What do I do if I have planned a homebirth and there is a shortage of midwives?
Some areas within the UK have reliable provision for home births and unfortunately others do not. If you are in a well equipped area and during labour your partner calls to request a midwife, it might be a shock to be told that you need to come in to the hospital as there are no midwives available to come to a home birth. What can you do?
Under Ternovszky v Hungary – a case brought before the European Court of Human Rights:
- It is your right to choose how and where you have your baby.
- The state has an obligation to facilitate that choice.
- You have the right to receive maternity care.
The Human Rights Act 1998 made the European Convention on Human Rights part of English law and all public authorities, including all providers of NHS services, are obliged to act in accordance with the Convention rights.
The Nursing & Midwifery Council (NMC) has recognised that midwives owe a professional duty of care to attend any woman who chooses to give birth at home and any withdrawal of home birth services clearly breaches this duty.
GPs may decline but midwives when called, must attend a labouring woman, where ever she decides to give birth, regardless of advice to the contrary.
It is a good idea to discuss with your birth partner/s in advance the possibility that this may happen and what approach you would like them to take. If you do not consider staffing levels to be a good enough reason for you to give birth in hospital, consider how you would like your birth partner to respond.
Once your details have been given over the phone, birth partners who find themselves in this situation have often found that not entering into discussion and simply repeating a pre-rehearsed statement is an effective approach. State clearly that you have no intention of coming into hospital, that their staffing issues are not your concern and that you expect them to send a midwife immediately. Obviously midwives are under often unacceptable levels of pressure and their jobs are at times incredibly difficult, but rarely as challenging as the job of the birthing woman and poor staffing levels in the NHS are really not your concern. If your children were to turn up to school and there was a shortage of teachers that day, it would be the responsibility of the school’s management to address the problem without causing disruption to your child’s education. They would cover lessons with other staff or call in agency teachers – in short, it would not be your concern.
If your birth partner does not feel confident relaying this and you are concerned it may be an issue, consider putting your intention to give birth at home in writing to both your Head of Midwifery and the Association for Improvements in the Maternity Services (AIMS) – An example letter can be found here. It also may be worth considering additional birth support to help with advocacy.
It is worth finding out what the local guidelines are in your area in these situations as some trusts will send an ambulance to transport a labouring woman in to hospital. If this is the case consider adding that you do not wish for them to send an ambulance to your pre-rehearsed statement.
There are areas in the UK where women are continually reminded about a shortage of midwives and where home birth services are regulary being suspended. If you live in one of these areas then it may be an idea to contact AIMS and your Head of Midwifery stating your intentions to give birth at home. An example letter can be found here and consider contacting a Supervisor of Midwives to relieve anxieties regarding lack of service provision. Unfortunately each time a labouring family agrees to go in to hospital rather than insist that a midwife is sent to them, this does nothing to encourage managers to address the staffing situation which in turn does not support already over stretched midwives. It may also be a concern if the reason that there is no midwife available is due to them being called in from attending homebirths to staff an over stretched labour ward. By agreeing to go in to an understaffed, busy environment you may feel this puts you and your baby at even more risk.
Even if you are comfortable changing your plans in the event of a staff shortage, consider putting something in writing after so that the issues are addressed for women following you.
Birthrights.org.uk – advice and support on UK women’s rights in pregnancy and childbirth
Written by Hannah & Lisa ~ doulas & homebirthers