Writer and broadcaster

Expectant mothers need facts, not fear. Hospital vs home birth. The Independent.

Here we go again. A debate about home vs hospital birth.

There is only one thing – I’ve found – that’s more emotive than where you give birth to a baby, and that is how you feed it.

This week, the Royal College of Obstetricians and Gynaecologists published a report called High Quality Women’s Health Care: A Proposal for Change. It proposed that more women give birth away from doctors and hospitals. I really want to see how this works, because if there’s anyone more scared of home births than the parents, it’s doctors and midwives. (Note: not all, I know.)

I’m not a doctor, nor a midwife. I have slightly more experience of pregnancy and birth than some, by virtue of being co-founder of a parenting website for the past seven years and working as a lay rep in a large maternity hospital for four. But really, my opinion, just like so many birthing women, counts for little.

Look at what this report says: “The model we are proposing focuses on the needs of the woman and her baby by providing the right care, at the right time, in the right place, provided by the right person and which enhances the woman’s experience.” Sound great, doesn’t it? But who will decide what the right care, at the right time, etc, is? Who listens to what a mother (and, let us not forget, the father who can make or break a birth plan) wants?

Hospitals are so tied by NHS policy and guidelines, and are so scared of being sued that midwives who once were perfectly capable of delivering breech babies, big babies or twins at home (yes, it can be done) no longer can, or do. So it’s easier to book everyone into the hospital. What will change? How will it change? There aren’t enough midwives as it is.

When I decided to try for a home birth I had to take myself out of the NHS system (an option that may no longer exist soon because of the threat to our independent midwives, but that is another story, for another time) because the idea so terrified almost everyone I met. I was simply deemed too high-risk. But this wasn’t based on any analysis of my actual, individual risks. It was because I ticked two boxes: “over 40” (this is still being cited as a reason not to have a home birth) and “previous C-section” (ditto). One of the paediatricians at the hospital where I was a lay rep told me I was being irresponsible, that my scar would tear (the risk of uterine rupture is, in fact, very small) and that I’d kill myself and my baby.

“Don’t expect us to attend to you” were her actual words. Amazingly, because I wasn’t on a dual suicide/infanticide mission, and I didn’t want to leave my firstborn motherless, I asked two separate, senior midwives to go through my previous notes with a fine-tooth comb. Conclusion: no reason at all not to try for a home birth if you want to. But really, how many hoops did I have to jump through?

For many – perhaps most – women and men, the thought of giving birth at home is terrifying. I toyed with the idea of a home birth with my first for about 10 minutes. It was only when I saw firsthand what hospitals could offer and after five years of researching birth that I was brave enough even to think about it for my second baby.

I’ll cut to the chase. I had my home birth without drugs or incident. Yes, it was fantastic. No, you shouldn’t have to have a home birth if you don’t want to, no more than I should have had to go to hospital if I didn’t want to. This brings me on to something that no report can ever address, and that’s the baggage we all – health professionals included – bring into maternity services: our own experiences. They should inform, but not dictate.

There is one bit of the report that I think is underplayed and it is the RCOG president Dr Anthony Falconer saying this: “Women themselves need the support and encouragement of society, including the professionals, to take responsibility for their own health”. Indeed, we all need to take responsibility for how babies are born. Women need to stop dramatising labour, especially to their daughters. (Maternal influence is huge on a daughter’s subsequent expectation of her own labour.) Health professionals need to stop lecturing a woman on how to give birth and start listening to what women want – and then provide consistent, accurate, non-emotive information to help her set the agenda.

We all need to stop projecting our own experiences and think that’s how it will/should be for everyone else. Only then can we hope to reverse this collective hysteria that surrounds giving birth. People who make TV programmes and films: I have a special message for you, because how you portray birth is so hugely influential. I know it makes for better TV to have a woman on her back, in a hospital, screaming and tearing off her husband’s earlobes, but please, counterbalance this with women also giving birth quietly, in a position other than prone and sometimes at home. It’s partly because of you that it took me nearly 40 years to realise that it could be done.