UK Midwifery Archives
These archives contain extracts from discussions held on the UK Midwives and Consumers email list, a discussion group for people interested in midwifery in the UK. Open to midwives, students, mothers, and anyone interested in improving maternity services in UK. Posts in these archives express the views of the individual authors, and not those of the Association of Radical Midwives.
Home Birth in the UK
Legal right to home birth in the UK?
I am expecting my second baby around January 9th, and receiving my care at the Homerton hospital, Hackney, London. I am hoping to have a home birth. at my last (28 week) check up, I raised the issue with the midwife who informed me that I could book a home visit at 34 weeks, but that I should be prepared to be told ON THE DAY I GO IN TO LABOUR that there are no midwives available for home birth. Whats more, I was told that I may not even be able to have the baby at the homerton, as they are expecting staffing problems, and had less than 6 weeks previously had to turn women away.
Surely I have legal rights here? (The Millennium staffing shortage) should surely have been planned for months or even years previously. I feel that I have paid into the system for years and am now entitled to what’s mine…………….. am I mad?? What are my rights?? How best to proceed??
I answer your E-mail from 2 viewpoints .
FIRSTLY as a midwife dedicated to her job but often exhausted mentally & physically from endless hours on-call/working. I work in a midwifery group practice, part-time ha-ha!!! I was called out at lunch time on christmas day last year, delivered the baby went home to a dried up, alcohol free lunch before returning to do my actual shift immediately after.(I think I saw my family at some point?) This week I spent 12 hrs with a woman in labour, I was on a day off.This is not unusual.
The team I work in has an unnofficial “second on-call” rota as often there would not be enough cover for home births.( We’re not paid for this!) Hours worked over contract have to be taken as time owing, but in an already short staffed unit when can we ever get the time back?
Last week, I went to a homebirth (I had already done 10 hours that night on delivery suite.) One of my colleagues came as 2nd. she was not on call or on duty. I called her knowing that she would rather me call her than the woman having to have a hospital birth because there were no other staff available. All the the other staff on call were already working. It’s not Christmas or New year, there just aren’t enough of us.
In our area, women who want homebirths get homebirths, and midwives love homebirths and are commited to providing the care (some of it in their own time.
SECONDLY as a mother of three children who has had domino and homebirth care in an overstretched system, but with fantastic, commited midwives. Take heart. Your midwives will do all they can to make sure you get what you want, because they want it as much as you do. Many ‘millenium babies’ have been carefully planned. Others have jumped on the irresponsible bandwagon to attempt to have a baby when many services will already be pushed to the limit.
This surge in births will no doubt begin early in December & end in late January.We all want to have time to be with our friends & family over the festive season, & no matter how important your job is to you to hear your child say “mummy you can’t go to work, it’s Christmas day” certainly tugs at the old heartstrings doesn’t it? Rather than gadding about on the ultimate milleneum experience, I’m hoping to have a convivial time with friends & family with my pager switched of!!! After all I’m working most of Christmas!
A GP or doctor can refuse to attend a woman in labour, but a midwife cannot and she has an obligation to find another midwife if she is unable to attend. This is being undermined by many Trusts who are now arguing that they are providing a midwife but the woman has to come into the hospital.
AIMS has challenged two Trusts on this issue and pointed out to them that if they refuse to send a midwife to a woman in labour and a disaster occurs the Trust will be held liable – the Trusts appear to have reconsidered. However, we have asked the Midwifery Committee of the UKCC to consider this problem and they are prevaricating like mad. The discussion continues.
AIMS advises any woman who is told that “if we have a shortage of midwives at the time of your labour you will have to come into hospital” to write a short letter back stating that they have no intention of coming into hospital and they expect a midwife to attend when called. So far, each one has had a midwife attend at home (a sample letter for women in this situation is available on the AIMS website at the address below).
However, I know that there are many more women out there who have accepted what they have been told and went into hospital. This is a very good system for keeping the home birth rates down.
Beverley Lawrence Beech
In the area where I live, the decision has been made to tell women that they can’t have home births due to a lack of midwives. One of my friends has been told this 10 days before her due date and was asked by her m/w to find out whether I’d provide 2nd m/w cover!!! She has been told that because the recommendations are for 2 m/ws (Paed Assoc) The Trust can’t provide home births. This situation to my knowledge has now been going on for the last 3 years, how long can a Trust keep using this excuse before it has to start addressing the problem? Any bright ideas for how my friend can word her letter? I’ts doubly frustrating because she knows that all she’d need to do to get a home birth without any hassle would be to cross Trust boundaries, maybe we’ll get our birth centre on our patch for these women!!
