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Home birth rates in the UK

The statistics for home births in Britain for 2003 have been released. Britain is famous for its “post code lottery” when it comes to health care - the way health care is administered (by small local Trusts ) means that the services you are entitled to depend on where you live and what your local Trust is prepared to offer. This becomes apparent when looking at the rates for home birth across the country.

It is often thought that Britain has a high rate of home birth as it is Government policy to provide this service for women. However, in practice, many Trusts don’t encourage home births and some refuse to make it available at all. Overall, despite Government recommendations, the Winterton and Cumberlidge Reports (“Changing Childbirth”) and numerous initiatives to encourage women to consider a home birth, the overall rate has risen to just 2.18% in 2003.

In the south, there is a much better chance of giving birth at home - Devon has a rate of 5.8% (with some local Trusts with this country having rates of almost 20%) . In the north, women have far less choice: Northumberland, near the Scottish border, has a rate of 0.2%and in Merseyside (Liverpool area) the rate is 0.7%. Wales has a policy of promoting home birth very positively, and they are aiming for a 10% home birth rate - so far it is 2.7%, with Carmarthenshire topping the list at 7%. In Scotland, they have a rate of just 1.03%.

Why are these rates so low, especially when there is so much support at Governmenl levels for home birth? Some trusts claim they don’t have enough midwives to offer this service. One midwife was sacked last year for attending a home birth when his Trust had a stated policy of only providing hospital care. In his case the woman insisted and knowing that the law in Britain says a midwife must not leave a woman in labour, even if advisable, this midwife helped her birth at home, as this was her wish. The result was the midwife was sacked, despite there being no problems and he was fulfilling his legal obligations.

One reason for the shortage of midwives is the insistence that there be two midwives at every home birth - one for the mother and the other “to take the baby” (using the quaint vernacular quoted to me by midwives). This is completely unnecessary and is a waste of scarce midwifery resources. Only one midwife is needed and if there is a problem (very unlikely) there will be other responsible adults who can assist in an emergency. This is how it works in most other places in the world where homebirths are available.

Fear is another major factor. The advent of constant “risk assessment”, the overplayed threat of litigation and the general fear of pain, women’s bodies, midwifery skills and Mother Nature has compounded to a point where having a baby at all, let alone in a home setting, is seen as a risky and complicated procedure. The culture around birth in Britain is not helping and changing this around, I believe, is now almost impossible.

I remember 30 years ago when rooming in with a newborn during the postnatal stay in hospital was considered dangerous. An outbreak of Staph infection in one of our biggest teaching hospitals necessitated all babies staying with their mothers because the nursery was infected. Surprisingly, the sky did not fall when babies roomed in, and in fact, breastfeeding was easier and mothers and babies were happier. Some important lessons were learned in a hurry and centralised nurseries disappeared very quickly. Perhaps we need drastic measures of a similar kind to prove that home is a good place to give birth - perhaps some hospitals having to shut down instantly due to infection, or damage by a force of nature (wouldn’t that be a nice ironic touch?), so that midwives had to work in the community for a while. Of course, such models already exist, in New Zealand, The Netherlands and many developing countries. Perhaps we don’t have to wait for nature to step in, but just let the scales fall from our eyes and take a few bold steps. Somehow, I can’t see that happening, which is such a shame......

Posted by andrea at February 04, 2005 07:12 AM