London - I was a “fit and healthy” woman who had a “low-risk” first pregnancy; I even went into labour on my due date.
There were absolutely no prior indications that I would end up needing an emergency Caesarean section.
And yet, if NICE’s latest guidelines (see below) had been in place 11 years ago, I might have had my first child at home or in a midwife-only centre. And that could have had disastrous implications.
For reasons best known to madam herself, she decided to make her grand entrance into this world back to front. She was the right way up (ie head down), but facing the wrong way. When the child is in this position, it can dramatically slow down the dilation of the cervix, prolong labour and put extra pressure on the spine, making pain relief almost impossible.
Often babies turn during labour, but in an early indication of her personality, my daughter was not budging. I was given oxytocin to speed up my contractions and ‘get things moving’, but all that did was increase my discomfort. What made it worse was the fact that the midwives really didn’t seem that interested. I think they thought I was just making a fuss. This went on for very many hours until a shift change, at which point an obstetrician took one look at me and the nipper and sent us straight to theatre.
I am just grateful I was in hospital. Had I been giving birth at home or in a midwife-only unit, my daughter and I might not have been so lucky.
The medicalisation of childbirth is not an affront to Mother Nature. It’s a sensible response to a biological process that has an unusually high rate of catastrophic failure.
Death in labour used to be an occupational hazard for women. Now, thanks to the miracle of modern medicine, it is rare. Let’s try to keep it that way.
WHAT THE GUIDELINES SAY
By Sophie Borland
A radical shift in National Health Service policy will see hundreds of thousands more women encouraged to give birth at home.
Mothers-to-be will be told that unless there is a high risk of complications they do not need a hospital delivery.
First-time mothers are to be advised they are just as safe having their baby in a small midwife-led unit as on the labour ward.
For most of those having their second child, giving birth at home is as safe as hospital – and far more pleasant – say new draft NHS guidelines.
The encouragement for home births marks a major change in NHS guidance, which previously advised mothers to be ‘cautious’ about having their baby at home.
NICE, the NHS watchdog, says its proposals reflect recent evidence.
But the change of policy at a time when many hospital labour wards are struggling to cope with the highest birth rate in 40 years, will lead to concerns the NHS is simply trying to save money.
Only last month, new president of the Royal College of Obstetricians and Gynaecologists Dr David Richmond warned that up to 300 babies a year are dying needlessly due to NHS staff shortages.
Union leaders have repeatedly told ministers that the health service needs an extra 5 000 midwives to ensure proper standards of care.
Currently, 94 percent of the 730 000 women who go into labour in England and Wales each year give birth in hospital. Only 2.5 percent give birth at home with the remainder going to midwife-run centres.
In the early 1900s nearly all women had babies at home but this fell rapidly after the creation of the NHS in 1948.
Most women say they prefer to be in hospital to give birth in case anything goes wrong.
But having a baby at home or in a midwife-led centre is far cheaper than having a hospital birth as women do not need a hospital bed. Staffing costs in midwifery units are also lower and they tend to rely less on pain relief or other interventions.
Studies have shown a birth at home costs the NHS an average of £1 066, compared with £1 450 at midwife-led centres and £1 631 in hospital.
Previously, NHS guidelines said mothers should be free to choose where they gave birth but urged caution over home births for women having their first child.
Women will now be advised to give birth outside hospital as long as their pregnancy is considered low risk and they do not suffer from asthma, diabetes, epilepsy or other chronic health conditions.
The draft guidelines say: “Midwives should explain to the mother-to-be that she may choose any birth setting... and support her in her choice.
“Midwives should advise low-risk women who have already had at least one child to plan to give birth either at home or in a midwife-led unit.
“Midwives should advise low risk women who are expecting their first baby to plan to give birth in a midwife-led unit. This is because women tend to have a better experience in this setting than a traditional labour ward.”
Midwife-led units aim to create a more homely environment and there are typically between four and ten beds and water-birth facilities. They are either stand-alone centres in the community or attached to hospitals. Doctors are summoned only in an emergency.
Cathy Warwick, chief executive of the Royal College of Midwives, said women had too often been denied a choice of where to give birth.
This should be at the heart of maternity strategy, she said.
A spokesman from the Royal College of Obstetricians and Gynaecologists said: “We support choice for low-risk women who have had successful previous births to give birth at home provided transport arrangements are in place for hospital transfer in the event of an emergency or should there be a request for pain relief.” - Daily Mail