Anecdotally, at Make Birth Better, we hear about the quiet decline of home births. We hear for example how personal choices are under pressure, we hear how in some cases there is not enough staffing to support a home birth or we hear about service suspension (during Covid but also post-Covid). We know for many home birth is a really vital choice they want to have to help manage their trauma. That’s why we want to hold space for these experiences. These are the stories of Emma, Catherine, Cat and Anna.

TRIGGER WARNING: Please read this story with care. If you’re finding the content challenging, please give yourself permission to step away. If you need support click here, if you need urgent help click here.

Listening is the first step to understanding how we can do better. We want to thank everyone who responded to our recent call on Instagram and shared their experience of home birth with us. In these stories we see themes emerging that are all too common in other birth stories too: not feeling heard or seen or feeling coerced in a medicalised system under pressure. Let’s take the time to listen. Let’s never stop asking: how can we best support individual choices?

Emma Shave

“Here is as much of my story that I am able to share right now, I'm just entering into a space where I feel well enough to process with a Perinatal Psychiatrist, 9 months into being a mum.

I am a community midwife myself so am very aware of place of birth studies and birth outcomes for first time mums planning a home vs hospital birth. Unfortunately, during my pregnancy I wasn't very well with my mental health so booked myself in for a home birth in order to feel some control, safety, having trusted friends and colleagues present as well as home being my safe place and a place of familiarity for my husband (who is never ill, and has never been an inpatient in hospital).

“Thinking about the labour in hospital makes me go all clammy and I remember feeling completely and utterly out of control”

Being a part of the community team that covers home births in my trust I was aware that there were large gaps in the on call rota (rota for home births overnight as well as escalation into the hospital) but friends had promised to come out to me if I was labouring and there wasn't any cover. During the day it is usually the midwives on postnatal visits that goes to home births.

However, come the day (I was labouring during the day) I was told via text that there were too many postnatal visits to see and that I would have to go to the hospital to deliver. Thinking about the labour in hospital makes me go all clammy and I remember feeling completely and utterly out of control.

There is still such an 'eye roll' attitude to home births from a large portion of midwives - they are often seen in units without a dedicated team as a hassle, and sadly excuses are often made to not attend or attend begrudgingly. It's sad and I hate that we are failing women and their families.

Here's to making a change!”

Catherine Pymar

“I was 18 weeks pregnant with my second child when we went into lockdown.

I'd been really lucky with my first pregnancy, it went smoothly and I had a fast water birth in a birth centre at North Mid Hospital and was in and out in a day. Due to this positive experience I was keen to have my second baby at home.

During lockdown I joined a remote session about home birth options. At the time, home births were all canceled and it was unclear as to when they would be reinstated.

At a regular check-up at about 32 weeks I went for a scan and was told my baby had a very low birth weight. I was told that the aim was to get me to 38 weeks and I would then be induced. There was no conversation or discussion about this. It really felt like that was the only option and because it was Covid, I was on my own in all the appointments so I didn't have anyone else there who could also questions or ask about options. It felt really scary.

“I felt like I had no choice but to be on a labour ward which was so far removed from what I hoped for”

I had weekly checks and when I got to 38 weeks, I was booked in for an induction. I felt like I had no choice but to be on a labour ward which was so far removed from what I hoped for.

My son was born at the beginning of August weighing between the bottom 0.4th and 2nd percentile. He's now 2.5 and he's still there at the bottom of the chart. It is just him.

My understanding is that it took a long time for home births to be an option post lockdown and I don't know if it would have been offered to us even if we weren't induced.”

Cat Leonard

“I’m a first-time mum (39+3) so don’t necessarily have birth trauma from a previous experience. I do however have a significant fear of needles (from previous hospital experiences) that I’ve been working on via exposure therapy since becoming pregnant.

I feel very supported by my Trust (University Hospitals of Derby & Burton, and the Midlands Foundation Partnership Trust) regarding this phobia and links to my upcoming birth. MFPT have a Lotus team which I understand sits between the standard midwifery service and perinatal service, supporting birthing people with anxieties/trauma et cetera but who don’t quite tick the box enough for specific focused perinatal mental health care. This has been useful in terms of access to a specialist midwife to go through detailed questions on birth preferences and discuss evidence behind different interventions et cetera (I’m a data-driven person with a research background so combined with natural anxiety and keenness for a physiological birth, I’ve had a lot of questions for healthcare professionals!).

However, due to my phobia and my research showing a higher chance of intervention by being in a hospital environment (which says to me ‘more chance of being exposed to needles therefore more anxiety/adrenaline, therefore self-perpetuating cycle of slowing down birth, therefore more chance of having to advocate against even further intervention, or take further intervention’), plus the fact there is no difference in outcome for home births for first-time mums, then we’re really keen for a home birth.

UHDB Trust are not currently offering this service and have suspended it until Autumn 2023 due to staffing pressures. I’ve also heard informally from my midwife that a contributing factor is that the ambulance service cannot guarantee being able to reach home birth midwives in the prescribed timescale. But I’m unsure of the validity of this information.

“I feel anything away from the home birth situation means higher likelihood of medicalisation of birth and intervention.”

