Do any GPs do home births any more? I have a romantic vision that, on some Hebridean island, the family doctor is still the ‘go to’ person for home delivery, but in the rest of the NHS, the GP obstetrician is pretty much extinct. When I was born (1962, since you ask), home birth was considered the norm, and although I came out with my umbilical cord wrapped around my neck, a very calm Welsh midwife expertly untangled it and delivered me unscathed. The GP was nominally in charge but left all the messy business to her.
In the UK, women have a legal right to give birth wherever they want, even into the leg of a ‘onesie’ in a hospital car park, as was beautifully demonstrated recently.1 This wasn’t in the birth plan, although mum Jessica Wynter claimed that the leg of the ‘onesie’ had cushioned her baby’s fall and prevented any damage.1 Although women can legally choose to give birth anywhere, the NHS isn’t legally obliged to provide services for them to do so. If you want to have your breech twins in a tepee high up on an ancient escarpment, you may have to go it alone, as the NHS is too busy dealing with hospital births to provide midwives for more outlandish situations.
Fans of home births will say that medicalisation creates its own problems. But we live in a risk-averse society, and the social, psychological, and financial costs of brain damage are huge. We naturally assume we’ll be safest in hospital with all that technology, but every birth has to be judged on its merits. The NHS is sometimes dangerously understaffed, and there are few places more aptly demonstrating that than on a labour ward.
We also live in an increasingly litigious society, where claims and payouts are skyrocketing for every conceivable type of medical accident. Unsurprisingly, maternity is top of the pile. According to the National Audit Office, £482 million was paid out in 2012–2013 for maternity clinical negligence cover, accounting for a third of the total NHS clinical negligence bill and a fifth of the total maternity budget. The number of maternity claims has risen by 80% in the last 5 years.2
Clearly, something must be done, but a turning of the litigation tide seems very unlikely (the NHS’s total clinical negligence bill in 2012–2013 was a jaw-dropping £1.25 billion). The best options must be safer staffing and practices, and legal reform: families and babies suffer from medical accidents, but so do taxpayers and other patients, as the money for litigation payouts is taken away from frontline services.
As with the rest of the NHS, midwifery is not known for its supportive attitude to whistleblowers. I’ve come across plenty of doctors and midwives over the years who’ve tried to raise concerns but got nowhere, except into a dead-end career. Until we acknowledge the harm the NHS causes, as well as the good, we can’t address or prevent it. You can only do a risk assessment if everyone is free to speak up so you know precisely the nature of the risks you’re assessing. Teamwork is crucial: obstetricians, midwives, and parents do not always share the same philosophy or plan for a particular birth. For every baby brain that doesn’t get the oxygen it needs, a cascade of suboptimal care may need to be addressed, step by step. And sometimes it’s just bad luck.
In a health service priding itself on treatment according to need, all families should receive the same financial help for birth injury, however it was caused. Settlements for brain injury are expensive because the lifelong costs are awarded for private care—NHS care must be disregarded. Instead, the NHS and social care should provide that care, to the same standard but at a fraction of the cost. This would provide additional funding for all patients, including those who cannot prove negligence, or who simply don’t want to take legal action. The same needs deserve the same care, to the maximum value. And that care should be provided promptly and kindly, not after years of wading through the courts.
- Mirror Online website. Woman gives birth to baby through the leg of her onesie and says it saved her child’s life. www.mirror.co.uk/news/weird-news/jessica-wynter-gives-birth-baby-2994777 (accessed 10 January 2014).
- National Audit Office website. Maternity services in England. www.nao.org.uk/report/maternity-services-england/ (accessed 10 January 2014). G