Tuesday, 30 March 2010

Midwives supporting home births

In March 2006 the Nursing and Midwifery Council issued a circular clarifying the rights of women, the responsibilities of midwifes and the obligations of Local Supervising Authorities (LSA) for home births. In brief it outlines guidelines in three areas
• As experts in normal birth midwives should be competent, and have confidence, in caring for women having home births.
• Home birth is at least as safe as hospital birth for healthy women with straightforward pregnancies. Whilst there are some clear categories of women for whom a hospital birth would be highly recommended, there are others with increased risk factors where opinion is divided. Risk is a complex issue. If a woman is legally competent to make the choice to birth at home then the midwife should support her, make a plan of care, and seek support from her supervisor. S/he should make all options and choices clear and respect the choices a woman makes.
• There should always be midwives available to cover home births. ‘Withdrawal of a home birth services is no less significant to women than withdrawal of services for a hospital birth.’ Women can contact the LSA for advice.

Hurrah! This is tremendously important for those planning homebirths. In the past six months I have known women trying to book home births who have encountered problems in all these areas: midwives who are not competent in water births, not competent in physiological third stage, not confident in normal birth and nervous about attending a home birth; there have been women with low iron, suspected big babies, previous caesarean, previous assisted birth with high blood loss; two women told no midwife was available, though one other woman was attended by a senior midwife who came out from the hospital. For all these women, and the many, many more, I am very grateful for this document. If you would like to see the full document, ask me for a copy or go to www.nmc-uk.org.uk.

Everybody should at least consider a home birth, simply because it is one of your options, and should be considered along with which hospital, what pain relief and which pram. In fact the National Institute for Health and Clinical Excellence (www.nice.org.uk - Clinical Guideline on Caesarean Section) positively recommended that you do “During their discussions about options for birth, healthy pregnant women with anticipated uncomplicated pregnancies should be informed that delivering at home reduces the likelihood of CS.”* Start at www.homebirth.org.uk or the NCT publications (home birth info sheet, £1; booklet, £2.50), or contact me

*Were you told this? The guideline also recommends that “Women should be informed that continuous support during labour from women with or without prior training reduces the likelihood of CS.”

Ref: www.nice.org.uk/CG013NICEguideline pg12

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