Friday, 19 March 2010

Suspension of home birth and specialist midwifery services in E Sussex

This is a message that was sent to me by Louise Wilby, Independent Midwives UK that I believe is worth sharing for any of my readers based in this area considering a Home Birth.


Dear All

Excuse the length of this message but the AIMS info is very helpful in telling us what we can do and how to do it.... please pass it on to all those interested in protecting normal birth ( I also have it as a word document if that is useful)

Very best wishes




Home birth – withdrawal of services

The Association for Improvements in the Maternity Services has been informed that the East Sussex Health Trust has unilaterally decided to revoke the home birth and specialist midwifery service.

This, apparently, is due to ‘staffing levels’ and the Trust has also revoked the ‘specialist midwife roles’ who are required to be ‘put back into the mainstream units’.

In 2000 the Nursing and Midwifery Council issued a statement about home births in which it


‘It is for the individual trust/health board to decide what type of maternity service it will provide. The service is expected to be one which is responsible to local requirements and, as far as home births are concerned, it is understood that a blanket policy of ‘no home births’ would not be acceptable to the maternity services in England, Northern Ireland, Scotland and Wales.’

It further states:

‘While the employed midwife has a contractual duty to her employer, she also has a professional duty to provide midwifery care for women and would not wish to leave a woman in labour at home unattended, thus placing her at risk at a time when competent midwifery care is essential.’

Many Trusts have had staffing problems for a long time and have done little or nothing to resolve it. The Chief Executive, therefore, should be asked to produce the following information:

  • How many Full-time (FTE) equivalent midwives are required?
  • How many FTE’s are in post?
  • How many FTE vacancies are there?

The figures are required for each year from 2005 to 2010.

It is presumed that the Trust’s action has been caused by a midwifery shortage in the hospital. The solution, therefore, is to take steps to recruit more hospital midwives. It is unacceptable to put low risk women who have booked a home birth at additional risk of delivery in large, centralised, obstetric units.

The WHO has stated that there is no health improvement for either mother or baby when the caesarean section rates exceed 10%-15%. In the East Sussex area the caesarean section rates fluctuate from 21.8% to 27.7% more than double the recommended level. Numerous studies have shown that home birth is as safe as hospital birth for selected women. AIMS would argue that home birth is far safer than hospital deliveries as no studies have taken into account depression, infection, breastfeeding or post traumatic stress or the high levels of medical interventions and unnecessary or avoidable caesarean sections. (Young et al 2000; Chamberlain et al, 1997; Northern Region Perinatal Mortality Group, 1996); Weigers et al,1996; Ackermann-Liebrich et al, 1996).

It is unacceptable when faced with staffing problems in an obstetric unit to disband the home birth service, and deprive needy women of the specialist midwifery care that was established to help them. The problems with staffing need to be addressed seriously, and this will only be achieved when a community midwifery service is established by a Primary Care Trust, so that community midwives can focus of supporting normal birth and not be seen as stop-gap measure to be used when the Acute Units have staffing problems.

Any woman who is told that the home birth service has been suspended should write immediately to the Chief Executive, Darren Grayson, at East Sussex Health Trust, 729 The Ridge, St Leonards-on-Sea, TN37 7PT along the following lines:



I have been informed that you have a shortage of midwives and that the home birth service has been withdrawn, so that I shall, therefore, have to come into hospital. I understand that it is Government policy that the NHS should support women who intend to birth at home. In a House of Commons debate (20 Dec, 2000) Lord Hunt of King's Heath stated: 'The Government want (sic) to ensure that, where it is clinically appropriate, if a woman wishes to have a home birth she should receive the appropriate support from the health service. At the end of the day, it must be the woman's choice'. This statement has received further support in the Government’s current document ‘Maternity Matters’.

Your midwives have been aware of my intention to give birth at home since ...(insert date). I have no intention of taking the additional risk of a hospital birth in order to alleviate your staff shortages, although I am prepared to transfer to hospital should a medical complication arise. I suggest that, if your hospital is short of midwives, you contact the Independent Midwives UK and arrange an extra-contractual referral.

I expect a midwife to attend when I call her in labour. Should a midwife not arrive and any untoward event occur that is related to your failure to respond to my needs and those of my baby, my family will take appropriate action and we shall hold you and the Director of Midwifery personally responsible for this failure and contact the Nursing and Midwifery Council.

It is important that as many people as possible are alerted to this so we suggest that you also write to the following and ask them to take action to ensure that a proper community midwifery service is provided for all women:

Your MP, you can find his address on:;

  • The Chair, Maternity Services Liaison Committee, c/o your local obstetric unit (every maternity unit should have a MSLC and you can check if your unit has one by ringing the Chief Executive and ask for the name of the Chair of the MSLC).
  • Rt Hon Andy Burnham MP, Secretary of State for Health , Department of Health, Richmond House, 79 Whitehall, London, SW1A 2NS
  • Christina Mackenzie, Nursing and Midwifery Council, 23 Portland Place, London, W1M 3AF
  • Cathy Warwick, General Secretary, Royal College of Midwives, 15 Mansfield Street, London, W1G 9NH
  • Your local County Councillor can be found on;

If, when you ring for a midwife when you are in labour, you are still told that a midwife cannot attend because they are short staffed, we suggest that you, or your partner, responds as follows:

'What is your name and your status? (Make a note of who it is). 'I have no intention of putting myself or my baby at risk of travelling in labour to the hospital and exposing us to the additional risks of a hospital delivery. If you fail to send a midwife and any untoward event occurs which can be attributed to your failure to provide a midwife you can rest assured that my family will take appropriate action'.

So far, in every case to date that we know of, the Trust has provided a midwife.

It is important that you alert as many people as possible to this problem. Do let AIMS know whether or not you achieved your home birth in the end. Email

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  1. I am truley shocked that any local authority could even consider withdrawing care for home births.

    I hope anyone effected compains appropriatley and has safe deliveries whatever they choose.

  2. Really shocking. They can't have done their sums to work out that homebirths are cheaper for them and less likely to end up with prolonged hospital stays/major surgery than they'll probably get with the unfortunate mums who don't know they can challenge the "system". Then of course, how do they cope with those babies who choose to arrive at home regardless of staffing levels, give the baby a ticking off on its irresponsibility?

  3. It is worse than you can all possibly imagine.

    The above is the tip of the iceberg.

    Plans afoot include,

    Down grading of midwives, forcing midwives to reapply for their jobs, replacing midwives with lower grade nurses and maternity assistants.

    Nurses are being employed in places like transitional care units, lower bands doing the role of higher bands..... and most importantly the effects of all of this.....
    Much lower morale and higher stress levels.

    Midwives staying in the profession and counting the days before they retire.

    Community midwives are expected to do day work and then be on call so my question is how safe is this practice, especially in light of the fact they are so stretched and so busy the likely-hood of them having the following day off is limited. Do women wanting home deliveries really want a tired exhausted midwife to care for them?

    I do not have the answers, all I have is my duty of care for women. This unfortunately is compromised by my desire not to enter prison for dangerous driving or for causing death by driving when returning home from a home birth. There is no easy answer to any of the funding issues.

    Perhaps I should be writing to my women, unfortunately due to staffing issues while I am happy to attend your home birth, you should be aware I may have been working all day, so will be tired, my judgement impaired, my reactions to emergencies will undoubtably be slower. If you go into labour in the night and are happy to accept the above facts of course I will be happy to come to your assistance.

    There are of course the issues of protecting the safety of women from health professionals who are too tired to care for them due to the staffing issues. I agree that home birth should be protected, so should the lives of the health professionals that have to work during the day and the night.