Choosing Midwifery Only Care

AIMS Journal, 2008, Vol 20, No 1

Caroline Corderys quest to get the care she wanted

The National Service Framework states that there should be 'the option for all women to access a midwife as the first point of contact'. This expectation, however, is difficult to achieve in many areas of the country. One woman, however, unhappy at being told that she had to book maternity care through her GP decided to take matters into her own hands and she wrote the following letter to the Director of Midwifery Services at her local hospital:

I am expecting a baby in July this year and I intend birthing at home. I have carefully researched this option and consider the risks of home birth compared with hospital birth and I am not prepared to risk my or my baby's health by being delivered in hospital.

I have already attempted to engage a community midwife for my care but have encountered a problem: I do not plan to involve my GP in my maternity care, in line with the DoH Children's National Service Framework (2004) which aims to provide 'the option for all women to access a midwife as the first point of contact'.

Having read this and many other sources assuring me that I could approach community midwives for my booking directly, I left my details at the health centre. I was disappointed to receive a call from one of the midwives from the centre yesterday who informed me that I would have to visit my GP after all in order to get a referral letter for a hospital number which would enable me to visit the hospital for scans etc. and that my booking could not be made without this. She gave me a booking appointment with a view that I would have obtained the referral from my GP by then.

However, it is against my wishes to visit my GP and I do not intend to do so, and so I would be very grateful if you would help me arrange my care to be provided by a midwife who is experienced and confident in assisting women to birth at home. I would like to be assured of having a hospital number before my booking date.

I would like to know why this trust does not yet have a system that can book and care for pregnant women approaching NHS midwives directly, and if it can be done without the GP letter, why the midwives at the centre do not know about it?

A month later she received the following response:

I am sorry the information the midwife gave you about engaging your GP in booking for a home birth was incorrect. Women can choose to see a midwife at the first point of contact for maternity care. The midwife has been made aware of the correct process and this information has been reiterated to all midwives working in the community.

I understand a midwife has met with you and the appropriate referral has now been made for you to have your baby at home. The referral letter which the midwife completed will generate a hospital number or will raise your hospital records if you have previously been a patient with us. This will be done prior to you having your first scan.

Having supported Caroline through this process, she sent us the following update saying, 'It's not all bad out there.'

At 24 weeks pregnant I finally had a planned meeting with my NHS community midwife and her supervisor, to discuss my birth plan. They are from the Community Midwives' Base, Edward Road Health Centre, Balsall Heath, Birmingham, attached to Birmingham Women's Hospital.

First of all they were thrilled that I had chosen home birth, and said that they were here to support me and my choices - nothing on my birth plan was incompatible with their practice, including:

• making my antenatal appointments outside of normal hours to fit in with my job
• not listening to foetal heart antenatally if there had been a lot of movements
• changing my EDD to my own evidence-based date rather than the scan date which had me 8 days earlier
• only having one midwife at the bir th rather than the usual two
• no VE in labour
• no breaking of waters artificially
• no excessive listening to foetal heart in labour, and not using ultrasound to do so
• catching my own baby (or partner to do so)
• acquiring cord tape for the baby's cord instead of a plastic clamp
• no administration of vitamin K at al
• the neonatal exam to be carried out in my home by one of their midwives who is trained in this - rather than having to go to hospital to do it after a home birth
• postnatal care to be negotiated by me and to be done over the phone only if that's all I feel I need.

After all the horror stories many pregnant women hear, I was pretty astonished to have met with no resistance to any of my proposals and I feel that they are truly on my side and looking for the same good birth experience that I am.

I didn't have to justify myself on any point. They have tried to encourage me into a water birth (not really suitable for my flat) several times now, and said that their transfer rate for home births was 'less than one percent'.

Hooray!

The supervisor even thanked me 'for challenging their practice'!

As it's my first baby I didn't have any previous experience of maternity services, and only had the usual mental images of screaming undignified melodrama, the ER version of birth. Knowing I wanted to avoid this, and being a meticulous early planner, I started researching home birth and found 9 out of 10 messages were saying, 'you will be opposed at every stage.'

I was led to believe before I'd even met my named midwife that I was in for a fight. When the very first contact I had with her (on the phone) was what I was already expecting by then, 'you'll have to go to your GP', I thought uh-oh, here it begins already.

I now think what she meant was, 'it'll be a bit of a pain for me if you don't just go to your GP like normal women because I'll have to do your referral myself.' The advice from AIMS at this stage, as well as my letter, allowed me to 'ace' them right at the star t and now my midwife and her supervisor are almost grovelling to assure me that I'll be treated in the way I expect.

Before that though, still terrified of all the potential battles that might ensue, I spent hours reading and researching. I wrote a birth plan early on and then was so amazed when they appeared to be completely at ease with it. I suppose on discussion forums and the like, women rarely write about what a dream labour they had, how everything went without a hitch and how they were treated like intelligent adult women to be respected at all times. Perhaps they tend to write about when it all went wrong, as part of getting over it, or perhaps they belong to different support groups.

I think it would be good to let people know it's not all bad out there. My pregnancy is going great, 27 weeks today and more energy every day, great sleep, I feel so lucky...

Keep up the good work AIMS, from a happy pregnant woman.