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More on the NMC Statement on home births

Last night I was discussing the recently released statement on Home Birth from the UK Nursing and Midwifery Council with my good friend Caroline Flint. Her perspective on this important document was very interesting and important, and she raised several issues that the NMC will have to address.

The statement makes it very clear that midwives must support women in the choices that they make. However, as Caroline points out, what does a midwife do when a woman goes against all the advice she is given and makes a decision that is clearly risky for herself or her baby? Some women have completely unrealistic expectations, which they maintain even when faced with a dangerous situation that they could avoid. If a midwife does the right thing and support this woman, carefully documenting everything and clearly enunciating the position, what happens when the woman, at a later date (perhaps even months later) decides that the resulting poor outcome was due to the midwife and demands an investigation? Will the NMC support the midwife in these circumstances, or will the midwife be subjected to months of harrowing inquisition, before eventually having the case cleared? The midwife may support the woman, but the authorities (Midwifery and others) do not usually support the midwife in the same caring way.

There is a real blame culture in the health services in the UK. People (staff and patients) seem unwilling to accept the idea that mistakes are made, not every decision will be the right one and that outcomes are unpredictable. It is rare for natural births to go wrong, but when they do, a scapegoat must be found, and often the blame falls on the midwife. Even when risks have been carefully explained, disclaimers have been signed, consent has been given in writing and contract provisions have been spelled out in detail, there is no guarantee that human nature will not kick in and retribution sought when the unexpected happens. Midwives are sitting ducks because they really do care, they often have a closer relationship to the woman than hospital staff, and are easier to target. In addition, midwives may feel they are powerless to complain about their own treatment if they feel the weight of a punitive system breathing down their necks.

I can see where Caroline is coming from when she talks about the woman who, despite outstanding care and consideration, turns on their midwife because the birth did not happen as expected. Caroline has been subjected to a number of high profile inquisitions (and acquitted of wrong doing) just because a woman has the right to complain. If the NMC is serious about enabling women’s needs during a home birth to be respected, then it must develop a quick, simple, supportive and fair system for hearing complaints and righting wrongs. The midwife must have the same degree of support and understanding as the woman concerned, in recognition that everyone has lost when tragedy strikes, and everyone is entitled to help with their own particular grieving process.

This new NMC statement offers some powerful messages about women’s rights in regard to homebirth. Midwives will now be waiting to see how the NMC will go about protecting the midwife’s rights in this new era of openness and expectation around the provision of homebirths.

Posted by andrea at March 27, 2006 11:11 PM