Guest post: Protecting choice in childbirth

// 8 December 2009

Albany Midwives Practice is facing closure. In this guest post, Amity Reed reports on the effort to keep it open and why it’s so important for reproductive rights

albanymidves.gifWhen we think of reproductive rights, we often automatically associate the term with access to birth control and abortion.

But reproductive rights also include women who have chosen to complete a pregnancy and are seeking care and support antenatally and in childbirth.

On the face of it, it may seem that women who have made this choice have it easy, with little to fight for or be conerned about other than the usual ‘mum-to-be’ anxiety about the process of birth and the health of their babies. But for many women the lack of choice and increasing pressure to submit to a medicalised and micro-managed model of childbirth (where “the safety of the baby” often takes precedence over the mother’s autonomy) is distinctly risky, not only to her health and that of her baby’s, but to women’s reproductive rights.

Women from disadvantaged socio-economic groups are even more at risk than others, with their chances of dying in childbirth being six times the rate for those from middle class backgrounds.

One-to-one care and continuous support in labour are important to every birthing woman, but especially to those who suffer the consequences of inadequate care at a much higher rate and severity level. That’s why women’s right to choose where, with whom and how they give birth is every bit as important as their right to prevent or terminate a pregnancy.

It’s also why the Association for Improvements in the Maternity Services is asking for our help in preventing the closure of the Albany Midwifery Practice, which serves around 200 women each year in Peckham, in South London, the 14th most deprived district in England.

Nearly half of the women using the midwifery service choose to have their babies at home, where they receive uninterrupted, dedicated care from a midwife known to them.

The Albany Midwifery Practice has long been recognised as a centre of excellence, with statistically better outcomes for mothers and babies than King’s College Hospital, the facility that is seeking to terminate its contract and, consequently, its ability to operate (14.4% Cesarean rate and a perinatal mortality rare of 4.9 per 1000 at Albany, as compared to 24.1% and 7.9 per 1000 at King’s). They also boast much higher breastfeeding success rates (80% as compared to 35%).

As stated in the press release:

In order to justify the suspension of the service King’s College Hospital appears to be trying to make the case that the service is unsafe. They have looked at a selected number of Albany cases admitted to their Special Care Baby Unit and asked the Centre for Maternal and Child Enquiries to investigate. We understand, however, that they have not examined the deaths of babies that have occurred in the King’s unit nor the babies from there who were also admitted to the Special Care Baby Unit. Nor do we have what AIMS believes is crucial data – comparative rates of mental illness after childbirth, where we believe the Albany is likely to have far better results.

AIMS demands that King’s College Hospital releases the CMACE Report and the comparable statistics for its own consultant unit so that data from both services can be examined objectively.

If you can take a minute to sign the petition and/or donate to help fund their fight, it would be very much appreciated. Spreading the word via social networking sites would also be useful.

Comments From You

earwicga // Posted 8 December 2009 at 3:47 pm

I think a homebirth would be the only way to get continious care in childbirth. I had no choice as it was a multiple pregnancy, and found the hospital birth absolutely horrendous and it took years to get over that experience.

By the way, have the comparison figures between Albany births and Kings hospital been adjusted to factor in high risk births where there is no choice – such as multiples, young/old mums etc. ? Otherwise it is a meaningless to compare the numbers.

Jess McCabe // Posted 8 December 2009 at 3:49 pm

@earwicga I think that’s something you’d have to ask them directly, those stats are just taken from the press release.

Rachael // Posted 8 December 2009 at 4:34 pm

I’m glad to see this article here (although obviously not glad to hear that the Albany may be closing) – birth choices is something that has greatly affected me over the past few years. I have been left disappointed by the lack of support I have receieved by the NHS. They have continued to lie and bully me out of the birth I want through both of my pregnancies. I believe they are fundamentally against homebirth, and wish there were more centres like the Albany that treated women’s birth choices with respect and understanbding, rather than shuffling us along into a birth full of interventions that leaves many of us depressed and traumatised. The only other choice at the moment seems to be hiring an independant midwife at a high price – so not a choice for those of us who are on a low income/benefits. This is an issue that has been ignored for far too long…