How can a trust get away with not allowing women to birth where they choose? The local midwives must not take it lying down. This is so against Changing Childbirth and the key components of it – Choice, Continuity and Control. In Brighton we have 8-10% homebirth rate , so we can’t have two midwives at a labour, but we do call a second for the birth. (They don’t always get there with our hideous traffic- but we also have managers and supervisors who will come out as seconds and that helps.)
A midwife can’t refuse to attend a woman in labour. I suggest that the woman stays at home and calls the midwife when she is in labour, declining to go into hospital.When the midwife arrives, if she is unhappy with the situation, she should notify her supervisor, who could then attend as the second midwife. Other possible alternatives could be to call an ambulance paramedic team to standby (for a normal birth!?!), or even possibly her GP.
Not a happy situation to be in, my heart goes out to your friend and the midwives involved. We are currently in a similar situation here, due to sickness and maternity leave both hospital and community are short staffed. The women booked for community midwife delivery in hospital in August have been advised that they may have to have a hospital midwife…but we will still attend any planned or unplanned home births.
What a dreadful situation. It seems to me that (the Trust’s) action is illegal, but I expect time is a bit short to get a judicial review! If the only option is to wait until she is in labour and then call out a midwife who may be neither skilled nor experienced, this seems equally unsatisfactory in terms of her enjoyment of the birth. She could, however, find out if there is an independent midwife who would be prepared to come, with a view to claiming the fee from the health authority on the grounds that they were unable to supply the service she requested, which they have an obligation to do. Previously fees have been paid on these grounds.
The Independent Midwives Association phone number is 01483 821104, website www.netcomuk.co.uk/~pvan/ima.html
In order to force a reluctant Trust to pay for an independent midwife one has to prepare the ground very carefully. That the staff say that they are not willing to attend is not sufficient as there is no documentary evidence that they have said so, and it is not uncommon for the staff to deny it subsequently. Therefore, it is necessary to proceed carefully.
1. The mother should write a letter stating that she intends giving birth at home on the ..(date)… and expects the Trust to provide a midwife. Under no circumstances should she pay attention to telephone discussions or meetings because in both circumstances the staff will often make statements that they would not dream of putting in writing.
2. After a telephone call or a meeting the mother should write to the person concerned as follows: At our meeting/telephone call on ..(date)… you stated that “……..” I would be most grateful if you would confirm in writing that the above is a correct record of what you have said and that I have understood . Love and kisses.
3. The more cunning staff will try to avoid stating that they are not willing to provide a midwife, so you send another letter stating that your question was not answered and would they etc etc.
Unless the mother obtains written evidence of the Trust’s refusal to provide a midwife, she will not be able to reclaim the costs. Even when she does have written evidence she can fail. It is not easy and no mother should be told that she will be able to reclaim the costs. I always tell women that they have to accept a very real possibility that they will have to pay the midwife’s fees themselves.
If anyone has any problems negotiating their way through this particular minefield do contact me.
I understand that Trusts can ‘legally’ (refuse home births) if their midwife shortages are such that by sending midwives to attend homebirths they threaten the safety of the majority of women having babies in hospital by drawing on hospital staff?
I suppose whether this is ‘legal’ or not depends on whether we do in fact still have a legal right to home birth or not. My understanding is that, IF (big if) the right has been lost as successive Health Service Acts were superseded, it has occurred as an oversight and certainly not after any debate, nor as the result of any declared government policy. I would not be surprised if that meant the loss of such a right was open to challenge, or perhaps even legally invalid.
The Autumn 1999 issue of Midwifery Matters includes a ‘gleaning’ from ‘Practising Midwife’ where someone writes that she believes the statutory right to home birth no longer exists, ‘with the help of some legal expertise’, but things are never as clear-cut as this (otherwise we’d have very few court cases!!). One barrister’s interpretation might vary greatly from another’s.
From what I understand, a midwife still has to attend a woman in labour who calls upon her. So what would happen if mum in labour at home simply rang the community midwives and stated that she was NOT going in to hospital? Horrible to be having that sort of conflict in labour, and also horrible to have reached the end of pregnancy not having got the support necessary to simply book a home birth – but what would happen in this case? Battle of wills?
