Home births

I heard a piece on the Today programme about home births. It was a follow up to a statement from the Royal College of Midwives. According to these various reports, only 2.4% of women in England have home births, because they are being scared out of it.

It made me think back to a period when I used to do night calls for a GP locum agency. At the time I also worked as a GP part time, but I didn't do home births. One night I was called up by the agency and asked to see a woman who needed sutures, having delivered a baby at home. I protested somewhat, on the grounds that I didn't sign up for that sort of thing, but they insisted that no one else was available. In the end, I went to the agency to collect a suture kit.

I found the house OK and was shown into a bedroom upstairs where a woman was lying in a big double bed, with a small baby lying in a little cot. The lighting could best be described as romantic, certainly not bright. There appeared to be no way of getting it to be any brighter. Luckily, I had a big torch. Usually I used it to be able to see house numbers from the car. It is surprising how small some people make their house numbers. No doubt they are discrete and artistic, but damn hard to see from the road.

Any way, there I am staring at this woman lying in a double bed that sags a lot in the middle. If she moved, it sagged wherever she lay.

I'm not going to go into the gory details as to exactly what has to be sewn to what, but it needs both hands to do it, and you can't hold a huge spotlight in your teeth.

With the torch balanced on the bed, I started off by putting in as much local anaesthetic as I had, because the last thing I needed was the poor woman to feel anything as I worked.

Of course, the main effect of the local was to remove any anxiety from the woman and transfer it to me.

Cold beads of sweat really do run down your back.

It all went together very well; maybe it was a good thing that I did more than 80 episiotomies when I was a medical student. I also worked Monday nights in a busy casualty department for five years and learned a few plastic surgery techniques. So, as far as I could see by the light of a powerful torch, it all looked beautiful.

That's when the really scary thing happened. As I was clearing up, and to the accompaniment of a very small gurgling baby the lady said, 'I had my last baby in hospital and it was awful, and really painful being stitched up. This time it's been lovely and I didn't feel a thing when you did the stitches. I'll definitely have my next baby at home.'

That woman was making a rational choice, based on the information that she had; information seriously distorted by all the local anaesthetic that I had available.

She wasn't scared - I was.

I’m not sure whether it is mothers who are scared into hospital delivery or doctors who are scared out of home births.

I am sure there are midwives who will say that doctors are not needed for childbirth, which may be true enough so long as all goes well. The real problem is that a whole system is needed and successive governments seem to be doing their best to break everything up into little pieces that are bought and managed separately.

If we really want to know the right number of home births and give mums and families the choice they should have, then we all need to work together. Any chance of that in 2011?