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Laura Keynes: An expectant mother writes: Overstretched hospital regards me as a nuisance


New guidance from health officials says midwife-led care is safest for women with uncomplicated pregnancies. The National Institute for Health and Clinical Excellence (Nice) is now encouraging women to opt for birth at home or at midwife-led units.

I’m due to give birth next week, and if there’s one thing I’ve already learned it’s that no matter what choices you make as a mother, everyone will have an opinion. For every positive home birth story you’ll hear a tale of horror too.

There is so much conflicting advice.

I’m fortunate enough to live near a London hospital that has recently benefited from a brand new midwife-led birthing unit directly across the corridor from the labour ward. Think more hotel spa retreat than NHS hospital: mood lighting, ipod docks, aromatherapy massage, double beds. It’s a far cry from the traditional labour ward where white-coated doctors lurk with forceps under neon strip-lighting. Needless to say, it’s where all the first-time mums in my antenatal group want to give birth.

The birthing centre is only available to mums who’ve had low risk pregnancies, the idea being that if complications arise during labour, it’s a quick transfer over the way to labour ward. It seems like a good compromise.

Even so, there’s only one big topic among expectant mums: When To Go In. It’s fraught with anxiety. We’ve all been told to wait until the contractions are lasting a minute and coming about three minutes apart. “When you can’t speak, basically,” said my midwife. I was left wondering how, if I’m in so much pain that I can’t speak, I’m supposed to ring the midwife, organise myself down six flights of stairs, and point myself in the general direction of the hospital. And then, having gone through of all that, I could be sent home again if I’m not in established labour, only to have to repeat the process when I’m in even more pain.

Midwives don’t put any gloss on it. They know – and we know – it’s because of staff shortages and chock-a-block labour wards. The general message you get as a pregnant woman is that you’re not welcome in hospital unless a) it’s a matter of life or death or b) you’re going to be in and out very quickly and as little drain on resources as possible.

It all leads to very mixed messages, as one midwife has thoughtfully documented: On the one hand, hospital is the safest place to have your baby. On the other, you should do most of your labouring on your own away from hospital.

So home birth has that one obvious advantage: when labour starts, you can get safe and settled without the fear of having to relocate and without risk of having to give birth in a lay-by or car park. There’s also less risk of medical intervention, simply because there aren’t any doctors hanging around wanting to do stuff to you.

That said, home birth requires one or two midwives to be ready on cue, and at the first sign of trouble an ambulance and a team of paramedics will be called out. Are there really the resources for this? I very much doubt it.

Like I said, the general message you get as an expectant mum is that the system is overstretched. You pick it up from the hurried way a midwife deals with routine antenatal checks, as if you’re a nuisance, or from the threat of being turned away when you’re in early labour. Recent midwife strikes didn’t exactly fill me with confidence: working conditions must be pretty bad if even the midwives are striking. Midwives seem stressed and rushed, over-loaded and over-worked.

These new NHS guidelines recommend that approximately 45 per cent of expectant women should be steered towards having a home birth or using a midwife-led unit. That’s bound to take some strain off busy labour wards. Is it too cynical to suggest that this plays into the hands of politicians who want to present a quick fix to the overcrowding on NHS labour wards? It might solve one problem in the short term, but in the longer term some serious staffing gaps are going to be exposed. The Royal College of Midwives has already spoken out about hospital chiefs “burying their heads in the sand” over midwife shortages.

Like most women, I’m all for midwife-led care, but I’d like to be reassured that there will actually be a midwife there when I need one. And also, if I need one, an ambulance and a paramedic. Right now, I’m not convinced.

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Laura Keynes
Laura Keynes
Dr Keynes is a Cambridge-based academic, writer and critic with two very young children. She writes for Standpoint magazine, the Catholic Herald and The Tablet. Find her on twitter @LMKeynes.

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