At the trust where I work, a suggestion has been made this week that we withdraw home birth services due to safety issues – due to staff shortages a second midwife is often not available at all. I am hoping that the women who are being denied their choice of birthplace will make enough noise that the issue will have to be addressed.
I am desperately curious about how this is laid out in your health care system. Can a woman demand an home birth under any circumstances(twins, diabetic etc..) as long as she has informed choice, or is there a specific guideline for this? If so is a woman carrying a breech baby considered a (god, I hate these words)”low risk” client?
A midwife who tells you that you are not permitted to have a home birth because the baby is breech is either misinformed, ignorant or lying. The decision where to have your baby is entirely yours, the midwife or doctors may ADVISE you that in their opinion it is not recommended but the decision is yours and they are required to provide a midwife. If they do not have one who is suitably experienced they can organise an extra contractual arrangement.
Beverley Lawrence Beech
In the UK women have the legal right to give birth at home. If a woman chooses against medical advice to birth at home health professionals are bound by law to attend her. This usually means that a midwife attends her, sometimes with an ambulance at the door, or other heavy pressure from local medical professionals. Few women are willing to take this kind of a stand.
Breech presentation is considered high risk by most medical professionals. On the other hand many midwives would say that breech presentation is a variation of normal labour, and not an abnormal situation. Most are agreed that it is preferable to give birth to a breech baby in hospital, given the higher likelihood of resuscitation being needed, but there are situations where transferring the woman from home to hospital might be riskier, either for emotional or physiological reasons.
As an independent midwife, I will discuss the implications of breech presentation carefully and in depth with the woman, giving her clear options for care. Usually this begins with efforts to encourage the baby to turn head down, and we have a good success rate with this. If she decides to go for a hospital birth I will try to make arrangements for the kind of care she wishes, although this may not be easy, and I may not be successful. If she decides to stay at home, or if the baby turns out during labour to be an undiagnosed breech, we would go ahead and deliver the baby at home if this is what the couple wishes, as long as good progress is evident all through and baby and mother are both in good condition. If there is delay during labour, or a complication arises, we would transfer the woman to hospital – with her consent, although I can’t imagine that she would refuse. There would be no problem about an NHS hospital accepting any labour transfer, whether from an independent midwife, an NHS community midwife, or a GP.
In the unlikely event that a woman refused transfer, I would document it all in the notes, contact the supervisor of midwives for support, and continue to care for her to the best of my ability.
Other UK midwives may have different opinions and perspectives on this, but this is my ha’pennyworth!
Is it against the law for a couple to birth a baby deliberately without summoning the assistance of a medical professional? Sometimes it happens by accident, which is a different thing. I heard of one couple who were prosecuted for not summoning assistance.
It is not against the law. There is no obligation whatsoever for a couple to call the assistance of a medical professional (and that definition includes a midwife). What the law states is that it is illegal for anyone other than a midwife or doctor to deliver a baby. It is not illegal for the mother to deliver the baby on her own.
Those who have been prosecuted, have not been prosecuted for failing to call assistance. The husband/partners have been prosecuted for delivering the baby.
In all the cases I know about the fathers have admitted that they did so. I know of no prosecution where the mother has stated that she did it herself and her partner/husband was away calling Auntie Nellie or taking the baby to the childminder at the time!
The law is very precise on this issue and we must not confuse prosecuting those who “attend” with prosecuting the couple. As I have said, a woman cannot be prosecuted for delivering her own baby – deliberately or otherwise. I hope this clears up the confusion.
The woman herself, as far as I know, has the absolute right to birth herself if she wishes and I know a few women who have done this – one of them having been referred to a psychiatrist for expressing a wish to give birth on her own! The law says, I think, that a woman in labour may only be attended by a registered midwife or doctor unless it is an emergency, but in the cases I have heard about it has been the partner who was prosecuted for acting as a midwife, rather than for not calling a professional. I think the chap in Bristol who assisted his partner got fined a nominal fiver (or some such paltry amount). It does seem a somewhat murky area – you could argue that the partner has a moral obligation to help if the woman has sent away, or refuses to call, a professional!
It’s the definition of ‘attending’ – I think this is a professionally-defined concept. I don’t think it means ‘just being there when the baby is born’ , but passing yourself off as a qualified person. Legally, anyone could actually assist at a birth without being qualified, at the mother’s request, as long as they didn’t try to tell the mother their name was Midwife or Dr So-and-So.
