‘Crisis’ in maternity care leaves expectant mothers facing difficult births in hospital or without support at home
A severe shortage of midwives has led to home birth services being closed or reduced by a number of hospital trusts across the UK, with pregnant women frequently left in limbo as to where they will be able to give birth.
The Observer has found more than 20 trusts that have had disrupted home birth services in the past three months. Eight confirmed their services remain suspended due to staff shortages. They include East Kent Hospitals, Swansea Bay University Health Board and NHS Dumfries and Galloway – all of which report that the situation is under constant review.
Home birth services at some trusts, such as Walsall Healthcare NHS Trust and University Hospitals of Derby and Burton, have been closed since August. Others have reopened after short suspensions or have written to expectant parents to say they cannot guarantee sending a midwife when there is high demand or staff shortages.
The findings come a week after midwives across Britain staged protests to call on the government to address the “crisis” in maternity care, with staff suffering from chronic burnout and stress.
Midwives are being driven out of the NHS by understaffing and fears they cannot deliver safe care, according to a recent survey published by the Royal College of Midwives (RCM).
Maria Booker, programmes director at the charity Birthrights, said: “Staffing pressures in maternity services are very real right now. But for many women the option to give birth at home is not a luxury but the only option that feels safe to them.
“Some know they will labour better at home while some do not want to visit hospital during a pandemic. Others have a had a previous traumatic hospital birth. We cannot just accept that home birth and other choices go out the window every time a maternity service is squeezed.”
Rosie Gothard’s baby is due on 5 December. Because her local birth centre has been closed since January, she opted for a home birth. She said: “I had my heart set on it but then, in July, I was told Maidstone and Tunbridge Wells had suspended the service. They kept saying it would return soon but this has not happened. I feel lost and can’t plan for my birth.”
She is now considering another birth centre an hour away from her home. “It feels like my reasonable choices have been taken away and I’m not comfortable with the remaining options. An hour is too far to travel when you are in pain but I want to avoid the potential consequences of a hospital birth which include an increased risk of medical interventions and the possibility of catching Covid-19.”
Katherine Revell from the patient advocacy group Aims said: “We’ve had lots of people copying us in on letters to trusts that have suspended home birth services. Some are finding out very late in their pregnancies, which is really distressing. One woman found out at 40 weeks and in the end she had an unassisted birth at home.”
She said Aims has seen an increase in women turning to freebirth – a birth without medical assistance – after trusts had told them they could not guarantee sending a midwife on the day of their birth.
Revell said: “That can be an empowering decision but if you don’t plan for it, and you are expecting someone to turn up, that can be a traumatising event.
“The midwives are trying their hardest but they are incredibly short-staffed and some people on the day have rung up in labour and been told there is nobody free to attend.”
Katya Selzer, from Olney in Buckinghamshire, was planning a home birth under Milton Keynes University Hospital: “The care during my pregnancy from the home birth team was wonderful. But in the run-up to the birth I became concerned about home birth suspensions in other regions.”
She wrote to the trust expressing her concerns. “I was told it would be a very rare scenario that nobody would turn up on the day.” But when she went into labour ahead of her son’s birth on 17 October, there were no midwives free. “We decided to stay at home for as long as possible because the labour was going really well and we hoped they would find somebody to send,” she recalled.
But when this didn’t happen, Selzer and her husband, Henry, felt their only option was to call an ambulance. “Despite being told to come in when I got there, I had to wait in a wheelchair in the corridor for an hour,” she said. By this point her labour had slowed down and she was told she would need to be induced. “This was everything I had wanted to avoid. I had an epidural and, after trying to push the baby out, was taken to theatre where I had a forceps delivery.”
While in hospital, Selzer was acutely aware of the pressures facing staff and alarmed at the lack of resources. “At one point, there were only two midwives on duty for the whole postnatal ward. They were apologising and it was heartbreaking what I saw. I felt sorry for midwives who have to go to work under those conditions.”
A spokesperson for Milton Keynes University Hospital said: “Due to the unpredictable nature of demand for maternity services, the hospital’s labour ward can quickly become very busy, with more women than expected arriving in labour.
“When this happens, the home birthing service is temporarily stopped. This concentrates midwifery staff on the labour ward. We explain this to every woman who books a home birth, so they are aware their plans may need to change to ensure they, and other women in labour, receive safe care.”
Birte Harlev-Lam, executive director at the RCM, said: “Despite the best efforts of maternity and other health staff, occasionally home birth services need to be suspended, often only for a few hours, but with an inevitable impact on women in labour. Suspending home birth services is only done as a last resort to ensure safe care for women.
“In recent weeks, pressure on ambulance services which support home births in case of emergency, has been intense. Similarly, we have highlighted the fragility of maternity services, where chromic understaffing is being exacerbated by burnout and illness. Despite the challenges, most trusts and boards have kept their home birth services running, which is a testament to their commitment to ensure continuing choice for women.”
The Department of Health and Social Care was contacted for comment.