Victoria // Posted 8 December 2009 at 9:25 pm

I was attracted to the idea of a homebirth for my second child (my first labour was fast), but was persuaded to have a hospital birth by my consultant. I ended up having neither – my labour was so quick I gave birth on the ground in the hospital car park, with the baby delivered by my partner. This was actually okay – no complications, over in no time – but I’ve since discovered from other women at baby groups that the hospital now use my partner and me as a “cautionary tale” about not leaving it too late to get to the delivery suite (even though they know we set off as soon as my waters broke, having phoned them an hour earlier and been told to leave it until the contractions were closer). I suspect this is one of many examples in which the specifics of an individual woman’s labour experience get misappropriated to make it appear as though everything can be controlled as long as women do what they’re told, but labour just isn’t like that. And okay, “next to a portakabin” wasn’t quite on my birth plan, but I seem to have had a much better experience than most new mothers I’ve spoken to!

Claire // Posted 9 December 2009 at 8:35 am

I am so glad I had all of my three children in hospital. There were complications every time and we almost lost number three. If there had not been a highly qualified doctor as well as the particular midwife on duty that night, I’d be the mother of two not three. I don’t mind pro-choice, but please respect the choice of those who want hospital births too.

Jackie Bather // Posted 9 December 2009 at 2:07 pm

I have signed the petition and hope that this clinic can be saved. As the mum of two children, I know how a woman can be ‘encouraged’ to follow a particular birth route, when retrospectively, the route was chosen for staff convenience. For example, I was told, before delivery, by a midwife that epidural analgesia was difficult to get on a Sunday ,at the hospital because of anaesthetists being on weekend leave…I didn’t choose that method anyway, but it’s pretty rough for women who might have wanted it.

As for independent midwives, I can see that they may become brassed off with working in the NHS, but I believe it is truly scandalous that they are trained and that their training is paid for, by public money.Then, goodness me, later they decide to leave the service and charge colossal fees for their skills. How grossly mercenary is that ??

Jess McCabe // Posted 9 December 2009 at 2:09 pm

@Jackie Bather I do see what you mean, but it’s no different to doctors or nurses doing the same thing, surely?

Jackie Bather // Posted 9 December 2009 at 2:17 pm

Hi Jess,

Yes, I totally agree with you that it is no different …it’s just that a previous correspondent mentioned the high fees charged by independent midwives. I guess that this whole topic is a bit of a ‘hot potato’ for me. I trained and worked in London as a nurse, often doing long, tiring shifts, as did my colleagues…but I have never worked in private healthcare and will not do so.

rose_hasty // Posted 9 December 2009 at 4:16 pm

It infuriates me that health professionals still say “you can’t have your baby at home/a birthing centre” or “you must have a hospital birth” because of multiple births/position or size of baby/g.d. etc. This is NEVER true. The choice is always yours as a mother. They should be saying “If you have a homebirth I would be concerned about…”. We aren’t babies, we’re making them! Apart from anything, I had a homebirth and when things took a bad turn I was taken to hospital with minimal fuss and no extra risk to my child (although he did pick up an infection from hospital interventions). Childbirth is risky, every one is different. It’s down to us as grown adults to weigh the risks and benefits of ALL the options available to us.

Amity Reed // Posted 9 December 2009 at 5:53 pm

@Clare – No one’s choice to have a hospital birth would be affected by this decision, only those wanting to have homebirths through this particular practice (though even those having hospital births would lose the right to have the midwives they’ve seen antenatally attend their births, which is a crummy position to be in, too). Since you said you had complications with all three of your births, you were obviously high risk and definitely belonged in a hospital with access to all the expertise and technology that hospital obstetrics offers. I’m glad everything turned out okay.

But low-risk women who want homebirths should not be denied that choice. Considering only about 2-3% of women have homebirths and hospital is considered the norm, I don’t think we have to worry about anyone taking the choice to give birth in a hospital away. We do, however, need to worry about the choice to give birth at home being taken away, particularly when women from disadvantaged areas or backgrounds have a much higher chance of suffering the terrible consequences of inadequate care.