Actually, I find it totally chilling to think that someone can be forced to have anyone ‘attend’ them for anything. We are talking major civil libs here, surely….the woman who underwent a court-ordered section appealed for damages afterwards, remember, and won (or have I got that wrong???)
I thought it was not illegal to give birth without medical/midwifery assistance, by accident or design.
Were the laws in place now not originally designed to protect the midwifery and medical professions from ‘imposters’ like the old neighbourhood ”handy women’?
It is illegal to present yourself or pass yourself off as a midwife without being registered as such by the relevant professional body. So a father, or mother-in-law, or a neighbour, could indeed be present at a birth and help with the delivery as long as they did not try to tell the mother they were professionally-qualified to do so.
If they did, they could be prosecuted. I mean, I know it doesn’t ever happen….
I have always interpreted the law to allow the mother to decide for herself who attends her. It seems to me to be an important principle…
Because we do not have a written constitution, there is no law which says a woman has a right to give birth at home. In common law a woman has a right to birth wherever she wishes. Although that has become much more difficult in the last ten years since hospitals unilaterally defined their own catchment areas.
The law defines the role of the midwife and restricts delivering babies to qualified midwives and doctors except in an emergency when anyone can wade in. The mother has an absolute right to determine who attends her (although few understand that) and anyone who attends a woman against her wishes can be sued for assault and battery. Therefore, a woman giving birth at home can refuse anyone entry, and she can do the same in a labour ward, but few understand that.
‘Attending’ is the word used in the Act and there has been some debate about exactly what ‘attending’ means. However, it does not mean that if the mother invites you to attend that is ok providing you do not pass yourself off as a midwife or doctor. Attending, so far, means anyone who is present at the birth. So you can “attend” providing it was a sudden emergency, otherwise you have to be a qualified midwife, doctor or student under instruction/guidance.
A mother-in-law, husband, partner or Auntie Nellie could not be prosecuted if they delivered a baby as a result of “urgent necessity”. In other words, if the mother suddenly, and unexpectedly, announced that the baby was about to arrive, they rang the midwife and lo! the baby arrived before the midwife.
Those men who have been prosecuted have said that they intentionally delivered the baby and decided to dispense with the services of the midwife. It is exceedingly difficult to prove that the baby was deliberately delivered without a midwife if the couple claim that it all happened very quickly and they rang the midwife as soon as they could.
Does UK law protect a woman who chooses to give birth alone?
I think the UK law DOES protect the woman. The law makers were wise enough to realise that you cannot possibly prosecute a woman for birthing her own baby. Freedom of the individual would go out the window were that to happen. Which is why, I suspect, they prosecute those who “attend” and why no-one has ever tried prosecuting the woman.
I recall a man being prosecuted in Wolverhampton, for deliberately insisting on being the birth attendant to his wife. He was still threatening this for the second. As a student there (1984-1985) I remember the debate, the problem not only being safe birthing, but also the legal requirement for the birth to be notified – then registered. You cannot have anybody being born without the state knowing of it’s existance!
This was also to monitor infanticide; remember, the 1902 act was a long time ago!
The man who was prosecuted for delivering his own baby was Brian Radley and both Jean Robinson and I were at the hearing and AIMS supported the family before the birth. His partner had been given pethidine during the first birth when she clearly said she did not want it and was so traumatised by the way she had been treated in the hospital that she refused ever to go near one again. They tried desperately to get a home birth, and did the rounds of the GPs (and were roundly abused at every surgery). They requested a midwife (as was their right) and the midwives told them that if they were called out they would immediately call an ambulance and take Michelle to hospital. Against our advice Brian Radley said in that case “I will not even bother calling a midwife, we will do it ourselves”. And that is why he was prosecuted. Had he followed our advice he would not have been.
You can read a short report of this case in the Autumn 1982 AIMS journal.
The Magistrate, clearly, was offended by a long haired hippie defying the might of the midwifery and medical profession and refused to take any notice of the disgraceful behaviour of the Midwifery Manager. He was found guilty and fined £500 which was anonymously paid by a psychiatrist who was disgusted with his profession. Shortly afterwards AIMS founded the Maternity Defence Fund which had the intention of raising money to assist people who wish to take legal action against the medical profession. It still exists (but has a very small amount of money which we use judiciously).
I was very keen to report the Midwifery Manager to the UKCC, but she was very ill and I understand she retired and died not long afterwards. A pity because I would have loved to have got her into court and made her justify her dreadful behaviour.
