Birth as nature intended

Having a baby at home can be rewarding and safe, and it's supported by the Government. So why, asks Liz Bestic, is Britain's only specialist NHS home-birth centre about to close down?

A nightmare experience of a hospital birth two years ago prompted 33-year-old Maria Andrews to have a home birth with her second child. "When I found out I was pregnant again, I was terrified my doctor would insist I had my baby in hospital – I had previously had an emergency Caesarean section with my daughter," she says. "During labour I was moved from room to room and saw at least 10 midwives who prodded and poked around without telling me what was going on. It was the worst experience of my life. I was determined to have this next baby at home and I was clear that I wanted continuity of care with a midwife I knew and trusted."

Maria got her wish and has just given birth to her son, Oscar, at home. Her experience of a home birth could not have been more different. "I met my midwife, Margaret, early on in my pregnancy. She was so relaxed and confident I instinctively felt at ease with her. She asked to see my notes and said there was no reason why I should not have a home birth. When she came round for antenatal visits it was like seeing an old friend. We would chat and have coffee and discuss any problems I had. I felt that if anyone could help me do this, she could. I couldn't fault the service I got from the home-birth team – it was exemplary."

When Maria went into labour early in the morning, she rang Margaret. "I told her my contractions were quite intense," Maria says, "and I thought I was progressing quite well. She arrived an hour later and remained calm and collected. It was reassuring to know she was so experienced in home births. She seemed to know instinctively what to say and how to get the best out of me. I think it was because we had built up this bond of trust that I felt so relaxed and hardly needed any pain relief. Margaret made me feel confident in my own ability to give birth at home. It was such a joyful experience – every woman should have the opportunity to have their baby like this."

Maria was able to have this experience thanks to the only specialist NHS home-birth team in the UK, based at the North Middlesex Hospital, North London. According to local women, it is a unique example of the sort of NHS maternity care where experienced midwives provide a one-to-one service to women in their homes during pregnancy and labour, as well as after the birth. Unfortunately, the service is about to be re-absorbed into the hospital, despite a campaign led by local mothers, GPs and local MP, Barbara Roche, and despte the fact that the current government professes to support home birth. "We stand to lose a community service that meets and surpasses government standards and targets, and gives women the birth they want," says Tessa Thomas, who manages the Home Birth Campaign. "There has been an increase in demand for home births – it's hardly surprising that this service has had enquiries from other hospitals wanting to set up something similar."

Most women who want a home birth have to rely on a team of up to 10 community midwives, who usually provide antenatal care in a local clinic. Opting for a community midwife means women often do not know which midwife will attend her during her labour until the day arrives. At the birth, the midwife will only stay for the period of her shift. Many women find that an unfamiliar midwife ends up delivering their baby.

"Most community midwives only do a handful of home births each year, so they lack the confidence of a home-birth midwife," explains Thomas, who had all three of her children at home. "That means that at the slightest hitch they are more likely to transfer the woman from home to hospital. Home-birth midwives work in an instinctive way, drawing on the relationship and trust they have built up over the months before the birth. They are not driven by medical protocol but by the needs of the woman during labour."

Women who can afford it can opt to pay up to £3,500 for a private independent midwife, as did TV presenter Davina McCall, who supports the Home Birth Campaign. Ironically, independent midwives would love this service to be available to all women but have opted out of the NHS because their values are not compatible. "Having a baby is an ordinary life-cycle process, not a medical event," explains Clare Winter, an independent midwife with 17 years' experience. "The relationship between a woman and her midwife is built on trust and communication. When a woman is in labour, they work as a team. It's a very intuitive thing, which is not just about delivering babies but also about empowering women to have the sort of birth they want."

Winter believes the midwife is a tiny part of a huge chain of events. "People say it's an amazing job to deliver a baby but all I do is enable a woman to do what she does naturally herself," she says. "The minute the baby is born, she doesn't want me around any more. There is a point during labour where most women say, 'I don't think I can go on any more', when the midwife does have to encourage her. It's the moment that if she were in hospital she would be offered an epidural or pethidine. At home, with a confident midwife who instinctively knows how her labour is progressing, she can get through that feeling and – as Maria found – have a truly joyful experience of birth."

The word instinctive crops up often when people talk about home births. Childbirth guru Michel Odent – who, during the 1970s, encouraged mothers to give birth squatting, or in birthing pools in darkened rooms at his low-tech birth centre near Paris – believes instinct is the key. "During a natural labour with an experienced midwife at home, women learn about their strength and power. A woman labouring at home is likely to feel relaxed and confident in her abilities – surrounded by family and friends in her own environment, she is able to manage her pain better. Mother and baby bond better and breastfeeding is established more easily."

Thomas adds that it is often a bonding experience for the family. "Giving birth at home meant that my other two children could be there, which made the whole thing an inclusive family experience. The kids not only enjoyed it but learned a lot from it, too."

For Maria and her husband Tim, the idea of a future hospital birth is not an option. "There was no comparison with what happened the first time," explains Tim. "Maria was at ease about giving birth at home, but she could not have done it without the encouragement of an experienced home-birth midwife. Margaret spent a lot of time getting to know Maria. So, all during Maria's labour she instinctively knew what to say. The birth was incredibly moving. After Oscar was born, Margaret went into our kitchen and cooked up a huge pot of pasta, which was what we needed. She had become part of our family."

For more information, go to www.homebirth-campaign.co.uk or www.independentmidwives.org.uk