Health: I had my baby, but I lost my GP: More women are choosing to give birth at home, but they risk being struck off by their doctors, writes Tessa Thomas

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Indy Lifestyle Online
A week after giving birth to her second child, Michaela Davey received a letter from her GP. She, her husband, their daughter and newborn son had been struck off the practice list. The crime? To have had a baby at home.

'I was devastated. I had a baby less than two weeks old and a two- year-old daughter and no GP. I was left with no post-natal care,' she said.

Mrs Davey's desire to give birth to her second child at home followed a complicated hospital birth first time around and corrective surgery.

Initially, her GP agreed to a home birth, but the midwife was never happy with this decision. In the end, a low-tech birth in a GP unit was offered and Mrs Davey reluctantly agreed.

However, she was still keen to have a home delivery. Finally, nine days before her due date, 'my GP informed me that I had every right to go elsewhere to have my baby'. She made hasty new arrangements. Mrs Davey contacted Dr Michel Odent, the natural- birth guru, and arranged to travel from her home in West Kirby, Merseyside, to a friend's flat in St Albans, Hertfordshire, so that he could attend the delivery.

Mrs Davey's GP said she was unable to comment on this case but that her practice 'did not encourage home births'.

Michaela Davey's story is not unique, according to Beverly Beech of the Association for Improvements in the Maternity Services (Aims). 'We've dealt with many such cases over the years, but they do seem to becoming more common. In one case it was not just the immediate family but the grandparents as well who got struck off,' she said.

Antonia, 38, became pregnant soon after she met her partner, Alastair, and they decided on a home birth. 'We didn't enter into it lightly. We went through everything with a fine-tooth comb and knew exactly what to do at every stage, depending on what course my labour took,' said Antonia. 'If there was any danger, we were ready to go straight to hospital.'

There was not and they did not. Antonia gave birth safely at home - but was struck off her GP's list six weeks later. Her doctor has since retired, but Dr Ahmed Moneeb, a former colleague who now runs a neighbouring practice, said it was standard procedure to advise against a home birth for women such as Antonia.

'It is not usual to take a woman off the list. I generally advise against a home birth, especially if the woman is over 35 or it is her first baby,' he said.

'There's a lot of talk about women's choice, but you have to recall that when home births were common mortality was high. And when a woman has waited so long, that baby is especially precious. Freedom of choice is fine, but the case shouldn't be argued on emotional grounds. Safety is still an issue.'

The Royal College of Obstetricians and Gynaecologists last week published a book calling for greater freedom of choice for pregnant women. The Future of the Maternity Services is its official response to recent reports demanding more 'woman-centred' services, and support for home births.

In March 1992, the influential Commons Select Committee on Health called for women-centred care and positively encouraged home births. Last year, the Government responded and the Cumberlege report, Changing Childbirth, endorsed many of the select committee's conclusions.

So if the tide is turning in favour of home births, why are women and their families being penalised? The legal history surrounding home births is long and complex. Regulations covering home confinement date back to the 19th century and are still enshrined in the GPs' contract. Under the Midwives Act 1902, GPs are obliged to attend a mother at home in an obstetric emergency.

The regulation overrides new contractual regulations set down in April 1992 that enable GPs to choose how much of a woman's ante-, intra- or postnatal care they wish to be involved in. While GPs are usually happy to be involved with ante- and postnatal care, they are less than enthusiastic about the birth itself.

So because GPs are only likely to be called out by the midwife when things are going wrong, most try to avoid the situation by persuading their patients to have hospital deliveries. If they fail to do this, removing the patient from their practice list - which they have every right to do - is an option.

The experience of community midwives bears this out. Catherine Nightingale, director of maternity services in Hillingdon, Middlesex, says that all women are given the choice of a home birth as long as there are no complicating factors. As a consequence, the number of home deliveries has multiplied tenfold in the past six years. On only two occasions have mothers had to be transferred to hospital because of lack of progress in labour.

Despite this precedent, two of Ms Nightingale's mothers were struck off their GP's list last year after giving birth at home against the doctor's advice. She has never been able to find out the reasons why and the cases were passed on to the local Family Health Services Authority. The patients were reinstated after 'misunderstandings' were cleared up.

From a doctor's point of view, striking a patient off the list may be the only ethical option, says Dr Brian Goss, a member of the British Medical Association's General Medical Services Committee, a practising GP and a former obstetric anaesthetist. 'Most GPs now feel unprepared and ill-equipped to manage home births. With the decline in home births since the Sixties, their skills have atrophied.'

First-time mothers are getting older. They also tend to be well informed about home births and vociferous in their demands about obtaining one. In removing women from their lists, doctors may also be expressing their concern over the feasibility of home births for the over-35s.

Both sides would agree that safety is the bottom line. But what are the facts? Following the Peel report, a government-commissioned study published in 1970 that advocated hospital deliveries, a generation was reared on the conviction that hospital births were the safest. Published figures suggest otherwise.

Marjorie Tew, retired medical statistician at the University of Nottingham, conducted research into the safety factors. She could find no published evidence to support the idea that hospital was safer. On the contrary, the evidence pointed to the fact that home births were safer.

She published Safer Childbirth? based on her findings. A new edition will be published next month by Chapman and Hall.

GPs are aware of their deficiencies. In a survey of doctors' attitudes to home birth published in the British Medical Journal last month, almost half of those questioned said they did not feel confident about handling such births. At the root of this lies an anxiety about being sued for negligence should things go wrong.

Mrs Davey says the only thing circled on her medical records was her husband's profession: 'barrister'; 69 per cent of the GPs questioned in the BMJ stated 'fear of litigation' as the main reason for not wanting to attend home deliveries. Yet this fear is quite unrealistic, says Dr Catherine Jones of the Medical Defence Union. 'You can count on one hand the cases of litigation over home births. Yet of all the issues that arise with pregnant women, home delivery is the one that concerns GPs most. We've had a four-fold increase in inquiries about it since 1990.'

Sceptics suggest this is not the only reason for their reluctance. GPs are paid only a small sum, pounds 38.50, for attending a home birth; many feel it is not worth the hassle. One GP said that a plumber gets twice as much for a late-night emergency house call.

This muddle of misunderstanding and vested interests comes against a background of increasing demand for home births. According to the Office of Population, Censuses and Surveys, the number of home births rose by 50 per cent between 1985 and 1992.

One solution would be to improve obstetric education for GPs, who do only six months' training in obstetrics and gynaecology, and some may not even see a normal delivery in that time.

Integrating the services of the hospital and community practices would help solve the problem, says Dr David McKinlay of the Royal College. . He has spent the past three years studying the question of GPs' training standards.

It is estimated that while 2 per cent of women give birth at home, some 8 per cent wish to do so. Until attitudes change, many women will continue to be denied that possibility - and face losing their doctor.

(Photograph omitted)

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