Interestingly, in Court the lawyers tried painting Brian Radley as a Svengali who was manipulating this poor, defenceless, woman to his own evil ends and desires. When Michelle got into the witness box she left everyone in no doubt at all who was directing operations (pardon the pun). Brian wrote the letters, which she dictated, because she was not as good at writing as he. She was the one calling the shots and was not going to be browbeaten by the collection of arrogant, insensitive and controlling midwives and GPs who were involved.
As for registering the birth, I am not so sure that it is as you suggest. I have not heard of a single case of action being taken against someone as a result of the registration procedure. All the cases have come about as a result of the midwives reporting a suspected case.
Finally, arrogant, insensitive, and controlling midwives are, I regret to say, alive and well, and still practising. The latest AIMS journal The Witch Hunt, Vol 11, No 2, 1999 has an account from Glasgow (an area well populated by such midwives) of a woman who delivered her baby at home without a midwife because she could not find a single midwife out of a team of twelve who even came close to her aspirations. Unfortunately Scottish midwifery care is pretty grim and those midwives who try hard to practise real midwifery (as opposed to obstetric nursing) have a pretty hard time.
I had an interesting experience this weekend which I think I would like some feedback about from you all…
I went as second midwife to a homebirth for another team. In the morning the case midwife had told me that the woman, P1, was in established labour and doing fine with the help of her birth partner.
I was called mid afternoon, when the woman was in second stage. Pulling up outside the front door, I was pretty sure that I had been there before, but thought nothing more about it. The woman was labouring in bed, with her husband and another woman supporting her.
This other woman caught my attention immediately – she was giving wonderful, ‘professional’ birth support – she had a lovely calm voice and was the only person speaking, myself and the other midwife just sat and listened to her gently coaxing the labouring woman to push her baby out (she was furiously fighting the expulsive contractions.) It was obvious that the ‘birth partner’ was a veteran of many births, and my first thought was that she must be a midwife herself. After the (lovely) birth, we asked her if she was, but she said no, people always told her she should be a midwife, but she had no interest in the “academic side.”
Anyway, cutting a long story short, we transferred the woman to hospital with a retained placenta and a PPH. The other MW went in with her client and I stayed behind to clean up. The woman’s husband also stayed, as he was waiting for his daughter to come home. An old sheet on the bed had got very bloodstained, and I asked him if he wanted it kept or thrown away.
To my amazement, he said “I don’t know, it isn’t my house, you had better wait and ask [the birth partner.]” I asked him why they were there, and he said “Oh, she looks after lots of women having their babies here, in fact she’s brought a lot of children into the world herself.” And I realised that I had been there before, more than once, visiting postnatal women.
I am totally amazed – there appears to be some sort of unofficial birth centre operating here! And this guy, obviously not realising he should keep his mouth shut, pretty much told me that the woman is doing births, in her own home, as well as running a postnatal hotel.
Now I should probably tell someone about this. But I was impressed by her. She was very knowledgeable, very supportive, very serene – I’ld let this woman look after me in labour before I let plenty of the qualified midwives I’ve worked with anywhere near me! What do you think? Anyone got any experience of this sort of thing? Maybe it’s going on everywhere and I’ve never noticed before? Opinions, please!
Sorry I know this isn’t what you would like to hear but … matter how ‘serene ‘ or wonderful it appears to be……..I really think this needs to be discussed with your superviser. If what you think is happening really is ..then it is unlawful and needs stopping for the protection of the woman and her baby.
It is perfectly possible for a REGISTERED Midwife to extremeley intuitive and to empower a birthing woman .And we do this in the full knowledge that we are legally & professionally responsible for our actions . It gives me the creeps to hear that this woman has no interest in theory ! And I am definitly not a theorist. It all just sounds extremely dodgy to me. It sounds more like the woman has her own ego as a first concern not the welfare of the woman & baby ……….Good Luck
A very interesting and well written letter. I too have been intrigued by this thread and – as any true Libran – am unable to decide what are the rights and wrongs of this situation. It would be absolutely certain that if complaints were made, this woman would probably be restrained from providing this service. Is she, in fact, doing anything illegal? The story told on this list does not indicate so. Is she making huge profits, or is she doing it for other reasons?
I think that if I were the midwife who attended that birth and who raised this issue, I would go and talk to this woman to find out exactly what she is offering and what role she sees herself taking.
