Joanna Moorhead: A bad birth experience can last a lifetime

Despite owing my existence, and my daughter's, to emergency intervention, I welcome the call to put the midwife back in charge
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The Independent Online

Nineteen years ago I – and my baby – almost died. I was 29 weeks pregnant at the time. The baby was my first, and all seemed well. Then a visit to an antenatal clinic changed everything. My blood pressure was high; there was protein in my urine. I was sent to hospital; admitted immediately; and by dawn the next morning, I'd had a Caesarean section and had a tiny (2lbs 13oz) daughter, who was fighting for her life in special care.

I'd been suffering, unbeknown to me, from severe pre-eclampsia; without emergency surgery to remove the baby from my womb, we would both have died. To this day, I owe everything I have – my life, my now 19-year-old daughter, and the three sisters who followed her – to the vigilance, and quick action, of the maternity services. Without those, Rosie and I would have been history – and Elinor, Miranda and Catriona would never have existed.

So you might say that I am the last person who should be knocking the UK's maternity care. Because at the most critical time in my life, when it really counted, it was there for me.

But – and here's the point – the fact is that most mothers-to-be are not at death's door, and do not suddenly find themselves in need of life-saving surgery. Pre-eclampsia, certainly in the extreme form in which I experienced it, is rare, and so are other life-threatening conditions of pregnancy. Pregnancy, nine times out of ten, isn't an illness, and most women don't need the hi-tech, full-on, Casualty-style care that saved my life and gave Rosie hers.

But the NHS – perhaps side-tracked by the fact that where medical emergencies do arise during pregnancy, the stakes are very high – has for many years (the past fifty, at least) failed to reflect this reality in the care it provides.

So, instead of treating all mothers-to-be as healthy and being vigilant for the unhealthy minority, the NHS has taken the opposite approach, treating all pregnant women as though they were likely to need high-grade obstetric care at any moment. The result is that the majority of women deliver their babies in acute-care hospital units. A particular downside of this is that, because these units are primed to intervene in childbirth, epidurals, assisted deliveries and even Caesareans are happening that simply would not be needed if the women concerned were giving birth in low-tech, midwife-run units. In the latter, the expectation would be that the female body could, and would, give birth unaided. What's more, the approach the NHS has taken has undermined women's confidence in their bodies' ability to give birth – so we now have a situation where many women genuinely believe that they "need" to be near a hospital.

But things might, at last, be about to change. Last week, the Royal College of Obstetricians and Gynaecologists (RCOG) – who aren't exactly what you'd call a radical bunch of people – called for change. A few women, it said, need full-on, consultant-led, care; the majority could and should be bypassing that system and giving birth in low-tech units run by midwives (who are, after all, the specialists when it comes to "normal" birth). So, after five decades of telling women that the nearer to an operating theatre they were during a delivery, the safer they'd be, the baby doctors are admitting that this feeling of "security" in a hospital setting is, for many mothers-to-be, unnecessary.

Some people aren't going to be very happy with that idea; but as far as I'm concerned, the sooner the RCOG suggestion is acted on by the Government, the better.

Apart from anything else, there are surely financial savings to be made if expensive consultant care is targeted at those who need it. But, much more importantly, how women give birth really matters – not only for the start of parenting, but on into the future.

After Rosie's delivery, I went on to have three more, entirely normal, healthy pregnancies. Because the NHS takes the view that every pregnant woman is a walking time-bomb (and especially in my case, given my history), there was no chance for me to get the low-tech, midwife-led care I wanted.

So, knowing I never wanted to be an obstetric emergency again, and believing that my main way of avoiding it was to steer well clear of those hi-tech hospital units where the answer to every little hiccup seemed to be heavy-duty fetal monitoring, followed all too quickly by talk of ventouse and forceps deliveries, I decided to pay a private midwife. She was only too happy to do what the NHS refused to do, and to classify me as low risk, until or unless something happened to make me high risk. It wasn't that she was prepared to sail close to the wind, or to allow me to stay at home when I'd be safer in hospital. Like me, she simply believed that home is the safest place for a mother-to-be who is fit and well.

Like so many healthy mothers-to-be, I gave birth easily and normally, especially when – with my youngest two children – I was able to deliver my babies at home.

And what experiencing both kinds of delivery – a hi-tech, surgical birth, and three low-tech, intervention-free deliveries – has taught me is that how you give birth really does matter; not only at first, in the immediate aftermath of the birth (though it definitely matters then), but also, and crucially, in the longer term.

Having a baby in traumatic circumstances, as I did the first time round, leaves a shadow across a mother's future. You are left with a feeling that your body let your baby down, and you're acutely aware of the pain and difficulty your child was put through. For many women – and this was true for me, too – a difficult delivery means endless problems establishing breastfeeding. These, in turn, made me feel depressed and a failure.

In contrast, giving birth naturally felt empowering and boosted my confidence. That empowerment and confidence, even nine and 12 and 17 years on from the babies' deliveries, stays with me.

So, yes, it will take a lot of effort and a lot of will and hard work for the NHS to reorganise itself in the way the Royal College of Obstetricians and Gynaecologists is suggesting, but I hope that what it said last week leads to change in the way our maternity service is run. It's talking about a real sea change, but it's a sea change that would make a huge difference to a lot of women and a lot of babies. And that would go on making a difference way, way into the future.

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