Homebirth service suspended in East Sussex

[sunriseanja]

Some of you may be aware that Sussex Hospitals Trust took a decision to suspend the homebirth service at the beginning of the week.

They quote staffing levels as the reason to have to redeploy midwives to cover the hospital and it has put local women in an unacceptable position having to leave their homebirth plans.

Various articles have hit the press so far: news.bbc.co.uk/go/em/fr/-/1/hi/england/sussex/8576115.stm www.thesun.co.uk/sol/homepage/woman/2896979/Shortage-of- midwives-deprives-mums-of-chance-of-home-birth-and-Caesareans-on-rise.html www.theargus.co.uk/news/5067977.Sick_midwives_force_cancellation_of_home_\ births/ And it has been covered on both the lunchtime and evening news on BBC Sussex.

AIMS has been very helpful in preparing a document to support local mothers. The document states a very important message:

' It is unacceptable when faced with staffing problems in an obstetric unit to disband the home birth service, and deprive needy women of the specialist midwifery care that was established to help them. The problems with staffing need to be addressed seriously, and this will only be achieved when a community midwifery service is established by a Primary Care Trust, so that community midwives can focus of supporting normal birth and not be seen as stop-gap measure to be used when the Acute Units have staffing problems.'

Please share this information with Sussex women and respond to this post if you want to help the campaign.

Many thanks, Anja
Homebirth Coordinator Uckfield NCT and Independent Midwife

Instead of them giving birth in the corridors and the wards, may it not be better that they give birth at home? Dunno. esp. if they were planning a HB?

Why do you think you have a right to a homebirth?

Mmm, the trust says it is temporary. But any action which can be taken to rectify the problem in the hospital in the future can be taken now. So I really doubt it is really temporary. If Sussex manages to do this without opposition, we'll have many trusts following suit in the coming months. Any chance to cut service and bills would be grabbed with two hands but legally women have a right to a home birth and Sussex is dangerously close to the mark on this issue.

"people are so demanding these days. oh it's our right to do this that and the other, with no regard to how that affects other people"
This is how I feel about luxury service only offered to a small percentage of users like midwife led care.

The money saved by closing the units and redirecting women to the nearby and often in the same building consultant led units. This would leave the existing home birth teams able to deal with specific groups of women who desperately need them (rather than fancy a nice room at the hospital like the MLU)

These groups include women for have such fast labours that it would be dangerous to be traveling to hospital for birth, women who have no support/childcare and need to stay home whilst they labour, women who have been psychological damaged by previous hospital births and would rather die than go to hospital. These women deserve support at home and yes if it means the small number of women who get the luxury midwife led unit service miss out...well, it is only temporary

"if people have the right to choose HB then they also have the right to choose an MLU"
They don't legally. Women have a choice between an hospital birth, which is defaulted to consultant led unit or a home birth.

The midwife led unit is a limited luxury service only offered to a very small number of users based on strict guidelines. My friend fought for months to use our local midwife led unit and failed, she had a successful home birth last week. It wasn't what she wanted but legally she could only choose consultant led unit or homebirth, so she had a homebirth in the end.

Lovely home water birth three hours at home. Lucky lady

"Why do you think you have a right to a homebirth?"

So a women has the right to have a homebirth but she doesn't have a right to have state provided midwives with her?

Sorry, and quickly I want to add I think homebirths should if at all possible be funded by the state, but if they are then it is a luxury not a necessity.

"Sorry, and quickly I want to add I think homebirths should if at all possible be funded by the state, but if they are then it is a luxury not a necessity."
In your opinion.

I have explained three categories of women (and there are many more) who will suffer and maybe die without this service, hardly a luxury to have qualified medical care to help them is it ?

If home birth is a luxury than the midwife led units should also be closed as they are in my opinion a luxury. Closing midwife led units saves money, frees up staff and does not endanger anyone.

StarlightMcKenzie, Bet you know of this study I read about one trust which saved loads of money and staff etc and they did what I am suggesting.

Holding open the CLU for emergencies and transfers and closing the MLU. They had midwifes go out to all labouring mothers at home to establish how far into labour they were and supported them to labour at home as long as they wanted. If the mother wanted to transfer at the start or any other point during labour, the midwifes took her in to hospital.

They saved a packet of money plus the homebirth rate rocketed with happy unexpected home birthing mothers.

Wish I remember where I read it, any ideas ?

Firstly I agree with you that MLU services should be shut rather than the homebirth, personally I think all resources and money given to MLU units should be channeled to hospital labour wards as why should some who say has had an c/s or high BP miss out on nice lighting and more comfortable surroundings - we should be working toward providing this for every labouring woman rather than the chosen few.

