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Change attitudes over homebirths

In your news report on plans to promote more homebirths, an impression was created of homebirths being undesirable, dangerous and potentially creating major legal problems for GPs ('GPs alarmed by moves to offer more home births', November 4.)

Where a hospital environment is the appropriate place to give birth for high-risk pregnancies, it might well be a less-suitable environment for low-risk pregnancies.

The move towards increasing medicalisation of birth over the last 30 years has done little to make childbirth safer and is largely responsible for some of the current major issues in maternity care, including increasing intervention rates, reduced satisfaction with the quality of the experience, and significant difficulties in retaining experienced midwives, who increasingly find they cannot work satisfactorily in a medically led setting for childbirth.

In contrast, childbirth out of the acute hospital setting, either at home or in midwife-led maternity units (birth centres), has been shown to be safe for carefully selected low-risk pregnancies (up to 50 per cent of all pregnancies), lead to very high patient satisfaction rates and allow midwives to do the job they have been trained to do in a way they want to do it. It is not surprising that where our local acute hospitals have major problems retaining and recruiting staff, our community hospital-attached midwife-led maternity unit has a waiting list of staff wanting to work there.

Comments are also made on the legal position of GPs, which are incorrect. In this context it is quite surprising that nobody seems to mention the existence, let alone the roles and responsibilities, of midwives in homebirths.

It is important to realise that midwives are highly trained professionals in their own right and are able to deal with all aspects of normal childbirth without involvement of GPs.

If problems occur, as will happen whether a birth takes place inside or outside hospital, they are trained to deal with these and there is no question of GPs being liable for the actions of a midwife.

However, if called to attend an obstetric emergency, a GP will need to deal with this as he/she would for any medical emergency. I would think legal action is more likely in the case of a GP refusing to respond, rather then in the case of an attending GP performing to the standards of a GP 'with similar skills and standing' (the Bolam test).

Nobody will expect a GP to be a mini obstetrician, and to get a forceps out of their bag to deliver a baby, and in many cases advising urgent transfer to a maternity unit, will be all that reasonably could be expected.

It is likely that the children and maternity NSF, currently being worked on, is going to emphasise the need for more births to take place outside consultant-led maternity units, with an increased role for midwives in settings more conducive to natural childbirth, like birth centres and at home.

Rather then resisting these developments, GPs would do well by preparing for this by familiarising themselves with the current evidence, by listening to their colleague midwives and patients and by taking a constructive attitude, so they will be in a better position to help their pregnant patients to make an informed choice on where they would like their child's birth to take place.

Dr Gerbo Huisman


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