I spent a lively day last Sunday with a new group of parents-to-be, working alongside them as they plan their forth-coming births. This time they were all first-timers, which tends to concentrate the presumptions & preconceptions about birth. The biggest of these - repeated again on Sunday - is that birth is safer in hospital than elsewhere, and by extension, home birth increases the risk to both mother and child.
This weeks tragic news story about the devastating failings of maternity care at Shrewsbury & Telford Hospital Trust (STHT) ratchets up existing anxiety even further. As if women needed a further reminder that NHS maternity services are in crisis, this story has lead to inevitable comparisons with the Morecambe Bay scandal. Several commentators have identified midwifery-led care as the source of failings. Fingers are pointed toward the very notion of physiological birth, suggesting that a notion of unassisted, drug-free, vaginal birth as somehow 'better' has caused women to take unreasonable risks (including choosing midwifery-led care) which have in turn led to deaths.
This is scary for women. Instinctively, many women want as little intervention as possible, which is why midwife-led care has increased in popularity over the past decade - women understand that when they enter the Institution the chances of intervention increase.
This news then, ratchets up the anxiety considerably. Pregnant women vulnerable, they are reliant on medics around them to provide reliable & honest information and to keep us safe. As one client said to me last night, at the moment none of the options look particularly reassuring or palatable.
If you are pregnant now, though, and planning where to have your baby, I would exhort you to look more closely at staying at home for as long as you are comfortable. Women are frequently put off planning a home birth because of the institutionalised 'either/or' approach to birth planning. You are either at home, or you're in hospital. If you end up moving from your planned place of birth to hospital, it's perceived either a failure of you or your labour. Women often feel disappointment or shame that they didn't 'complete' what they'd started, and it's often an opportunity to reiterate that the only 'safe' place to birth is hospital.
However, for most women labouring at home - supported by two dedicated, known midwives, secure in your own nest, undisturbed by travel and invasive observations by myriad unknown health professionals - remains the most comfortable place to be. And not only comfortable. Safe.
Still not convinced? This brief, clear, to-the-point article by Jim Thornton, Professor of Obstetrics at Nottingham University, highlights what most women feel to be true, but are often unable to define; for low-risk women, birthing in hospital introduces different, but not inconsiderable, risks of it's own.
The answer then? Make your decision about place of birth in the round. Consider the general statistics (as Jim says, you'll be well served to review the 2011 Birthplace study). Also consider whether your health & the progress of your pregnancy puts you in a low-risk category. Think about your own personal values and preferences. Where would you feel most comfortable? Safest? Confident? Take a look at the statistics from your local hospital - do they seem to support the sort of care you'd like to receive in your labour? Finally, remember that booking a home birth does not necessarily mean having your baby at home. Re-frame it. Plan to stay at home for as long as you are comfortable and safe. That may well mean having your baby at home, or it may mean chosing to transfer to hospital at some stage. Both these options are reasonable, safe and pragmatic.
Finally. When you're looking at the fall-out from both Morecambe Bay & Shrewsbury and Telford, remember that these are hugely complex situations. It's not simply about which location is 'safer' than another. In large part these issues arise from cultures where women's wishes and experiences going unheard. To many assumptions are made why a woman might choose an elective caesarean birth, or a home birth. Too few answers are sought.
Here's to us all, and to creating a safer environment for all birthing women in all locations.