Secondly NONE of those categories of women NEED a homebirth, there are always ways, incl ambulance. None of those women would DIE if they didn't have homebirths.

How do you know the unexpected homebirths were "happy"?

"Secondly NONE of those categories of women NEED a homebirth, there are always ways, incl ambulance. None of those women would DIE if they didn't have homebirths."
Proof please

"How do you know the unexpected homebirths were "happy"?"
The article said so and the woman had chosen during labour to stay home, they could of transfered at any point and choose not to

If the midwife led units are closed as we both agree it is a waste of money. Why shouldn't the existing services of consultant led and home birth be run alongside each other ?

Those categories of women would be unable to come into hospital and by denying them a midwife during labour, in most cases would end up with these women free-birthing.

It is like trying to ban abortion, it does not go away it just gets more dangerous and undercover and the mothers-to-be and babies suffer.

People who are planning home births rarely do so as they just fancy a change. They do it because they have very strong and often compelling reasons and have the safety of themselves and their child at the heart of this decision.

Hospital is not the safest place to give birth for all women.

Right you are the one who said they would die but I have to provide the proof they wouldn't? oookkkkk.
They can ALL get to hospital they just choose not to, just take your first example where you say fast labours, well if the ambulance can't get them to hospital quick enough then the m/w wouldn't get out to see them quick enough either so they would still have an unassisted birth.

Well if the article said so.... (even tho I do agree that a midwife should be sent out to every mother the moment they phone in and say they are in labour that type of resource and/or funding just isn't readily available)

I AGREE that the two SHOULD be able to run alongside each other but IF there is a lack of midwives surely the hospital takes priority?

If the midwife led units were closed there will be enough resources to keep the consultant led unit and the community midwifes going.

Community midwifes are locally based and can get to a labouring women much quicker than an ambulance. Plus ambulances are highly trained medics but they are general medics, not highly trained in one specialism like midwifes.

Having all the ambulances taken up with labouring women is hardly likely to improve the situation.
As a labouring woman can not be forced into hospital, an attending paramedic would be required by his/her duty of care to the patient to stay at the home if she refused to leave it. Much cheaper and easier to send around a community midwife.

The other thing no one has considered yet, is that the community midwifes have chosen to work in the community supporting homebirths. Would they move to the hospitals to work ? I know the simple answer is if they want there jobs they will have to, but will this result in midwifes leaving the profession or moving into other home birth friendly areas ? Just a thought.

I think it's unfortunate that home births have been temporarily suspended but I agree it;s not the end of the world.

If you feel that strongly then you can pay for an independent midwife, not ideal but is an option.

"If you feel that strongly then you can pay for an independent midwife, not ideal but is an option."

So every labouring woman in Sussex has the money to pay for an independent midwife ?

I certainly don't have the money, if our area put this policy in place, I would be free birthing and sadly legally that would probably involve cancelling my doula and sending away my husband so no one gets in trouble. Not a very welcoming thought

I just feel for the Sussex women that this policy will affect.

I agree it's not great as I said but I don't think they should 1) compromise on cover at the hospital or 2) have to pay lots extra for extra cover if this is a short term issue. The NHS is stretched enough, people can't get lifesaving drugs because of costs therefore this is a temporary expense that can be avoided.
I'd rather someone who needed lifesaving treatment got it than I got to have a home birth, is that so unreasonable?

Again, if people feel that strongly about it, pay for it.

It's short term, if that changes and becomes long term start the fight then.

thisisyesterday I also had a homebirth in West Sussex 9 months ago!

I also had a hb with my first 5 years ago.

Both great experiences.

I agree with the poster who predicted chaos on the wards if there is no hb service.

With DD I was told that there was nobody to come out to me and that I would have to come in. I was then told that there was no room on the labour ward. So where were they going to put me!?? I eventually persuaded them to come out. 3 hours later DD was born, fed, house cleaned and midwives back on the ward. To my mind this was an extremely effective use of resources. I would have been more of a problem had I gone in.

Tootlesmummy,
You have it the wrong way around, they are cutting back on the home birth teams to cover the hospital.

The NHS is stretched enough, people can't get lifesaving drugs
Yes, yet despite this we still fund IVF treatment and cosmetic treatment on the NHS, surely this should be axed before home birth cover is stolen to cover the shortages on the hospital wards ?

"I'd rather someone who needed lifesaving treatment got it than I got to have a home birth, is that so unreasonable?"
That is not the choice. Already people do not get life saving treatment on the NHS Cutting the home birth service will not magically increase the pot for lifesaving treatment, it just deprives more people from having NHS treatment.