Sue in Perth
It doesn’t sound like there was anything unlawful about the situation you described. Perhaps the partner was using a “freedom of speech” to praise the woman who sounds like she was attending as a doula. I have been to one homebirth with a doula similar to the one in the story. She was very helpful to the labouring woman.
Even in England some women choose to birth their babies without registered midwives or doctors in attendance. On the other hand, often it’s a very unplanned, undesired event (even in hospitals!).
As I understand it, it is not illegal for a woman to birth her baby by herself or with “samaritan” help, in fact that would be a farcical law. The question of who should be in attendance is not much of a controversial one here (and not often addressed it seems)as the professions of Registered Midwife and medical doctor have had a legal monopoly on birth attendance for most of this century and all others are very underground including one or two religious groups I have heard of. One husband got arrested a few years ago as he announced his intentions beforehand and went ahead with attending his wife in labour. Safety issues will always be a concern but I believe the choice should remain with the informed, pregnant woman about who attends her and what happens to her.
In USA it varies from State to State. In some places traditional midwives and even naturopaths attend birthing women without breaking the law. MANA is introducing the Certified Professional Midwife qualification to assist the traditional midwives in their pursuit of legal recognition for their safe practices.
This may turn into an interesting list debate because as UK midwives I think we take a lot for granted about women expecting to conform to the system here.
I take your point about the midwives’ physical presence at the birth, but they were hardly doing what midwives do, if they were just an interested audience. The ‘doula’ was acting as midwife; they were simply there for the appearance of the thing, and I don’t think that’s satisfactory.
It’s all very well that this ‘doula’ should be helping women to birth when all goes smoothly, but the midwives were ( I assume) the ones who had to step in when it didn’t. If the woman had died, I don’t think the UKCC would have been too impressed with a story that they stood by and watched someone else work illegally as a midwife.
This is what I mean about where the accountability lies – with us, as professionals, not with someone who doesn’t want, or can’t be bothered with, ‘the academic side’. It’s a cop out. This is someone who wants the kudos, but not the responsibility.
I feel strongly that the midwife should talk to her supervisor and the LSA, with a view to either regularising, or putting a stop to this situation. In the case of women who are not British it is my view that we should support the assimilation of TBAs into the service in order that women can give birth in a way which fits their cultural and spiritual needs, but I would add to that, the proviso that this is a service which all women deserve. Until the time arrives where all birth-workers are fully accountable to the public and their peers, I cannot support the amateur enthusiast.
I did not say that this woman did anything except talk. We ‘did the delivery’ – we listened to the FH and caught the baby. And anyway, even if the woman had caught the baby herself, how is that different to supervising a student delivery? I appreciate there is a legal difference but there is no actual practical or moral difference, surely?
What makes you assume this woman was not British? I have no intention of saying anything specific about her, but if you think she was an elderly African woman just because I used the expression TBA, you’re quite wrong.
It wasn’t clear from your post that you ‘did the delivery’ – the impression that I, and others apparently, had was that the woman was actually functioning as a midwife: you said, “myself and the other midwife just sat and listened to her gently coaxing the labouring woman to push her baby out”. What you seem to be saying now is that this woman was a supremely good labour partner – and I certainly would support that – but it does make the discussion up to now rather academic.
There are fairly hefty legal regulations governing the establishment of maternity homes, about who can practise there, and what facilities are required, which are also to do with protecting the public from fly-by-night opportunism.
I do see a difference between this woman and a student midwife catching the baby and it comes back to my point about accountability, which I perceive as a moral distinction, as well as a legal one. It’s also true to say that if I have a student practising on my licence, I’d rather she had some sense of full commitment to the women in her care, as well as to her chosen profession. It’s not just about the birth.
Finally I made no assumptions on the labouring woman’s culture or nationality. In fact only when I was considering my post did I think to include some thoughts on women who, for reasons of nationality, culture or religion, find themselves outside the dominant culture. The question of race is not of prime importance here, only the issue that women should be able to give birth where they feel safest and where their attendants are morally and legally responsible for the care they give.
Just to open up the debate a bit more. I believe all birthing women should have a right to an accountable, skilled, sensitive attendant and it is very desirable. On the other hand I can understand women who do not choose this option, having been personally attended by supposed accountable skilled attendants who appeared to have very little skill or accountability. This politicised me somewhat. Sadly, in some instances, midwifery education, a piece of registration paper, nor the UK Supervision system guarantees a skilled midwife at a birth.
