Home or away?

MORE women may be able to give birth at home as the Government seeks to extend choice in the health service to maternity services.

Health Secretary Patricia Hewitt is said to be ready to "challenge the assumption" that the safest place to give birth is hospital.

She is understood to have commissioned a report to examine the latest evidence on home births, with a view to making them more available.

The Department of Health denies that there has been a shift in policy, as was reported in some quarters.

A spokesperson said: "The Government's vision for maternity services includes choice for all women over where and how they give birth, and what pain relief is used.

"This was laid out in the 2004 National Service Framework for Children, Young People and Maternity services, and underlined in last year's manifesto commitment."

Whether it is a policy shift or not, the widely-reported move raises important questions about childbirth and the NHS. Such as: which is best place to have your baby - the familiar surroundings of your own home, or a hospital where there is specialist medical care on hand in case anything goes wrong?

And, even if more women were to opt for home births, would there be enough midwives to go around?

In the York area, only two per cent of women have their babies at home, according to Margaret Jackson, head of midwifery at York Hospital.

That is despite evidence that, provided you are healthy and your pregnancy is progressing normally, giving birth at home can be slightly safer.

Clearly, Margaret says, if there are complications during pregnancy, or concerns about the mother or unborn child's health, hospital will be the safest place to have your baby.

"But if you are low risk, it is safer at home than in a unit," she says. Having your baby in hospital, for example, always exposes you to the risk, however small, of picking up an infection.

Women who give birth at home, in familiar surroundings, also seem to cope with pain more easily, and are less likely to want pain relief, Margaret says.

There are even indications that the less medical intervention there is during pregnancy, the less risk there is to mother and baby.

In the end, Margaret says, the best place for a woman to give birth is the place where she herself feels safest and happiest.

Women in York are offered the option of home birth, provided they meet the right criteria and are not considered at risk of complications.

Margaret accepts that women who have planned for a home birth are sometimes asked to come into hospital to have their baby - simply because there are not enough midwives to go around.

That figure of two per cent of home births is in line with the national average, she says. "But I think there are some women who would like a home birth if it was more widely available."

She would broadly welcome a Government move towards encouraging home births. But it would have to be accompanied by an increase in funding to allow the training and recruitment of more midwives, she says. "At the moment we would not have a sufficient number of midwives to be able to fully provide that service for the number of women that might want it."

Private midwife Chris Warren, of Yorkshire Storks, is a firm believer in home births.

She agrees with Margaret Jackson that the best place for a woman to have her child is wherever she feels happiest and safest. If a woman wants to go to hospital, she says, that is absolutely fine. But if she wants to give birth at home, she should have that choice.

"There are enormous benefits to home birth," she says.

"The main one is simply the fact that most women are more relaxed at home than in hospital, because home is .... more homely. It is not an unknown, alien environment. You can go to the loo when you want to go to the loo, and you don't feel you have to ask permission.

"There's also the fact that while your home is not always cleaner than hospital, at least the bugs you're exposed to are your bugs. Ones that you're used to."

But what about the mothers themselves? Where do they feel is the safest place to give birth?

We spoke to one woman who has just given birth at home and another who has just had a baby in York Hospital.

Home birth

Kirsty Kennedy's first child, Oliver, was born by emergency caesarean at York Hospital in 2004.

While it wouldn't be possible to love Oliver any more than she does, she says, she realised that when she became pregnant again, she wanted a different, more natural experience second time around.

There were concerns, however, that if she gave birth naturally, there would be a risk of her scar from Oliver's birth rupturing.

It wasn't until late in her pregnancy that she was given the all-clear for a natural birth, and decided to have her second baby, Tabitha Honey, at home in Bishophill. "I'm perfectly fit and healthy," she says. "Labour progresses better if you are relaxed, and there were some aspects of hospital that I knew were going to make me quite frightened."

She had read up on the matter and was convinced there were other benefits to a home birth, too. For a start, she says, the risk of problems developing is lower if medical interventions during birth are kept to a minimum.

She also wanted the reassurance of knowing that she would be able to have her midwife of choice - private midwife Chris Warren, of Yorkshire Storks - with her throughout childbirth. "They couldn't guarantee who I would see if I went into hospital."

In the event, despite worries caused by the fact she had to have an emergency caesarean first time around, everything went smoothly. Her contractions started about midnight on November 10, and she went into labour at 3am. Chris was with her throughout, and Kirsty used a pool and a TENS machine, which uses electrical nerve stimulation to ease pain, to control the pain of labour.

Tabitha Honey arrived at 11.15am, weighing a healthy 9lbs 5oz. The most astonishing aspect of the experience was its ordinariness, Kirsty says. "It was an amazing, unbelievable, magical event, as births are, but in these really ordinary surroundings."

She slept in her own bed that night, she says. And even better, Oliver never had to put up with losing his mum while she went into hospital. He went out to a local park with his grandparents in the morning - and when he came back, he had a little sister.

She's not sure she's going to have another child, Kirsty says. But if she did, she'd opt for a home birth again.

Hospital birth

Heather Pronk's aunt is a midwife. And when the 30-year-old customer services assistant from Osbaldwick became pregnant with her first child, her aunt suggested she have the baby at home.

Heather was having none of it. "I wasn't interested," she says. "With it being my first one, we didn't know what to expect. And I felt if there were any complications, hospital was the best place."

In the event, there were not complications. Heather arrived at York Hospital at about 9pm on May 3 this year, expecting her baby to be born the following day. Little Noah Jay, however - who was by this time already four days late - arrived at 11.14pm after a two-hour labour.

It may have been a short labour, says Heather, but it was very painful - even with the help of medication. Her husband, civil engineer Mark, stayed at her side, calming and comforting her. "I wouldn't let him go!" Heather jokes. When Noah Jay put in his appearance, however, it was all suddenly worth it. "It was so quick, I didn't know it had happened."

Heather and Noah had to stay in hospital because Noah wasn't feeding properly. But the midwives and maternity staff were brilliant, Heather says. And it was nice to have other mums around her on the ward. "You knew you weren't on your own."

With Noah being her first baby, Heather says she'd have been too nervous to have him at home.

What about if she had another baby? Would she opt for a home birth second time around, if she had the chance?

She pauses for a moment. "Possibly," she says. "But my husband says no way! He's quite a worrier, and he thinks that if something does go wrong, you're in the right place in hospital.

"So I think I would probably stay with the hospital, if that puts his mind at rest."

Midwives welcome new 'support'

The Department of Health may be trying to play down the idea of a "policy shift" over childbirth, but the Royal College of Midwives has welcomed what it calls the Government's "renewed support for home births".

RCM general secretary Dame Karlene Davis said: "Women should have the freedom to choose how and where they give birth, including in a midwife-led birth centre and at home. This will benefit the majority of women, who are able to have a normal birth, but at present are denied the choice mainly because of ongoing staff shortages.

"The Labour party promised choice in their general election manifesto last year and it appears that they are now moving towards delivering on that. But this will remain rhetoric without making sure working midwives can deliver this on the ground and that NHS Trusts are not diverting resources elsewhere."