BE you can free birth with your husband or doula there, I am led to believe.

What a doula or husband cannot do is act as a midwife.

they could do whatever it took to make you comfortable and support you. In fact, they can do anything that birth partners do when they are in a hospital with you.

they couldn't for example start to take your bp, do a VE, monitor the baby's heart beat, or do any other medical interventions.

as for home births being a luxury, I'd like the poster who stated that to define how she has arrived at that conclusion.

Thanks foxytocin. I welcome your correction So people can act as non medical supporters without getting into trouble ? Good to know.

On a purely selfish point of view, I am concerned if Sussex is not challenged legally and soon, other trusts will follow suit and my hospital has a terrible home birth rate as it is

Suspending a HB service seems like a poorly thought through, knee-jerk response to a problem. I can see the dilemma, but I'm unconvinced this is the best solution. One of the reasons we were given against booking an NHS HB was that if the CMW were too busy or called in to the ward we might have to transfer in - the more times the HB service is suspended the stronger this argument appears. But then the more women that are put off even booking a HB the easier it is for the PCT to say there is no demand for the service and the easier it then is to cut... I can sympathise with the PCT, but it concerns me.

Re. the legal implications for birth with no MW, sadly I think its still a grey area. This link came up recently in another thread, from which I've taken the quotes below. The letter of the law comes form the 1902 Midwives Act and states that:
----
16. (1) A person other than a registered midwife or a registered medical practitioner shall not attend a woman in childbirth.

(2) Subsection (1) does not apply -

(a) where the attention is given in a case of sudden or urgent necessity; or

(b) in the case of a person who, while undergoing training with a view to becoming a medical practitioner or to becoming a midwife, attends a woman in childbirth as part of a course of practical instruction in midwifery recognised by the General Medical Council or one of the National Boards.
----

This was clarified in a letter from the DoH to an MP in 2002, which said that:

----
'Attending a woman in childbirth, as opposed to general support given by partners and relatives, has been an offence against the protected function of midwifery since the Midwives Act 1902 and the fines are set at a level to reflect the seriousness of the offence. By 'attend' we mean, 'assume responsibility for care' and this is not intended to outlaw husbands, partners and relatives whose presence and support during childbirth are extremely important'.
----

To me that's still clear as mud for instances where it was planned for the birth to happen with no MW present. I asked my IM earlier out of curiosity and her opinion was that doulas and other birth supporters (including DH's) would still need to be extremely careful. I don't think there have been any cases since the 80's, when a husband was prosecuted after declaring in a hospital that if they wouldn't support his wife at home (who, IIRC, had had an extremely traumatic first birth in hospital) then he'd do it himself. The verdict caused outrage amongst the medical profession, who felt he had been treated very unfairly, but I don't believe the decision was overturned. I wouldn't want to be involved in the test case that used that letter as the defence

I hope everyone gets the support they want/deserve/need to allow them the lowest stress and most straightforward birth possible

My SIL is one of those naughty East Sussex midwives on maternity leave. She was pregnant for 9 months - did they not have the foresight to anticipate that she wasn't going to be there and to cover her ? It's not as if maternity leave comes as a suprise to employers is it ? Especially a maternity unit.

I am in East Sussex - we previously had one of the highest homebirth rates in the UK and I am shocked by this news.

"Sorry, and quickly I want to add I think homebirths should if at all possible be funded by the state, but if they are then it is a luxury not a necessity"

By that argument you obviously think women should pay for epidurals then - they aren't a necessity after all. Or IVF or all other manner of non-necessary treatments that the NHS funds.

No I'm not missing the point, I know they're cutting the home births team to cover the hospitals and rightly so.

And the point re drugs is a principle. The NHS is already under pressure and making cuts to life saving treatment as a result and other areas are also having cuts so why not this!?

No, they won't spend more on life saving treatment as a result of this but if they spend more to cover this service and have to make other cuts where will that come from?

The question of IVF is purely selfish, just because you can give birth you think that gives you more rights than someone who needs help to conceive (and I'm not someone who thinks that you should get multiple goes etc but I don't think it's right that people don't get at least one).

Cosmetic surgery is only meant to be available when the person is at risk of depression or harming themselves so again why should they miss out because you want not to have your options taken away! .
I've said I sympathise but as it's short term I think it's selfish to deny others because you want a choice when others don't have them.

I'm not sure I understand how closing MLU would save money. Up here in Tayside there is only one CLU, in Dundee. All the other towns in quite a large radius have MLU only, and mothers have to transfer if required. It seems to work well (I realise that the population up here is not so dense as Sussex).