Call us, say midwives, as they back home birth advice

Over coffee and hobnobs at their kitchen table, eyed by a greyhound called Jim, first-time parents-to-be Poppy Mardall and Chris Pensa are discussing babies, birth and umbilical cords with a community midwife from St George’s hospital in Tooting, south London.

The couple say they took a while to decide what kind of birth they wanted, before finally deciding on a home birth. Some 2% of all births associated with the hospital are done this way.

“We struggled with which ‘camp’ we were in – do we go for a full-on hospital birth?” says Mardall, 31, who runs a modern funeral company. “We’re pretty laid back, but we’re not, like, vegans. But we decided that we feel safe and happy in our home, so why not here?”

Guidelines by the National Institute for Health and Clinical Excellence, published on Wednesday, now recommend that all women with low-risk pregnancies, some 45%, give birth in a midwifery-led unit and, for non-first-time mothers, at home.

Chris and Poppy are having their first meeting with Gloria Green, midwife and acting leader of the four-strong Rainbow Team, responsible for around 100 births at St George’s last year. Green, a chatty, caring professional with 20 years’ experience and a wide and ready smile, quickly gets the couple talking. They are sold on the idea of having all their ante- and postnatal work, including blood tests, done at home and the continuity of care that the community midwives provide. Each mother-to-be has an antenatal visit every four weeks from the same midwife who will, unforeseen circumstances excepted, deliver her child.

Green tells the couple that 98% of their mothers choose a water birth, “because it’s fabulous, a natural pain relief and causes less trauma to the perineum”.

Within minutes, they are discussing who will cut the umbilical cord. “Chris is going to be a great dad, but he has a mortal fear of belly buttons, so that’s not going to happen,” says Mardall, who is 27 weeks pregnant.

The conversation generates a lot of excitement. “It’s almost as if when this [home birth] became an option it made the birth very exciting,” Mardall says.

Chantelle Winstanley, a consultant midwife at St George’s, says the new guidelines support what they are already doing. “For midwives, they are preaching to the converted,” Winstanley says. She cites the Birthplace study, published in 2011, as providing the first evidence that “having a baby at home or in a midwife-led unit was as safe or in some cases safer than going to a central delivery suite”.

Winstanley says women giving birth in midwife-led centres and at home will “be less intervened with and have better outcomes psychologically, socially and clinically. The model of midwifery care is that we look beyond the statistics of so-called ‘normal birth’.

“By socially we want mum and baby to be in the most optimal physical and mental health to promote bonding. When a woman feels empowered in her labour she feels free to express what her body is designed to do. There is less fear and less chance of a caesarean.”

For Green, fuelled on lemon drizzle cake baked by her patients as she drives around Wandsworth in her battered mini Mercedes, it is this aspect that makes her job so appealing. She leaves Mardall and Pensa with the words: “It’s going to be fun.”

“Job satisfaction is very high in this team,” she says, as we leave to go to her second visit of the day. “Aren’t they lovely? How interesting, you learn a lot from people in this job.”

Green, who organises home birth tea parties once a month as a way of helping mothers network and meet other midwives, and has even set up a Facebook page for mothers, says “continuity of care” is a big attraction for many women who want to give birth at home. Even on her days off, Green will deliver a baby if she gets a call from one of some 25 patients she looks after.

Her next port of call is to the home of Jessica and Steve Copstone, who are recent parents to Asher, 12 days, and Ziva, almost two years old, both of whom were born at home. Ziva, a water birth baby, was born in six to eight hours while Asher took four.

“How are the boobs?” says Green to Jessica, after hugs are dispensed. “What do you think, Steve?” she asks, seeking his advice as to whether his wife should take medication as a precaution for a problem.

As Green weighs Asher, Jessica, 34, a complementary therapist, talks about why she opted for home birth: “I’m a therapist so I try to do things naturally. Hospitals stick to protocols, they have pressure for interventions, and I think that you need flexibility. But I had heard so many wonderful things about midwives giving you more time. I don’t want to do down hospital birth. Midwives are amazing anywhere. But birth is so natural and yet so complicated, it’s not easy to standardise. At home, you get the same midwife through all antenatal and postnatal appointments and through delivery. They understand you. If I’m panicking and saying: ‘I want an epidural,’ she might say: ‘Just hang on.’”

Jessica said the key moment for her decision was Green telling her that she was always thinking half an hour ahead. “The fear is like: ‘Oh my God, what if I start haemorrhaging?’ But an excellent midwife can see things that start to deteriorate. They are on the lookout. Gloria is always half an hour ahead.

“Giving birth is an overwhelming feeling and you can start to panic. I wouldn’t say it was completely pain free, but it was without a scratch. Everything’s intact.

“I believe a lot of that is about being relaxed. If I want to get into my dressing gown, it’s my dressing gown. He is wrapped in my towels. If I need anything to eat, I can get it from my own fridge. We even had Ziva here – she got up at 5.30am and came downstairs and we stuck a video on. There was no need to make arrangements for her while we were away.

“If things start to go wrong, they would transfer you to hospital.

“I have had two perfect births and wonderful babies and I’m convinced it is down to the quality of care. And this is the NHS. These are NHS midwives, which gives you extra confidence.”

Last year, 5,000 babies were born in St George’s, around 100 of which were home births. Another 9-11% were in the Alongside Midwifery Unit (AMU), the midwife-led unit at the hospital.

St George’s hospital has been classed as a level 3 “baby-friendly” hospital by Unicef.