Perhaps one of the reasons for the rising c/section here is what appears to be the relentless and almost overwhelming medicalisation of midwives through ctg monitoring, active management and augmentation practices and unfounded, knee jerk, risk management/ litigation avoidance policies. Perhaps you can include poor supervision and lack of traditional midwifery skills being shared. Throw in media scare-mongering- Alas what does the future hold?
Back to midwifery accountability and supervision-, I have never had a Supervisor of Midwives attend a home or hospital birth with me- She has read my notes but that’s it- does this really present the whole picture? Ultimately, though I believe I am accountable to the women I provide care for. I don’t think a Supervisor has ever asked for feedback from these women, yet I would welcome this. Also, women are not told very often about the UKKC and how to make a complaint. In contrast, there is a lot of word of mouth in midwifery supervision and that can be problematic for many midwives. ARM has often had reports of bullying because of unfounded gossip up the heirarchy. Often that gossip seems to be when very skilled midwives support and attend women in sensitive, non-interventionist ways with good outcomes.
Yes there is a sanctioning system here in the UK and every so often it works to stop bad practice but often it stops short of promoting best practice or being able to guarantee resources to promote best practice. Of course, I suspect we are not even at all sure what best practice is yet….still looking for the “evidence”.
About the legality of birthing homes- I don’t know anything. However, I thought it was lovely to hear about the traditional Japanese model of care in the midwife’s home (very good statistics there with the traditional midwives I understand!) at a Midwifery Today conference and I’ve wondered if the women of the UK would be open to it?
This has got me thinking hard. My first reaction was ‘good on the women for choosing the type of maternity care they wan’, but then that there’s going to be a terrible witch hunt until this ‘illegal’ activity is stopped then there will be a whole lot of women left without the sort of care they want and need.
I wonder how illegal it is, for example, if the TBA (Traditional Birth Attendant) always calls in a registered midwife then perhaps no law is being broken. Does she get paid? If not then is she really ‘practising midwifery’ at all? Do women have the right to choose where to give birth, i.e. does is need to be their own home (one of the women in my study chose to have her baby at her mother’s house which was nearer to the hospital if she needed to transfer)?
Another thought, this is partly how I interpret ARM’s The Vision – a safe house in one’s own neighbourhood to go to birth one’s baby. OK so this one isn’t being run by a registered midwife (we need to think about the reasons why the TBA doesn’t feel able to train, it’s not necessarily an over developed ego, is she from an ethnic minority without GCSEs or A levels, does our present culture of midwifery education exclude her in some way, is she afraid she would not last the course and end up worse off than before?…..) I think it might be more politic to regard her as a ‘doula’.
Although I appreciate that the advice to let the supervisor know of the possible existence of an unofficial birth centre is right, part of me is groaning deeply that the likely result will be that it will be closed down and the TBA/doula prosecuted. I think that a visionary Head of Midwifery/Trust would acknowledge its existence and regularise it by giving it some registered midwives and allow it continue in a modified way.
This is an example of women voting with their feet and the NHS should take note. If it doesn’t deliver the type of maternity services that women want some of them will seek other care that may be unsafe. The NCT has issued a press release saying that 50% of GPs still refuse to ‘allow’ home births and that some strike women off their lists. And this 6 years after ‘Changing Childbirth’. There are some very brave women out there, fighting in their own way to enable women to birth how they want to. I think we should all get ready to support these women and their TBA/doula and use the furore which will probably come to fight for all women to have true choice in childbearing.
This is fascinating because this goes on the US all the time.
It took this to get me in off of the side lines. I have been enjoying the discussions and information of this community for a long, silent while, but now I want in! Please realize that this is a RANT. For a better researched(and spell checked)version, please wait for my final synthesis paper, due in three years! Please note, too, that I do not know the legal implications of calling yourself a midwife and catching babies without a licence in the UK, but I am trusting that it can’t be any more regulated than in my area where it is illegal, similar to practicing medicine without a licence.
I am a midwifery student in Canada, as well as an administrator for a midwifery practice group here. A couple of loosely connected ideas begin to mull as I think on this topic, two ‘biggies’ – there are states in the USA where it is a woman’s constitutional right to choose her birth attendant – in Ontario it is illegal to practice midwifery without registration with the College of Midwives.
