Health: Deliver me from hospitals

Women have the legal right to give birth at home in this country - but ac- cording to a survey published this week, GPs are denying thousands of women the chance of a home birth. It is believed that as many as 20 per cent of mums-to-be would like the opportunity, yet only between 1 and 3 per cent actually get the chance to do so.

A National Childbirth Trust survey found that more than 50 per cent of GPs fail to mention home birth as an option to expectant mothers, while many of those questioned said their doctors actively discouraged it. I've experienced home and hospital births, and the only advantage of leaving the comfort of your own home, to give birth under bright lights among strangers, is that you save on carpet cleaner.

I hate hospitals and my fear of needles borders on a phobia. But two years ago, after 14 hours in labour awaiting the arrival of my son, the midwife, whom I'd never met before, suggested I go to hospital. I was feeling mangled and my blood pressure was through the roof. It was a pleasant 10-minute trip in an ambulance. But given the treatment I received on my arrival, I wish I'd taken my chances at home.

I've met more sensitive vets than the doctors who attended me. They wanted me to have a caesarean, even though my son, Charlie, was showing no signs of distress. They did not intervene, because I swore like a trouper. I had an extremely supportive husband and a midwife who said: "Okay, so she's taking up a whole delivery suite. But baby is fine, mother's hanging on in there, come any closer and she'll sue."

After 26 hours my son was born naturally on the floor because the bed was so narrow I kept falling off during contractions. We returned home an hour later.

When I was pregnant with my daughter, Bo, I saw the same midwife on every visit, which, according to the NCT's survey, is unusual. Despite government recommendations in 1994 for improved maternity care, little has changed. More than half the women surveyed said they were cared for by several unknown midwives. Childbirth isn't like having a quick hernia operation. We become slaves to our hormones. Dealing with strangers, however well-meaning, can slow down a labour for hours, contributing to what is known as the cascade of intervention.

Any woman whose labour is still in full swing after 10 hours will have her membranes ruptured or may be given a drug called oxytocin which speeds up the contractions. This is painful and an epidural could follow, making it impossible for her to move around, and thus slowing down the labour. They will then clip a monitor to the baby's scalp who might then, understandably, show signs of distress. They will attempt to pull him out with forceps or opt for an emergency caesarean. One in three women has their baby delivered in this way at some London teaching hospitals.

Now consider this: five months ago, and pregnant with my second child, I was watching Father Ted when I began to think: "This could be it." We phoned the midwife and a complete stranger turned up as I cleaned the cooker. She told me to have a bath, get some sleep and call again when I needed her.

At 4.30am it was most definitely it. I stayed in bed, cuddled up to my husband. At 5am my waters broke. We called the midwife. By now I was on that roller-coaster and there was no stopping it. I knelt with my bum in the air, holding on as best I could. When the midwife arrived at 5.45am she tried in vain to get some plastic sheeting under my knees. Bo's head was appearing. "Fuck the carpets!" I screamed before pushing my daughter out in one go. The midwife still had her coat on. The second midwife arrived just in time to make everyone a cup of tea, while Charlie, who had slept through his sister's arrival, danced around the house banging his tambourine.

I'm convinced the birth was easy because it was my second child (they usually come quicker), I was well-rested and it took place at home. "Your own environment restores the balance of power to the woman," says Nicky Wesson author of Coping With Labour Pain (Vermilion pounds 7.99).

"If you're uptight which is often the case in hospital, it slows down your contractions. At home you can cook, potter in the garden and do anything that might be frowned upon in hospital, such as eating. This means you're more relaxed which really does mean less pain and a faster labour."

It is generally accepted that for high-risk pregnancies, the woman is better off in hospital - for example, if she has high blood pressure, protein in her urine, narrow hip bones, if she has experienced excessive weight loss, or if the placenta is low lying. But if there are no complications during pregnancy, comparative studies of home and hospital births have concluded that home births are just as "safe" as hospital births, if not safer.

Babies born in hospitals are twice as likely to have a low Apgar score - a health checklist taking into account factors including complexion, heart rate and general alertness. Research has shown that mothers are less likely to need pain-killers and stitches at home. If they need to go to hospital for the actual delivery, studies show less intervention such as forceps or a caesarean is required. There is also evidence that breast feeding is easier and the risk of post natal depression is reduced. So why are GPs so resistent to offering women home births?

"The trouble is," says Roxanne Chamberlain, who conducted the NCT's survey, "women feel they must visit their GP to have their pregnancy blessed, instead of booking in with midwives. Yet many GPs haven't delivered a baby in 20 years, if ever. Most have never seen a normal birth and many feel, that should something go wrong, they will be liable. But if there's a problem midwives don't call out the doctor, they transfer the woman to hospital. Doctors also seem to think that hospitals are by far the safest place for childbirth."

Consultant Obstetrician, Rick Porter, believes it is wrong to attack GPs in this way. "It's not constructive to knock them. If this is turned into a battle between health professionals, women will be the losers." Porter works in Bath which has a 14 per cent home-birth rate, the second highest in the country. "Obstetricians, midwives and GPs work together here. When we started telling women about home births, we expected a 2-5 per cent take up but we were soon into double figures. What this proves is the demand is out there."

Useful Numbers: Association of Radical Midwives 01695 572 776

National Childbirth Trust 0181-992 8637

AIMS (Association for Improvements in the Maternity Services) 01753 652 781

Hospital vs Home Birth

HOSPITAL

Don't forget your toothbrush

You can have an epidural

More likely to require medical intervention

Staff may wear surgical masks

Be surrounded by monitoring equipment

HOSPITAL

You might be allowed a water birth

You will be encouraged to lie down

You can hear other women screaming

Your partner may be asked to leave the room

Have plenty of change for phonecalls

HOSPITAL

You get hospital food

Buy drinks from a vending machine

Staff will clear up the mess, armed with mops, buckets and disinfectant

You will sleep on a noisy ward

Baby must sleep in a cot

Visitors may be limited, as no one likes hospitals

You can go home

HOME

Don't forget to buy plastic sheeting

You can bite your pillow

More likely to need new carpets

Midwives may wear dungarees

Be surrounded by your family

You can give birth where you like

HOME

You will be encouraged to move around

You can listen to the Archers

Your partner may be asked to cut the cord

Don't forget to turn off the phone

You get home cooking

Get the champagne out of the fridge

HOME

Partners must take a deep breath and then try and find the Shake'n'Vac

You can sleep in your own bed

Baby can sleep with you

Visitors may overstay their welcome

You can stay in bed