From : Private Eye No. 1183, 27 04 07

Maternity tatters

Health secretary Patsy Hewitt is at it again, making promises about patient choice that she won't keep. This time it's the turn of pregnant mothers, who, in just two years' time, will be able to choose where they want to give birth (home, midwife units, hospitals, organic gardening centres or in a tepee at an ancient burial monument).

Legally, women have always been able to give birth wherever they want but most are led to believe hospitals are safer. Offering choice to all, including those with higher risk pregnancies, may not be wise but we've known for years that for women with normal pregnancies home birth is safe. You just can't get the staff...

Back in 1992, the Health Committee chaired by Nicholas Winterton reported on the future of the maternity services. It found that women wanted continuity of care during pregnancy and childbirth, choice of site and method of birth and control over the birth process. It concluded that "the policy of encouraging all women to give birth in hospitals cannot be justified on grounds of safety".

In 1993, a Mori poll found that hospital birth was the only option offered to most women and that 73 percent would have liked to discuss alternatives. Of these, 22 percent wanted the option of a home birth. The same year, the Tory's launched Changing Childbirth, which is remarkably similar to "new" Labour's Maternity Matters. Six years of maternal choice later and only three (3) midwifery units in England could deliver the quality of care promised by the Tories - largely due to the national shortage of 5,000 midwives. In 1994, a large UK cohort study found home birth to be safe for mothers with normal pregnancies, with half the risk of having either an assisted vaginal delivery (forceps or vacuum) or caesarean section. Provided the midwife is competent enough to recognise the rare occasions when transfer is needed and it happens swiftly, home births for low risk women (around 30 percent of pregnancies) are safer than hospital.

Despite 22 percent of women wanting the option of a home birth, only 1 percent have delivered at home since 1980, and half of them unintentionally. So what makes Patsy think she can succeed where the Tories - and the first nine years of Labour - have failed? For a start, she's allocating no (zero) additional funds. And although midwife numbers have increased since the Tories, they are currently being cut or frozen because of hospital debt. The Royal College of Midwives estimates another 3,000 are needed for Patsy's birth plan but only another 1,000 will graduate in 2009. As all health workers (even doctors! - shock horror) are discovering, there's a world of difference between getting a qualification for the NHS and getting a job in it.

We've known for 13 years that carefully selected home births, with adequately trained staff, are safer than hospital. But botched, fly by the seat of your pants "1'm sure the midwife will be here soon" births are not. One guess what "new" Labour, or perhaps even the "new" Tories, will deliver.

P.S. Even those able to pay an independent midwife to deliver their baby at home will soon lose the option, as the government is planning legislation to make professional indemnity insurance, unavailable to independent midwives, a precondition for registering. Choice indeed!

M. D.