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

"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"

Maybe elective c-sections should not be funded by the state. Many women in the past have given birth to breech babies vaginally.
If pain relief was not provided on the NHS then there would be no cascade of intervention. Our births would be throughly active as as we would be rolling about in agony just as nature intented.

Or maybe we should start charging for drunks who turn up at A and E, or a supplement for those who are obsese and cost the nhs more. Where would all this end?

I would like to see laws to limit the amount that people can sue for litigation with the nhs. There needs to be a cheaper way of assessing compensation claims for mistakes without making the lawyers rich. I would bring partial crown immunity for the nhs and get rid of no claim, no fee lawyers sueing the nhs.

Then we would have more money available for care and more money available for victims when things go wrong.

Providing a range of birth choices, including elective c-sections or a homebirth is about maximising safety. For some women an NHS homebirth is the cheapest and safest option. I am glad that my daughter was delivered by a community midwife and not a paramedic.

This always makes me laugh because when we are talking about state schools people argue that others shouldn't be allowed to buy their way out of bad schools and everyone should have the same choice, a level playing field.
And yet when it comes to the NHS which is also funded by us the tax payer it's a case of the very basic service is acceptable and if you don't like it pay to go private
What about all those people using independent midwives that aren't supporting the NHS and campaigning to make it better or does this situation not suit the socialists argument ?

We were planning on hiring a doula for our home birth, seeing her later and will discuss the way forward then, but at our initial meeting she said she has training in how to be present at a birth and not take responsibilty, but assist the mother with positions etc if the midwife doesn't arrive on time.

re independent midwives, we have considered this and it would cost £3000. there are not that many of them around, so I would think it unlikely that every woman in sussex would be able to get hold of one. I rekon they'll be booked up pretty quick.

I don't think homebirths are essential, but I also suppose that at a lot of births having 2 midwives is not essential. And it's not unheard of to have no midwives. So it is a case of where to draw the line really.

"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. "

Yes of course epidurals are luxuries and if the anesthetist is not available then the woman doesn't get one, in this case the midwives are not available.

I am not arguing what should or shouldn't be in place in a PERFECT world, I am saying in THIS INSTANCE there is a shortage of midwives and in this case homebirths become a luxury. If you choose to endanger the life of your child by free-birthing then that is your choice.

"If you choose to endanger the life of your child by free-birthing then that is your choice."
No, I will be informing my hospital in writing that I have discussed everything with their consultant and he agreed that we are planning a home birth and to give them notice of need of a midwife. If a midwife is not available on the day it is my hospitals choice not mine.

sorry, don't have time to catch up with this right now but:

babieseverywhere you said
"Community midwifes are locally based and can get to a labouring women much quicker than an ambulance"

erm NO! I am in Sussex. During the night/at weekend there are only 2 community midwives on call. They cover a VAST area, they may be over an hours drive away from you.
If it is at night they have to meet at the local hospital, collect equipment and arrive together.

At my last (planned!) homebirth the ambulance arrived about 10 minutes after ds3 was born, and the midwives another 6 minutes after that.
We were told by the delivery suite to call an ambulance if I needed to push before they arrived because they knew it would be at least 45 mins to an hour before they got to me.

Libra there was a time not long ago when homebirths were the norm and hospital births were a luxury.

Moving the vast majority of births into hospitals did not suddenly begin to save lives. Good antenatal care, better health and education for all, and the availability of midwives made the death rates of women and babies drop decades before we moved birthing to hospitals.

Should I, by this recent history and recent ressearch, tell all those women who are having normal low risk pregnancies that they ought to give birth at home because giving birth in hospitals is a luxury?

I don't think so. Giving birth in a hospital is also a choice, not a medical necessity.

if they have the money to do all the caesarians they are doing, how can they possibly not have he money for homebirths?

and for both my HBs (in West Sussex) the second MW only turned up at the last minute - in total staffed hours much less time/expense than if i had been taking up a room in hospital.

HBs also progress faster and with less (expensive) intervention (think about it - epidural = anasthesiologist has to be there & cost of drugs/ equipment) - cancelling HBs is the last thing they should have considered.

I actually think this will have more to do with some consultants opinion about hmebirhs than someone actually having crunched the numbers.

I expct some ladies close to the border will be booking their HBs with hospitals in West Sussex/Kent.

Oh, and community MWs on a roster turned up - no-one was taken off the ward to attend my deliveries.

I'm not in the UK at the moment, and I've been researching my options in the two countries I might end up giving birth. Since I'm paying for this, I know the costs involved - and a hospital birth (with only one night stay - it goes up for longer stays) is more than twice the price of a home birth in either country.

Home births are cheaper - there's no way anyone's subsidising any part of my care.

Besides the cost implications, for a normal birth you are increasing the risk of medical intervention for these women - you are actually endangering them. Home birth is not a luxury, it should be the ideal for a normal birth.

It seems to me that a home birth is cheaper than a hospital birth, the number of births won't decline as a result of this measure and so the number of hospital births will increase markedly, so those births are going to cost a lot more overall that running a normal service. I'd be interested to see a comparision between suspending home births as a solution and using bank staff to maintain the hospital service rather than pulling in the community midwives.

That is another of my concerns missedith, no fewer babies will be born, and with no homebirths more people will be on labour/postnatal wards.

The options for me are a MLU, hospital or home. I guess the MLU will fill up pretty quick, and I dread to think what it will be like on a hospital ward running at a higher than normal capacity. I can't see it as being a wonderful experience at such a special time!

Fantastic discussion.
I think it is interesting to note that the hospitals involved stated staffing levels as the reason for the suspension. However, a midwife from the unit stated: 'The birth rate is increasing, the number of midwives being employed is decreasing and there is no more money in the pot, so we are told.The commissioners, PCTs will not free up any more money for maternity services within our area.'

