Pregnant women are inundated with advice – from whether or not to drink alcohol, to how long to take off work after the baby is born. Anyone who has been or is expecting will be familiar with this dizzying barrage of often conflicting beliefs, and they make you question your own maternal instincts. And there was new advice yesterday on possibly the biggest decision of all: where to give birth.
The National Institute of Clinical Excellence, after examining the evidence, has ruled that it is safer for expectant mothers to give birth at home, or at a midwife-led unit nearby, than at hospital. The health watchdog says giving birth in hospital can often lead to risky surgical interventions and that, as long as the pregnancy has been uncomplicated and the mother is deemed to be low-risk, home is the better place to be.
This is merely the “advice”, Nice insists. Of course, they say, the final decision is up to individual mothers. But in my own experience, “advice” on where to give birth is much more than that.
When I was pregnant five years ago, I was assigned to a midwife group linked to my local GP surgery. From my first visit to their office when I was 16 weeks pregnant, I could see their overwhelming enthusiasm for home birth: photographs of happy women who had just gone through labour on their own sofa covered the walls.
I was asked to consider a home birth, and told how wonderful it would be – even though this was my first child and I was clearly nervous. With each home visit I became a little more confident in saying, actually, I’d quite like to have the baby in hospital. Of course, that’s your choice, they said, although “you do risk getting doctors involved”.
“Risk”, relating to doctors? This seemed a strange word to use. My local hospital, King’s College Hospital in south London, was supposedly the best for obstetrics in Europe – why would this be a risk? Yet this was the narrative that continued all the way until nine months.
My pregnancy was entirely normal – supposedly “perfect” for a home birth. I was only a week overdue when my contractions first started, on the Thursday evening. After 24 hours of just about bearable pain, late on the Friday evening the contractions were every three minutes or so – a good indicator that we should call the midwife and get to hospital. Our local midwife came out and, after an examination, said I wasn’t progressing enough to deem it necessary to get to hospital. At 4am, when the pain was unbearable, we called her again and she finally agreed that we should go in – but still seemed grudging.
On the labour ward with my local midwife I had gas and air. But by 8am, because I still hadn’t progressed far enough, I was moved into an ante-natal ward. My midwife’s shift had ended, and she said that another midwife from my local practice would be in to take over. But within an hour I was told that the new midwife was off sick, so I would be left with the hospital midwives. Great, I thought, I can ask for an epidural because the gas and air was making no difference. That was at 10am.
Maybe because it was because it was a Saturday, but I wasn’t examined for nearly eight hours, despite the desperate screams from me and the pleas from my partner. Only at 6pm was I checked and that they agreed to an epidural. Hardly a rushed intervention.
Yet by 4am on Sunday I still hadn’t given birth. The hospital midwife who was with us throughout the night was lovely and kind but still she warned against “those doctors” who might have to come and help. Yes, please, send them in, I begged her. It was quite clear, after nearly 60 hours of being in labour, that my baby was not coming out easily. At 5am, at last, the doctors intervened. I was prepped for a Caesarean but, by then, my baby was stuck halfway – an incredibly dangerous position to be in. In the end, “those doctors” used forceps and my daughter was born, healthy. She had been delivered by doctors in a clean and safe hospital.
I cannot imagine what would have happened if I had stayed at home. Yes, I would not have been left unexamined for eight hours, but I could not have lasted on gas and air all the way through. More important, my daughter would not have been delivered without intervention. I am convinced that that intervention saved both our lives.
Nice and home birth enthusiasts talk of “doctors” and “interventions” like epidurals, forceps and Caesareans – as if they are dangerous things, not often essential procedures. Nice deny that this is about cost, but of course it is: hospital births are £600 more expensive than home births. When Nice recommend midwife-led units, they fail to mention that there are fewer than 140 of these across England.
We don’t allow patients to have operations without some form of anaesthetic, so it is medieval to think women can go through hours and hours of unbearable pain without it. Medical advances like epidurals are there for a reason. Childbirth in the 21st century shouldn’t be left to some Call The Midwife homespun romanticism. Expectant mothers should ignore the “advice” and demand the best care.Reuse content