Home birth rates stagnate
For 30 years, policymakers have sought to reverse the ‘medicalisation’ of childbirth. Yet home birth rates remain low,
FEWER than one in 100 mothers in Scotland are having home births despite repeated statements that the option should be routinely available.
Figures obtained by The Herald reveal that just 325 women delivered their babies at home in 2017, equivalent to 0.67% of all births. It is down slightly from 0.75% in 2013. Scotland also lags behind England and Wales, where 2.1% of mothers had a home birth in 2016.
The Scottish Government has never set a target for home births, but its new maternity agenda, Best Start, says women “should be encouraged to consider home birth as an option” if they have had a previous vaginal birth without complications.
Elizabeth Duff, policy adviser for the National Childbirth Trust, said she welcomed that aim but said it could only be delivered with more dedicated home birth midwives and a change in attitudes.
She said: “It’s a question of getting the numbers up so that you’ve got those midwives in place who are experienced and confident in home births, who regard it as a really genuine option and are able to say to the mother ‘we’ve got the staff, we can support you, you’ll be fine but if you need a transfer to hospital we can arrange that in a very calm and organised way’.
“There’s still a lot of fear that is largely unfounded. It’s entirely up to women to make the choice, but I think for some women it’s really off-putting that people say things like ‘oh, you are brave’ or ‘wouldn’t it be better to be in hospital, just in case?’.”
In the past five years, only NHS Tayside has seen a steady increase in its home birth rate, from 18 in 2014 to 56 last year. In 2017, 1.4% of mothers in the region had a home birth, more than twice the Scottish average and up from 0.4% in 2014.
The main driver behind the rise was an award-winning pilot scheme in Angus, which increased the home birth rate by ten-fold in a year, and is now being extended to Perth.
Justine Craig, NHS Tayside head of midwifery, said: “It was identified that for women who have previously had an uncomplicated birth, planning to give birth at home or in a midwifery led unit is particularly suitable for them because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit.
“In order to support this choice option fully, NHS Tayside piloted a dedicated home birth team in
Angus, fully integrated within the wider team. This team provides all care throughout pregnancy, birth and postnatal period to women choosing a home birth.
“Following this pilot, the number of home births [in Angus] has increased, meeting its goal to increase the home birth rate from 0.3% to 3% within a year.”
In NHS Highland, the number of women having home births halved from 40 in 2013/14 to 21 in 2017/18, a drop in rate of 1.7% to 0.9%.
The health board blamed the decline on an increase in pregnancies deemed “high-risk”, and therefore unsuitable for births at home or in midwife-led maternity units. This can include complications such as obesity, a previous caesarean section, or maternal diabetes or epilepsy.
However, a spokesman said a “more
There’s still a lot of fear that is largely unfounded
individualised approach is now under development” in line with the Best
Start recommendations.
When the NHS launched 70 years ago, half of mothers in Scotland gave birth at home and only one in a 100 was delivered by C-section, compared to 32% today.
A Scottish Government spokesman said:“our review of maternity and neonatal care, The Best Start, makes it clear all NHS boards must ensure they are able to provide women with a full range of options for where to give birth, including at home.”