Valerie Gommon Midwife’s Blog

Archive for the ‘www.onemotheronemidwife.org.uk’ Category

Yesterday I was asked to speak at the Hinchingbrooke Maternity Services Liaison Committee AGM.  I think it went okay.  The title of my talk was Normal Birth Successes and I spoke about some of the clients I have in my Independent Midwifery Practice www.3shiresmidwife.co.uk (obviously stories are anonymized to protect client confidentiality).

I spoke about five beautiful births, one was a lovely waterbirth of a 10lb plus baby, another was a normal birth when the mother had been so frightened that she was planning an elective caesarean when she booked me.  There was also a story of a woman whose first baby had been born by caesarean, her second had been a forceps delivery and her third son (11lb) was born, at home, at Term + 18 days and a client whose first baby was born at home in the breech position and finally a client expecting her first babies who had twins at home.

I spoke about the benefits of having a known midwife at the birth, women are:

  • more likely to have a normal birth
  • less likely to have a caesarean or forceps delivery
  • have shorter labours
  • need less drugs
  • more likely to breastfeed
  • more likely to be happy with their experience
  • less likely to experience postnatal depression

All outcomes are improved when women have a midwife they know and trust.

I often work with women who are considered to be “high risk”, but these brave women sometimes make the difficult choice to labour at home because they want to be left alone, in an unpressurised environment, to get on with their labour in peace.  We know that oxytocin (the hormone needed for labour) flows better when women are relaxed and feel safe.  Often the journey to hospital, or meeting a new midwife will be enough to stop contractions (if only temporarily).

I am passionate about caseload (or one-to-one) midwifery – I believe every woman deserves to have a midwife she knows with her throughout her pregnancy and birth journey.  I fully appreciate the difficulties this provides for an under-staffed, under-resourced health service – but there are many areas that make this work for a large majority of their clients – why can we not make this a reality for more women?

There are several campaigns to improve things for women (and midwives), please visit  www.independentmidwives.org.uk or www.onemotheronemidwife.org.uk for details.

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Well what a surprise, new research “Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births” http://www.rcog.org.uk/news/bjog-release-new-figures-safety-home-births has found that homebirth is safe for low-risk women.  These findings echo the work of Marjorie Tew way back in 1986 British Journal Obstet Gynaecol 1986 Jul;93(7):659-74

This large scale research from the Netherlands – which has a high rate of home births – found no difference in death rates of either mothers or babies in 530,000 births.

Low-risk women in the study were defined as those who had no known complications – such as a baby in breech or one with a congenital abnormality, or a previous caesarean section; additionally the researchers noted the importance of both highly-trained midwives who knew when to refer a home birth to hospital as well as rapid transportation.

I wholeheartedly support the initiative of the Dutch midwives, and also that of the Albany midwives (based in Peckham, South London) http://www.albanymidwives.org.uk – midwives attend a woman at home in labour and together they decide whether to stay at home or transfer to hospital.  If all is well many mothers opt to labour and give birth at home, but if she prefers to transfer her midwife will accompany her into hospital.

In my Independent Midwifery Practice www.3shiresmidwife.co.uk this is pretty much what happens.  Mothers often plan a homebirth, but know that they can transfer at any point if they wish, conversely if they plan a hospital birth and change their mind I will care for them at home.  Indeed many of my clients would not be considered “low-risk” but these women believe that by staying at home they are more likely to give birth without interference.

The number of mothers giving birth at home in the UK has been rising since it reached a low in 1988; currently only 2.7% of births occur at home in England and Wales.  Our government has pledged to give all women the option of a home birth by the end of this year. At present just 2.7% of births in England and Wales take place at home, but there are considerable regional variations – so we have a huge way to go in achieving this.

Louise Silverton, deputy general secretary of the Royal College of Midwives, said, the study was “a major step forward in showing that home is as safe as hospital, for low risk women giving birth when support services are in place, but she also acknowledged that ” the NHS is simply not set up to meet the potential demand for home births”, she went on to say that there needs to be a major increase in the number of midwives.  My experience fully supports this fact, sadly I am regularly hearing of women being denied a homebirth on the grounds of inadequate staffing – this is outrageous and women need to be campaigning and lobbying for better maternity services (www.aims.org.uk; www.onemotheronemidwife.org.uk; www.kentmidwiferypractice.net)

Further reading

www.nhs.uk/news/2009/04April/Pages/HomeBirthSafe.aspx
http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/7998417.stm
www.independent.co.uk/opinion/commentators/annalisa-barbieri-i-gave-birth-at-home-ndash-and-heres-why-1669309.html

I am really sad, but not suprised as the news has unfolded this week about the Healthcare Commission Report into care given by Stafford Hospital.  www.healthcarecommission.org.uk/newsandevents/mediacentre/pressreleases.cfm?cit_id=1640&FAArea1=customWidgets.content_view_1&usecache=false

I believe that similar situations are occurring throughout the UK, and that what has happened at Stafford is merely the tip of a terrible iceberg.  Whilst I am sure there have been mistakes made, I was outraged by Alan Johnson’s comments about poor management at Stafford.  The Government must take some responsibility for what has happened.  The NHS is in crisis.  Someone (with a greater mind than me) has to look at what is happening and make changes.  Clinical staff are overworked, indeed a year ago nurses and midwives were being made redundant in many Trusts and staff are expected to work even harder to make up shortfalls, alongside being given additional work in the form of clinical responsibility and paperwork.

The Report cited low staffing levels, inadequate nursing, lack of equipment, lack of leadership, poor training and ineffective systems for identifying when things went wrong.  I know from personal experience that the NHS is often reactive rather than proactive – staffing shortages mean that training sessions are often cancelled, and there is no time for proper planning.  Sickness levels are high due to exhausted staff.

I don’t want to scaremonger – I do believe that the NHS, on the whole, delivers “just about” safe care.  But that is it.  It is just about safe.  No TLC, no extras, and much basic care such as washing and feeding of patients is done by relatives.

It is for these reasons that I decided to leave the NHS and work in Independent Practice, www.3shiresmidwife.co.uk.  It was not an easy decision, but I felt that I was unable to give the quality of care and the continuity of care that I felt clients deserved.  I spent so much of my day apologising, and promising to get back to clients.

I am now very happy, giving good quality care, time and full continuity to my clients, but I do feel guilty that this care is not available to all, and I do feel huge respect for my colleagues who are still working within the NHS.

I believe that the public HAVE to be heard.  Staff are so exhausted that they don’t have enough energy to campaign, and they probably aren’t listed too.  As happened with maternity services in New Zealand, it is only when women and midwives work together that change can be effected.

We recently had a series of showings of “The Business of Being Born” www.thebusinessofbeingborn.com around the country; women need to mobilize to improve things.

For ideas I suggest you look at www.onemotheronemidwife.org.uk or www.independentmidwives.org.uk or feel free to contact me at info@3shiresmidwife.co.uk to discuss your ideas.


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