So if it is a money issue should the hospitals not get rid of non-essential expenses first i.e. elective caesareans, epidurals, non-essential inductions etc.

I find it interesting that many women still consider homebirth a luxury rather than the proven way for low risk women to have better outcomes. Less instrumental deliveries, caesarean births and less Special Care admissions for babies.
Can you imagine how much money this would be saving?

And we know what the outcome of overstretched hospitals is: huge increases in sections rates! See Brighton as an examples - they ended up with over 30% section rates last year!!!

Funnily enough my MW is actively encouraging me to go for a HB, and apparently it is because the local ward is constantly full. I had to give birth on the antenatal ward last time, and with a labour of only 5 hours a HB might be my best option this time. I was just surprised by how much she was lobbying for it.

"No, I will be informing my hospital in writing that I have discussed everything with their consultant and he agreed that we are planning a home birth and to give them notice of need of a midwife. If a midwife is not available on the day it is my hospitals choice not mine."

No it's defintely your choice and any outcomes will be your responsibility to bear. You do know that going to hospital doesn't HAVE to mean intervention? You are an adult and can have the confidence to say no to them to monitoring or internal examinations or anything else you are so scared about in hospital.

Again I think homebirths should be finded by the state but if there aren't the staff/resources then describing a perfect world scenario isn't going to get you anywhere.

And we know what the outcome of overstretched hospitals is: huge increases in sections rates! See Brighton as an examples - they ended up with over 30% section rates last year!!!

this is why plenty of Brighton mums book into Worthing....

agree - if the issue is money, why aren't they looking at reducing inductions (NICE guidelines say not bfore 42 weeks just for over-term - yet i met many women induced before then without any good reason)

ultimately - the same number of women are going to give birth. This is tantamount to admitting that they are going to be on their own, labouring strapped to a machines, in hospitals, instead of receiving the care they deserve.

That's sad. It always makes me feel a bit stressed the thought of not being able to get a home birth.
I had very very fast labours, one bba, and I needed midwifes with me asap. I don't know what I'd have done if I'd had to find a midnight baby sitter and get to hospital first.
I hope they reconsider.

"it's defintely your choice"

Well, if it really is my choice, I choose that a midwife will be available...simples

once you are pregnant, past a certain point - you are going to give birth whether you like it or not.

hardly a choice is it?

I don't think wanting a HCP of some kind to be there is a 'luxury' option.

in countries where resources are very limited - they send a midwife round on a bike. that is the basic provision - how can anyone here call a home birth a 'luxury?'

I am fairly sure that all women in the UK have the right to birth in the place of their choice, and hospitals have a duty of care to a mother in labour, irrespective of where she is labouring, and how many staff are in the department. As such, if you are having a (planned) homebirth and you ring the labour ward to request a MW to attend you, if they try the "there aren't enough staff, you'll have to come in" line you just tell them you want a MW, you know that you are legally entitled to a MW and expect them to send one and they are breaking the law if they don't.

Surely the same applies here? Legally, can they suspend the whole service? They have a legal obligation to provide midwifery care in hospital and in women's homes. Homebirth is not only legal in the UK, it is one of our rights. Surely suspending the whole homebirth service is breaking the law?

I beleive if you refuse to go in to hospital, then they WILL send someone. But whether they do it in time, and whether they send someone from the labour ward or call in someone on their day off, I don't know.

I think one of the issues is that if a community midwife has been up all night for a home birth, she needs the next day off and someone has to cover her appointments.

I hope you are right, GreenMonkies. It does not sound legal that they can cease (even temporary) such a vital service.

Especially as the women it will affect in the coming months, would of got pregnant in the knowledge that there is a home birth service.

According to Birth Choice UK we have the right to homebirth.

Also, Home Birth Reference Site say it's our right too.

Again, here the Good Birth Company says;
"you have an absolute right to choose your place of birth, regardless of perceived risk, and at all times, even in labour, this remains your choice. The issue of a legal right to home birth has become a bit complicated recently, because there is no right in law for women to give birth at home, and the Department of Health has issued advice to NHS Trusts saying that they should provide a home birth service "where practicable" rather than insisting that they provide one. However, the bottom line is that in law no one can be compelled to attend a hospital for treatment or care, and that includes birth. Furthermore, the rules of conduct for midwives say quite categorically that no midwife may refuse care to a mother in labour. Due to midwifery shortages some hospitals tell women who book a home birth that if the hospital is short staffed when the woman goes into labour, they may have to come into hospital to give birth. This is not true, and if you are told this, you could write to the hospital and tell them firmly that you have no intention of coming in. Alternately, if you are in labour and are being told to come in, you can simply tell them you are in labour and you expect care and put the phone down. They are obligated to send someone to care for you. This might seem stroppy, and you might feel worried about being seen to be "awkward", but birth campaigners say women who assert themselves do not receive poor care nor hostility from their carers, but rather, quite the opposite. The Association for Improvements in Maternity Services (AIMS) has produced a sample letter which they suggest women send if they are told the "you have to come in" story or are asked to sign a form saying that you will come in, in the event of staff shortage."

So, by the looks of it, if they do withdraw the service they may not be breaking a law as such, but if they refuse to send a MW to you when you are in labour, they are. Which says to me that in theory they are breaking the law on an individual patient-midwife level.

well, i had one appointment cancelled for that reason, but it was just a standard MW appointment and non-urgent. so no problem. And my Mw did 2 the night dd was born, and there were 3 on the day DS was born...

I am comforted that there is a get out, as i have often wondered what would happen if i was told 'oh, we don't have anyone'...

Enough letters written to this trust and they will have to reinstate. I'd copy them ot your MP and AIMS.