March 26, 2003

The British version of a Birth Centre

One of the issues that came up in the London Active Birth workshop that I have just concluded was the concept of a “Birth Centre” as interpreted by the British. In the rest of the world, a birth centre is an autonomous midwifery unit that offers normal, natural birth with a small team of designated midwives. These centres are usually located within a hospital precinct, although many of the American centres are completely freestanding (I have visited US birth centres in office blocks) and in New Zealand, many midwives have clubbed together to convert residential houses into a birth centres.

Wherever they are physically situated, the basic principle is that women who choose that care are aiming for a completely natural birth, with no electronic monitoring (CTGs), drugs for pain, epidurals, inductions, ARMs, episiotomies etc and optional oxytocics for 3rd stage. Women will be offered baths and showers for easing pain, complete freedom of movement, open access for families and friends as birth companions and no limitations of food and drink in labour. Both the women using the unit an the midwives staffing it have a deep belief in the positive nature of birth and women’s capacity to handle it well without interventions of any kind.

In Britain there is a new movement gathering strength to establish birth centres across the country. It seems to be a re-badging of the “midwifery led units” that were a central plank of the Cumberledge Report that initially gave midwifery such a boost 10 years ago, but which has faltered since. These “birth centres” are springing up in many hospitals, but the way they are operating and the basic principles underlying their operation appears to be quite different from the kind of service defined by this term elsewhere in the world.

Firstly, there appears to be no commitment to drug free, natural births. Women can have pethidine and nitrous oxide (Entonox) on request and the majority use these medications freely. TENS machine are also encouraged. Whilst baths and showers are on hand, and water births are an option, these are sometimes being used togther with medications, a dangerous practice and poor midwifery as well.

The London workshop venue was in Guy’s and St Thomas’ Hospital, where they actually call their regular labour ward the “Birth Centre” and their “low risk unit” the “Home from Home Unit”. This is appalling and is a deliberate attempt to con women into thinking that they will be getting midwifery care when they will be subjected to regular obstetric management. I understand that the same tactic has been used at Kings Hospital as well, and this shameful situation needs to be exposed so that women are not being duped into accepting medicalised birth when they are expecting a birth centre approach. This duplicity will become more obvious as there is more publicity about birth centres and women begin to specifically seek out this alternative.

Other workshop participants told us about their attempts to get a “birth centre” established at Southend Hospital. After many years of struggle, they have been able to obtain 4 rooms within the labour ward area that will be designated as a birth centre. It will attempt to provide midwifery care, but they face considerable opposition to the midwifery guidelines they want to introduce, and a lot of retraining of the midwives who are not used to working without CTGs, for example. I have no doubt that these midwives have the women and their own profession at heart and will do their best in obviously difficult circumstances, but to call this service a “birth centre” is, I believe, a travesty of the concept that will undermine its effectiveness and debase the nature of this type of service.

There is to be a conference on Birth Centres presented by MIDIRS in April. I hope that this can at least establish some basic definitions of this type of care so that the British efforts can be brought into line with the approaches that have been used overseas for over 20 years. Consistency of purpose and the adoption of accepted definitions will strengthen their cause and provide a real alternative in hospital based birth, particularly when using the evidence from the many research studies undertaken in overseas birth centres to underpin their push for these centres.

If maternity services choose to accept the current watered down version of the birth centre that is being developed in Britain then there is a risk that these services will be no more effective than the midwifery led units they seem to be replacing, where women continue to use drugs, breastfeeding rates are still very low and a lack of continuity of both care and caregiver are often the norm.

Posted by andrea at March 26, 2003 05:12 PM

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it is my understanding that women can receive both pethidine and nitrous at birth centres in Australia. Please correct me if I am wrong. Having birthed in an Alternative Birthing center in the USA and worked in Free standing birth centers there too, I was appalled that women could receive these medications in a birth centre here and remain in the birth centre for the birth. I know this definetly happened in a Sydney hospital birth centre and since I have asked this question on the ozmid list and mw's agreed it was so I am assuming it is correct.

I agree with you Andrea, it medicalises birth and is dangerous practice, but it happens here too. Could it be because of the preponderance of British midwives in the system who are used to this practice and see no harm in it??

marilyn

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