Home birth? No thanks, hospital labour ward gets my vote

Birth is the worst possible area in which any health service can skimp.

Britain's booming birth-rate is colliding with a shortage of mid-wives Photo: GETTY IMAGES

By Jenny McCartney

The women of Britain are being cordially invited to give birth at home. Hospital maternity wards are “not necessarily the safer option”, said a report last week by the Royal College of Obstetricians and Gynaecologists.

The only people who should definitely give birth in hospital, the report concluded, are women at clear risk of complications, such as the clinically obese or the over-40s.

I know of women who have very happily produced thriving babies at home. But when a kindly midwife visited me when I was heavily pregnant with my second child, told me that I would have my baby that evening and floated the notion of a home birth, I almost knocked her over in my haste to make it to the labour ward.

The thought of yowling in the bedroom while the three-year-old persistently asked what the matter was with Mummy – not to mention the terror if anything went wrong – made me yearn to be in a hospital bed surrounded by bleeping machines and with a consultant up the corridor.

Still, I had all that with the first one, along with a nice young hospital midwife who appeared to be looking after several labouring women at once.

Early on, she made a judgment that it would probably be many hours before I had the baby and – although I protested that things felt rather more immediate – was too busy elsewhere to check.
Meanwhile, I felt increasingly as if I had eaten a very large bomb, which was in imminent danger of going off.
My mind addled by this sensation, I locked myself in the bathroom at the end of the corridor, presumably so that when I did blow up, it would be easier for the cleaners to scrape stray parts of me off the walls and ceiling.
The midwife, to her credit, coaxed me out: the baby was born 10 minutes later, without the sedative effect of so much as a Junior Disprin. I still get occasional Vietnam-style flashbacks to the event.
Birth is a feral and unpredictable business, and this is what mothers know when we hear first-time mothers-to-be solemnly discussing their birth plans, packing their hopeful little bag of aromatherapy oils and scented candles for the side of the birthing pool.
We nod and say “That sounds lovely”, when secretly we’re thinking “Poor love” as we mentally fast-forward to a fortnight’s time when, whey-faced, they tell us about the shredded birth plan, the emergency caesarean, or gruelling 24-hour labour followed by a ventouse delivery performed with all the delicacy of a scene from All Creatures Great and Small.
The truth is that, so long as mother and baby are alive and undamaged, it can be counted a great success.
The problem with evaluating women as “low-risk” or “high-risk” is that it fails to take into account those last-minute emergencies that can change the game in a matter of minutes.
As one sceptical consultant obstetrician, Lawrence Mascarenhas, pointed out last week, a British 2003 study of three million births found that 14 per cent of women having a home birth had to be transferred to hospital during labour. In that group the risk of a baby dying increased 12-fold compared to those in hospital.
Home birth, with the right support, might work beautifully for many women who choose it, but for a minority it remains the riskier option.
This entire discussion, however, takes place around an elephant in the birthing-room: a booming UK birth-rate combined with a severe shortage of midwives.
Home births require the presence of two midwives; in hospital you are not always guaranteed the constant presence of one.
The truth is that Britain couldn’t actually staff a sharp rise in home births; we can’t even guarantee an adequately monitored hospital one.
As a result of staff shortage, among other factors, medical errors during birth can cause untold sorrow and vast insurance pay-outs to parents. Yet birth is the worst possible area in which any health service can skimp, because the stakes are so fearsomely high.
Over the past 14 years, the NHS has paid out £1.8 billion in compensation to victims of the most severe cases of medical negligence during birth. In a more enlightened society, I wonder how many trained midwives that sum would buy?

My fear of flying ends at take-off

The very thought of flying fills me with nameless horror. It’s not that I’m frightened of hurtling through the clouds in a metal tube with only a slim chance of surviving a crash – not at all. No, my true dread is summed up in two words: airport security.

You arrive at the airport to join an eye-wateringly long queue for the area in which the hatchet-faced guards are concentrated.

In the approach, you start scrabbling wildly for a forgotten pair of nail scissors in the bottom of your overstuffed handbag, along with some liquids or gels of less than 100ml, and a missing clear plastic bag.

Ten minutes later, you are chugging baby milk, wild-eyed, from a bottle with a teat on it, in front of a suspicious guard. The elderly lady in front of you is painstakingly removing her lace-up brogues. You’re almost through but – stop there! – you must remove your hat. There might be a bomb under your hat, or a pair of tweezers.

I’m a big fan of real security – I’d obviously prefer not to get blown up by a lunatic – but I don’t know that the bulk of this palaver has any preventative effect, since a committed wrong-doer can go on to buy any number of inflammable and sharp things in Departures.

At last, it was reported last week, the Government is ready to introduce technology which will replace the need for this preposterous carry-on. Which begs the question: what took them so long?

Sugar makes business too bitter

The final of The Apprentice, in which the winning candidate will get the chance to go into business with Lord Sugar, will unfold tonight. With its intimate exposé of backbiting, blame-shifting, bossiness and naked sycophancy, it’s addictive, in a mildly shameful way.

It is, however, interesting that Britain’s economic woes, and so many real redundancies, have seemingly not dented the nation’s thirst for hearing Lord Sugar tell contestants gruffly: “You’re fired!”

On the contrary, this confirmation of the innate savagery of corporate life appears to have a cathartic appeal.

Jim Eastwood, the flinty-eyed, fast-talking Northern Irish contestant, was my favourite, at least until he named his Mexican restaurant “Caraca’s” (mangling the name of Venezuela’s capital) in the belief that it meant “maracas”.

Yet I fear The Apprentice gives a skewed impression of the business world, which often requires an ability to cultivate loyalties as well as to eliminate one’s rivals.

Hemingway defined having guts as displaying “grace under pressure”. There is certainly a lot of pressure in The Apprentice, but I doubt that grace would get through the first round.