Claire // Posted 9 December 2009 at 9:35 pm

Dear Amity

No, you’re wrong to say I was obviously high risk. I was not high risk for any of my deliveries. The complications set in well into delivery and were different each time.

I’m not saying I don’t suppport community midwives, I do. But I also support mothers who give birth in hospital and the hospital staff who support them, for little thanks. Giving birth is quite an emotive issue where it is difficult to respect choice sometimes because the choice can become clouded by what is medically indicated as the best for the mother and the baby. People say “no drugs” in their birth plan, then change their minds when the pain gets really bad. All sorts of things happen.

I’m just saying I was really glad that I was in hospital each time. I don’t want to be made to feel that I didn’t live up to some feminist ideal by choosing that route.

earwicga // Posted 10 December 2009 at 12:17 am

@rose_hasty

I was told I couldn’t have a home birth, which was what I wanted. If I had insisted that it was my right and gone for a home birth it is unlikely that my first twin would have been born alive, and the second one would definately have been born dead. So actually I am glad that the decision was taken out of my hands. Be careful what you say because it was true in my case and I have two live sons.

I did feel giving birth in a hospital was traumatic, and it did affect me badly, but that doesn’t mean I shouldn’t have been there, it means that hospital births should and could be significantly better.

For normal pregnancies home-birth should always be an available option which is resourced adequately.

Beth // Posted 10 December 2009 at 12:37 pm

Slightly off topic but – I’m curious about whether there is a north-south divide here. Where I am there is a midwife-led unit that is apparently very laid-back and gives a kind of half way between a home birth and a hospital birth. There are other units (relatively) nearby if you want or need more support, or if anything goes wrong. And I have a friend who has had homebirths for her two children with no fight. Any other northerner out there that think services for them are better than those down south seem to be?

Autumn // Posted 10 December 2009 at 9:14 pm

We need to reclaim midwifery to combat the increasing medicalisation of child birth. Midwifes spend much of their time “covering their backs” by excessive record keeping, having to slavishly follow hospital guidelines – which differ depending on the hospital and ultimately the Obstraticians in each hospital.

I was trained to be a professional in my own right – I am not an obstetric nurse – but i am seriously considering becoming a doula so i can return to being” with woman”

Independant midwifes are brave to set up private practices – dont knock them their fees are not high compared with the time they can spend with women. They do practice midwifery as it should be practiced. They also are repeatedly criticised and face diciplinary sanctions including being struck off by the Nursing and Midwifery Council (NMC)

Jackie Bather may be scandalised that midwives whos training is paid for by the state leave and set up private practice – what is more scandalous is the number of midwives who no longer practice as midwives. There are more non-practicing midwives in the UK than practicing – the shortage of midwives could be solved if midwives returned to work – but they dont want to work in the current system

Claire // Posted 11 December 2009 at 9:26 am

Amity

I wasn’t high risk for any of my deliveries. Complications which were unrelated to the previous births developed each time. It really depends on the quality of the staff you get at the time wherever you are located. For me the important thing was having multiple staff on hand, including people able to make clinical judgments with the equipment to act on those judgments straightaway. Medical emergencies can and do arise unexpectedly in childbirth. I’ve had bad experiences of midwives really, and a friend died in a well publicised case as a direct result of negligence from a midwife. So fine, if you choose midwife led care, but fine for me not to and certainly not a cop out to go for hospital birth.

I wish that expectations weren’t encouraged to be so high for birth. Lots of magazines and marketing for childbirth services do the soft focus sort of thing that make it sound like a lovely experience. For most people I know, it was anything but, and the disappointment they felt – whether giving birth at home or at hospital – was one of the factors in their recovery.

Kez // Posted 11 December 2009 at 11:08 am

Home births should certainly be much more available and accessible than they currently are. However not every woman wants a home birth and, in some cases, it may be inadvisable. I believe we also need to focus on improving the hospital birth experience in areas where it is currently not good enough. (Hospital births don’t always fall short. Some women have excellent experiences in hospital. But sadly, very many do not.)

I’d like to see a situation where home, hospital or midwife unit are all equally valid, accessible and acceptable choices and where women’s choices are respected – while also accepting that those choices may change with circumstances.

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