Is it the role of the state to tell us how to birth? If so we had better make sure we run the state! I would, on a more serious note, say that in fact it is not the role of the state to govern the way we birth and with whom. In Canada we too, have an established public health care system. Is it’s role to prescribe how we care for ourselves or is it too ensure that a minimum of care is available for all. I would argue that it is the latter. As midwives do we believe that women birth best, and safest when they can find a place, and a caregiver who makes them feel safe? Is this or should it be their right?
Maybe relationships, by and large would be physically safer if the involved parties were always chaperoned by a trained psychologist and crisis intervention worker, but that does not mean that all of us would choose that “care”. If an RCT showed this I would still opt for intimate time with my lover to make love and fight as we do; these are essential elements of our relationship.
I am a strong advocate of state provided care, and personally pursuing midwifery in this model of care and I believe to that any body registered or not, misrepresenting the care they provide, what options are available, and what the legislation is surrounding that care ought to be penalized. But what of those who wish to have care outside of community standards with fully informed choice. Without the assistance of such women as you describe, they might be forced into situations which are not safe or comfortable for them, and therefore may compromise the safety, and if I might be so trite, the pleasure of their birth.
My final area of concern on this topic is that our health care system, and I trust yours as well is ideally designed for those who are, with room for little variation, of the dominant culture. For those whose religious, cultural of personal needs bring them to a choice for birth that is outside of these bounds, there can be huge implications. Is birth safest when homogenous? Are all women’s needs the same as they birth? Have we not got an obligation to defend those rights for others?
I marvel at a list whose participants waves flags when home birth is threatened in their communities, but will not defend a woman offering homebirths in her community. If homebirth is eradicated within the public system entirely, where will those of you who birth your babies out of hospitals go?
Why was a midwife called to this house if the woman living there was presenting herself as a midwife? Intriguing question, to my mind.
The situation in Norway is that anyone at all can attend a birth, but only an authorized midwife may call herself that. No one but an authorized midwife can be reimbursed by our national health scheme for attending home births. If a doctor should happen to attend a woman at home, the payment is for a sick call only (we gloat no end over this one).
All women have a legal right to be attended by an authorized midwife and well over 99% claim this right, either by coming to a labour ward or having midwifery care at home. Midwives have no legal right to attend women, we are merely compelled by law to do so if the woman wishes. Unfortunately we sometimes get confused about who has rights and who has obligations in this constellation.
I am with Sue–someone should talk to the woman. If in any doubt as to her honesty to her clients about her qualifications to do what she does, be wary. But be sure our motivation doesn’t stem from being threatened in our own role as midwife. The validity and strength of that role is unrelated to what she is doing.
I would like to point out that whatever the status is of a person who is catching the baby, it does not absolve them of legal and moral responsibility. When I proposed catching my first born I was repeatedly warned by a number of authorities, my wife’s family, and the various prenatal professionals who examined my wife, that if either my wife or newborn died I could be charged with manslaughter. This took place in Hawaii, but when I was in the UK a similar situation prevailed.
My wife’s family also vehemently assured me that they would take civil action if any mishap occurred. An interesting exception to this was my wife’s Grandmother who had given birth by herself while working on a sugar plantation in Hawaii. The grandmother told her granddaughter that the births took minutes and were painless. As compared to her last birth which, because of the introduction of universal health care in Hawaii took place in a hospital. This was extremely painful, labor took hours, and she felt totally degraded by the experience. However her experiences were discounted by the rest of the family.
I can assure you that I was very conscious of the moral issue. However my wife also assured me that the moral aspect was shared. It was her total agreement that we should take that minute risk that matters could go awry. We had a direct entry midwife attending who had no professional qualifications, but much experience of birth and willing to advise if complications ensued that we didn’t know how to deal with. As it turned out my wife had an enjoyable and pain free birth.
I feel that the core of the problem is that many obstetricians are temperamentally unsuited for facilitating healthy birth. Either their upbringing or their lack of training in communication and empathy skills is to blame. This is a tragedy for babies, mothers, midwifes and physicians. Over the years I have met a few very fine, empathetic and loving men who obviously are dedicated to the health and welfare of the women and children in their care. But I must say that the majority have been horrors.
Somehow, and I don’t know if this will ever happen unless we can educate mothers to demand it, the education of physicians needs to include people skills. Entrance exams for medical school should include aptitude and emotional compatibility tests, with special tests for students who wish to enter the field of obstetrics and pediatrics. In my view it is essential for the future of birthing that physicians are given an in depth training by experienced midwifes in the kind of skills that mothers need.
The Nurturing Center
AH updated 21 September 2000