when I asked him to go easy. When I tried to breast feed, the only help I received was being told ‘to put tit to target and get on with it’.” Another new mother writes: “The whole catalogue of neglect and shocking treatment has left myself and my family extremely distressed and traumatised. Last night we even spoke about the fact that we would never have children again because we were so saddened. The experience ruined what should have been the happiest time of our lives.” Maureen Treadwell, a committee member on the BTA, said: “Communication, respect for dignity, listening skills — that’s what matters to women. “They don’t want to be left naked with their legs in stirrups while the registrar finishes off an instrumental delivery somewhere else. They want pain relief when they ask for it, not to be told they are too early, too late or too fat. If they need a caesarean, they want the same kind of support that anyone who has had major abdominal surgery would receive — not to be scolded because they find it impossible to breast feed.” Belinda Phipps, the NCT’s chief executive, said: “Maternity services need a sea change. We estimate that barely a third [of mothers-to-be] are offered a choice between hospital and home. We know an awful lot about what makes birth easier — things like being in warm water, feeling comfortable and cared for, being looked after by another woman who looks you in the eye. None of them are high tech, but we’re not doing it. It’s madness.” Mothers who want to give birth at home but do not trust the NHS can employ an independent midwife for about £4,000 — although not for much longer. The small army of private midwives has been without indemnity insurance since 2002, when the last company willing to provide cover pulled out because of the multi-million-pound awards typically made by the courts to victims of botched births.

The government has warned independent midwives that they must obtain professional indemnity insurance within the next 12 to 18 months or quit. Susan Stephenson, an independent midwife in West Yorkshire, said: “There is no insurance available to us at all. This means that the UK will lose a small but crucial element of what pregnant women and their families are offered in terms of care.” She insisted that private midwives were not the preserve of the rich: “We often care for women on low incomes, who spread the cost as much as they can or budget because of what they regard as a priority. “Very often we care for women who do not want to be pampered by a private service but who want to be supported and helped in making decisions and kept safe from humiliation, degradation, lack of care and excessive intervention.” Pitted against the vocal home birthers is the medical establishment. There are no romantic notions here. Many doctors say giving birth is a dangerous business, prone to unexpected complications, and the best place to do it is in hospital. Who cares if the rooms are a bit cold, the paint is peeling and the wards are noisy, if there is an operating theatre, a crash team and a state of the art neonatal unit within a 30-second dash? Patrick O’Brien, a consultant obstetrician and spokesman for the Royal College of Obstetricians and Gynaecologists, said: “In a situation where both baby and woman are low risk, then a home birth is a safe option. But you can’t always identify which babies are going to have a problem. If you’re in a hospital and things go wrong, you’ve got everything to hand. “If you’re somewhere far from the hospital and things go wrong and it’s a real emergency, it will take a long time for the ambulance to get out and come back again.” Helen Westwell, who had two difficult births at the Whittington hospital in north London, where there is a state-of-the-art neonatal unit and an operating theatre by the birth ward, said: “At least one of my babies, and possibly two, could have died if I’d been giving birth at home. “My son Otto stopped breathing immediately after he was born and had to be rushed to the intensive care unit. My son Joel had the umbilical cord round his neck and also needed emergency treatment.I never even considered a home birth. If I had done, it would have been a very unpleasant experience.” There are also those who argue passionately that women should have the right to even more medicalised births.

The biggest single trend in childbirth has been towards delivery by caesarean section, which now accounts for 23% of births. A handful of GPs and obstetricians are prepared to help women obtain an elective caesarean on the NHS, although women who want to go down this route, even for good reasons, are still derided by natural birth pedagogues as “too posh to push”. Into this passionate debate has stepped the calming figure of the “doula”, a Greek word for a woman who helps other women. She fulfils the role that the grandmother might take in traditional societies, with emotional and practical support during childbirth. From a handful in the early 1990s, the number of doulas in Britain has risen fast. They are now easily available online for fees of about £600, whether for home or hospital births. Many NHS trusts are only too eager to embrace the extra hand that they provide on overstretched maternity units. Perhaps this is where the solution lies. While ministers sweat over how to deliver on their promises, an informal public-private partnership between the NHS and the doulas can alleviate the agony and be alert to the dangers of childbirth — whether in hospital or at home. Births by numbers – There are about 600,000 births a year in England – Until 1955, a third of babies born to married couples were delivered at home. By 1975, the home birth rate had plummeted to 3.3%. At present only 2% of births take place at home – The vast majority of births take place in NHS hospitals. Only 0.4 per cent of hospital deliveries were originally intended to take place at home – Nearly half of all births are normal deliveries, meaning there is no surgical intervention, use of instruments, induction or epidural or general anaesthetic – About 23% of births are caesareans, with most classified as emergencies – About 11% of births — 66,110 — are by planned caesareans. The number of caesareans has doubled in 20 years; the rate was just 5% in 1989 – The World Health Organisation has recommended that no hospital should have a caesarean rate of more than 20%. Many hospitals in the UK have a rate which exceeds that – Some 20% of births are induced. A third of women giving birth have an epidural, general or spinal anaesthetic – Figures show that 64% of deliveries are by midwives, 36% by hospital doctors – The majority of women (51%) leave hospital within 24 hours of childbirth and 16% leave the same day Just 15% are still in hospital three days after giving birth – Government guidelines say: “Women in the UK have a right to insist on staying at home to give birth and should be supported in this decision. NHS maternity care providers should ensure that the range of antenatal, birth and post birth services available locally constitutes a real choice for women.”

Sources:

NHS Maternity Statistics, England 2004-2005, and National Service Framework for Children, Young People and Maternity Services, 2004 http://women.timesonline.co.uk/tol/life_and_style/women/families/article1563975.ece

Disclaimer:

Any views or opinions expressed are solely those of the author and do not represent those of The Federation of Antenatal Educators (FEDANT) unless specifically stated.