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Guidelines for midwives at homebirths in the UK

Midwives in the UK have a number of laws that govern their practice. One of the most useful is a law that requires the midwife to remain with the woman at a home birth when complications arise, especially if the mother refuses to move to a hospital against the midwife’s advice. This protects midwives from being hauled into court if disaster strikes at a home birth - the midwife must stand by and do whatever she can to help even though she has made it clear that there are problems and medical help is advisable.

In recent years, some Hospital Trusts have used various “legal” means to get around clauses such as this, and have refused women the care of the midwife because of staff shortages or unwillingness to provide a service. Many women have been forced into hospital births against their wishes and some have complained loudly. Trusts have justified their stand using various anguments, such as taking staff from hospital wards to attend a home birth will increase the risks faced by mothers giving birth in hospital.

There have also been cases where women giving birth at home have been refused a waterbirth because it is claimed the midwives “don’t have the training” or “there is no policy in place for waterbirth”.

To help clarify the responsibilities inherent in a homebirth for the mother and her midwife, the Nursing and Midwifery Council has released a document covering home birth. The full text can be obtained here. The following are some key statements:

• Midwives are experts in normal birth and the NMC's standards require them to be competent to support women to give birth normally in a variety of settings including in the home.
• Whilst a midwife must not provide care that she is not competent to give, it is not acceptable to refuse to care for a woman on this basis and take no further action.
• Research over the last couple of decades suggests that home birth is at least as safe as hospital-based birth for helathy women with normal pregnancies.
• Midwives may have some anxieties if there is a clash of a woman's choice versis the percieved risks of caring for women in a home setting. If there is a clash then the midwife must continue to give care but can seek support by discussing her anxiety with her supervisor of midwives.
• It is a midwife's duty to make all options and choices clear and to respect the choices a woman makes if she is legally competent to make that choice.
• Whilst an employed midwife has a contractual duty to their employer, she also has a professional duty to provide midwifery care for women. A midwife would be professionally accountable for any decision to leave a woman in labour at home unattended, thus placing her at risk at a time when competent midwifery care is essential.
• Should a conflict arise between service provision and a woman's choice for place of birth, a midwife has a duty of care to attend her.
• Women have the right to make their own decision on these issues if they are competent to do so and midwives have a duty of care to respect a woman's choice.

I am grateful to Beverley Beech of AIMS UK for drawing attention to this recent release. She has been campaigning for years for better access for women to midwifery services, especially for home births and the release of this document must be very pleasing for her.

Posted by andrea at March 23, 2006 10:19 PM