I’ve been told my only choice is to freebirth or attend the labour ward. UHDB used to have a standalone Midwife Led Unit called Samuel Johnson but this service was suspended during Covid and they’ve still not reopened it. The majority of prospective attendees now go to Burton. I can also see another option would be to hire a private midwife, but this is not currently financially viable for us.

As first-time parents we’re not confident enough to go for a freebirth. The main fear for us is the risk of not spotting when medical attention may be required, and then the poor ambulance service situation giving no guarantee of getting suitable medical attention at the time required (and even then I’d prefer midwife attendance who are specially trained in birth, not a random paramedic who doesn’t have specialist midwifery skills). We do only live 10 minutes from the hospital but I don’t want my husband having the pressure of transferring me and our baby mid-labour/post-labour in an emergency situation (plus the not medically trained factor et cetera).

So due to suspension of the home birth service and closure of MLU at Samuel Johnson Hospital we’re left with MLU at Derby (35 minutes away on a good day) which has 4 rooms, therefore no guarantee of access once travelled that way. Or the labour ward at Burton (10 minutes away).

I feel anything away from the home birth situation means higher likelihood of medicalisation of birth and intervention. Therefore a higher likelihood of needing to advocate for ourselves and almost ‘battle’ for our preferences, or have more decisions to make. Plus higher likelihood of being exposed to needles/memories linked to needles. All the things that I don’t want to be exposed to during the birthing process, and potentially very far removed from my calm, quiet birth environment in a familiar home setting.

I of course realise there is a chance everything goes very smoothly at the labour ward and no interventions are required. It’s the lead-up and uncertainty that is causing anxiety, plus the higher chance of triggering trauma by starting off in that hospital setting, rather than having the option to be at home and escalate where necessary.

If UHDB are severely understaffed, then I can see how they would prioritise moving their available midwives to staff the labour wards. And I feel really supported by the Trust in terms of other factors. But the implications of not providing a home birth service or an alternative deeply affect how I’m feeling about birth, and no doubt many others too. Which in turn makes me feel I’m already on the back foot in the best chance of having a physiological birth (maintain oxytocin et cetera ahead of birth when anxiety already raised due to situation). I feel there should be some sort of recognition (locally and nationally) that it’s not just a case of ‘oh well, those handful of hippy parents that want to go against the system and birth at home will just have to put up with it’.”

Anna Murray

“I had planned a homebirth for my second birth in 2019 due to a traumatic birth experience the first time round. I wanted to avoid all intervention and have minimal input from healthcare professionals. However my homebirth was changed to induction on the labour ward due to hypertension, queried pre-eclampsia. I was diagnosed with low papp-a at my screening bloods and prescribed 150mg aspirin daily until 37 weeks, I also had regular growth scans.

All was fine and homebirth on track until the middle of my third trimester when my blood pressure became labile and my white blood count halved. I was refused medication at this point to help stabilise my blood pressure as it wasn't consistently high, but I did stop taking the aspirin, which helped increase my white blood cell count.

At this point I was having serial blood pressure measurements every 48 hours with CTG monitoring and having my urine dipped at every appointment, sometimes more than once. The day I was admitted to the postnatal ward and told I would need to have an induction was devastating.

I had been to the antenatal day unit that morning for my blood pressure check, CTG and two urine samples. I then had to go back late afternoon for a consultant appointment where I had another blood pressure check and another urine sample dipped. My blood pressure was now consistently high at this point and there was query protein in my urine (although samples before and after were fine) so I was told I had pre-eclampsia and would need to be induced that day at 39 weeks.

I broke down, I was alone and the consultant (without reading my notes) remarked "you have a real thing about induction don't you" then turned away and reeled off instructions to the midwife who never consoled me or acknowledged my despair. She also didn't ask for consent to do a vaginanal examination, she just told me to get on the bed and that she would be performing one.

I was then sent back to the antenatal day unit while they found me a bed where another midwife told me they would never do anything if they didn't think it was for the best. Once I was admitted to the postnatal ward, my family was with me. Although I was still crying and very upset with my body and the system, I had come to terms with being induced. I agreed to suppository and nothing more, if that didn't work I would go straight to Caesarean birth.

“My choice to go home and wait was taken from me”

Doctors agreed to this first step, then a conversation after if it didn't work. I was also put on medication to lower my blood pressure at this point and told if it lowered, I would be able to go home without starting the induction process. I found out after my birth that my blood pressure had lowered and stabilised but no one had informed me before the induction process had began, so my choice to go home and wait was taken from me.

I went on to have 3 suppositories and sweeps, a 3.5 hour labour and a manually managed Postpartum Hemorrhage 12 hours after birth. The whole process left me extremely traumatised with PTSD symptoms.

I would like to add that I worked in the department and knew all of my medical team. I then had to go back and work in the department for a short time after my maternity leave. I did feel more let down as they were my colleagues, I also felt like I couldn't make a fuss and be ‘one of those women’ because I would be talked about behind my back and would feel awkward coming back to work.

There were aspects of my care that were amazing, and I do have some positive memories because of that.”

Voices of home birth: how can we better support individual choices?

Emma Shave

Catherine Pymar

Cat Leonard

Anna Murray