-Third of women should give birth without seeing a doctor, say medical experts
By Sophie Borland
Women should no longer assume they will give birth in hospital with a doctor on hand.
In a watershed moment, leading medical experts declared that mothers should be given more opportunity to have babies at home because a maternity ward is not necessarily the 'safer option'.
A report by the Royal College of Obstetricians and Gynaecologists suggests that as many as a third of all women should give birth 'without a doctor going anywhere near them'.
House call: Medical experts are urging more women to give birth at home
It calls for a radical shake-up in the NHS which could lead to thousands more women having babies at home, as was the case 50 years ago.
In 1959, more than a third of women gave birth at home but by 1988 this had fallen to a low of 0.9 per cent. By last year this had risen only slightly to 2.4 per cent, figures from the Office for National Statistics show.
The report states that only women most at risk of suffering complications – such as those expecting twins or triplets, the obese, diabetics or those in their 40s – should have to give birth in hospital.
In addition it calls for dozens of maternity wards in smaller hospitals to be closed or merged into 'super units' to ensure those most likely to suffer complications receive the best care.
It warns that currently there are too many maternity units but not enough top-level consultants able to intervene should there be problems during the birth.
Often they are looked after by junior doctors with limited experience, particularly at nights and weekends when there are fewer staff on duty.
There are also concerns that maternity wards are becoming increasingly less safe because a shortage of midwives has left them at breaking point.
The report says that expectant mothers who are unlikely to need an emergency caesarean or suffer life-threatening complications such as pre-eclampsia should be offered the chance to have their babies in local birthing units or in their own homes.
At present, just three per cent of women give birth at home.
A further seven per cent use midwife-led units – which are small centres designed to provide a more homely environment than hospitals.
Senior health experts warn that the present system is 'not acceptable, nor sustainable'. The number of women going into labour every year is a fifth higher compared with a decade ago.
And higher proportions are suffering complicated labours due to rising levels of obesity and women delaying motherhood until their late 30s and 40s.
Anthony Falconer, president of the RCOG, said: 'Too many babies are born in the traditional "hospital" setting'.
He added: 'There is a perception among patients that they still see the hospital birth as the safer option. The use of some of these midwife-led units is not as great as it should be. These places are very safe and appropriate to have babies.'
Dr Falconer said: 'Roughly a third of women need a doctor, roughly a third need midwives and roughly a third might need both.'
David Richmond, vice president of the RCOG who wrote the report, said that most women could have their babies in a local birthing centre 'without a doctor going anywhere near them'.
'Do they need to be in an institution that can do MRI scans and renal transplants and brain surgery? Probably not. So we need to have this network of care where the woman is guided to the right part of the network to receive her care.'
Low tech: Most women giving birth do not need the hi-tech facilities offered by hospitals. (Posed by models)
Earlier this year the Royal College of Midwives warned that maternity units were 'at breaking point' due to a shortage of around 3,500 midwives.
Cathy Warwick, general secretary of the RCM warned that unless staffing levels were drastically increased women and their newborns would be put at risk.
In response to the report she said: 'It clearly supports local care for women who do not need specialist support and supports midwife-led maternity units, informed choice for women about options for childbirth, and women-centred care models. The RCM thoroughly supports and endorses all these aspects of the report.'
But campaigners warned that putting pressure on women to have their babies in local birth centres could also put them in danger. They also pointed out that as these centres don't administer epidurals – strong pain-relieving injections – women would be forced to suffer unnecessarily.
Maureen Treadwell of the Birth Trauma Association said: 'The problem with maternity care at the moment is that women can appear low risk at the start and develop horrendous problems during the birth.'
She also warned home births could become an expensive business for the Health Service.
She said: 'If a woman wants a home birth, she will need two midwives and an ambulance – and there simply won't be enough resources for this to happen on a large scale.
Last November a damning report by senior midwives said mothers and newborn babies were being put at risk by cuts to maternity services. It found that at least one in three labour wards were being forced to axe staff as part of belt-tightening.
Home or hospital? The great childbirth debate
The declaration that women should no longer think of hospital as the main option for giving birth has prompted fierce debate. Here, experts and mothers give their views
Lawrence Mascarenhas, consultant obstetrician and gynaecologist, The Birth Clinic
A lot of obstetricians are afraid of speaking out against home births as they don't want to appear non-politically correct towards midwives. But others of us – certainly me included – have our reservations.
If everything runs smoothly during a home birth, it's absolutely fantastic. But problems arise when it doesn't.
When you look at the evidence of infant mortality at birth, the statistics are more than a little concerning.
Emergency: According to a British study, 14 per cent of women who had home births ended up being rushed to hospital
In 2003, a British study of 3million births showed that 14 per cent of women having home births ended up being transferred during labour – and of these, the risk of their baby dying increased twelvefold compared to hospital birth. That's already quite frightening.
More recently, a U.S. study of 500,000 home births reported the risk of infant death being three times more likely than hospital birth. Whichever you believe, there would undoubtedly be an increase in the number of babies that died during labour if the uptake of home birth increased.
The problem is, you cannot predict who will need intervention – and when they do, the transfer time to hospital is critical. In Holland, they have a maximum transfer time of ten minutes. In this country, can you imagine how long it could take, say, to get to a central London hospital during rush hour?
It is dishonest to downplay the risks of home birth, but it's happening because of economic factors. Our hospitals are already full to the brim. But even if home births increased, staffing is an enormous issue. We would need thousands more midwives – you need two for a home birth. There's a reason that more babies than ever survive, and that's due to medical advances, so why go back to Victorian times?
Eleanor May-Johnson, 40, is an independent midwife based in Hampshire
As a midwife, I have probably attended about 100 home births and I firmly believe that it is the best, most natural experience. This is based not just on my experience as an independent midwife, but also as a mother.
When I had my first daughter, I couldn't have her at home because we had moved house only three days earlier and all our belongings were in boxes. But my next two daughters were both home births, in water, and it was a wonderful experience.
Most women can give birth to their babies with minimum intervention, provided they feel safe, secure and well supported. The resulting experience is better not just for the mother, but for her partner and everyone involved.
When women are in labour they produce a hormone called oxytocin, it's the same hormone produced when you are intimate with your partner, and it helps produce good contractions. But oxytocin is what you might call a shy hormone, the bright lights and noise of a busy hospital are just not conducive to it working properly.
Having a baby is a physiological experience, not a medical emergency. Being able to give birth at home, with your own kitchen, bathroom and things around you, is so much better than hospital. You feel much more in control.
HOME BIRTH THAT ENDED UP IN HOSPITAL
Charlotte Kemp has three daughters Amelia, eight, Beatrix, six and Martha, 18 months
A course of National Childbirth Trust classes was all it took to convince me I wanted a home birth. The woman running them was a bona fide hippy who said it would lessen the chance of medical intervention.
As I've never liked hospitals, I was easily persuaded. My husband, however, wasn't so keen.
As it turned out, though, my first experience of home birth wasn't exactly positive. After spending ten hours pacing the floor of my living room having contractions, I had to be rushed to hospital, sirens wailing, when my daughter got stuck in the birth canal.
It was high summer so the maternity unit at my local hospital, King's in London, was short staffed.
As my GP surgery didn't have a community midwife team (some do, some don't), two hospital midwives had to be sent out for a home birth. They were so busy they left it to the very last minute before they arrived.
By that point, I was already fully dilated (although I was too inexperienced to know it) and they'd been in such a rush, they'd forgotten the gas and air.
Two hours later, I was told my time was up and was rushed, in the most undignified state imaginable, to hospital with my mother and my green-looking husband.
Thankfully, my daughter Amelia was finally born, James Herriot style, by suction pump-aided delivery so all ended well (ish).
You might be surprised to hear it didn't put me off having my two other daughters, Beatrix and Martha, at home – but I made sure I found community midwives whom I got to know before the birth.
I certainly wouldn't advise first-time mothers to go down the home birth route but my other two labours went without a hitch.
HOSPITAL BIRTH THAT ENDED UP AT HOME
Claire Poole, 37, is a full-time mother to sons Rufus, three, and Rafe, 19 months, and lives with her husband Keith in South-West London
I was born at home and my mum always told me it was a positive experience, so it was something that I was aware of when I was pregnant the first time. But it was my first baby and I think I was a bit scared of the unknown. Nobody really suggested home birth as an option.
My experience of a hospital birth was mixed; the actual birth was good and I was well supported, but it was late at night and after Rufus arrived my husband was asked to leave. I was left feeling alone, in a hospital ward with no support at all.
Despite that, I still chose hospital the second time, I think mostly because I still had some residual fears.
My second baby, however, had other ideas. We were just getting into the car and about to head to hospital when my waters broke and ten minutes later Rafe had arrived.
In the end I gave birth in the living room with my mum and husband. The ambulance arrived moments later and because of a shortage of midwives – which meant one couldn't be sent out to the house – they ended up taking me to hospital to be checked over. But within three hours, I was home.
Having experienced a hospital birth, and then a home birth, albeit an unplanned one, I know that I would definitely choose to give birth at home if I got pregnant again.
It was so reassuring to have all my own things around me – no hospital ward, no noise, no pressure to make conversation with strangers – that I would definitely choose that route.
In fact, my midwife suggested that if we have another child, I might be best to have a home birth because the baby could put in another quick appearance.