It may only be eight in the morning, but midwife Laura Hughes is already looking at a busy day.
From her scheduled morning visits to the maternity hospital to visiting numerous expectant mothers at their homes to check on how their pregnancy is progressing, the 32-year-old will spend the next seven and a half hours She raced across Bradford (a 160 square mile tract of land) tending to her many patients.
However, Laura explains, her day doesn’t end there. Although she has two children of her own to look after, she will also be on call in the evenings to step in and help with the birth of a baby should the need arise.
Having a baby at home in 21st century England is a far cry from what you might see in posh Sunday night drama, Call the midwife, until 9 p.m. everything is neatly packed. Laura’s hectic schedule is simply the norm for the home birth midwifery department at Bradford Teaching Hospitals.
And we’re about to find out all about her, as cameras have followed the team of six midwives – and some of the pregnant women they look after – for a new BBC Two series entitled Yorkshire midwives on callwhich shows what life as a home birth team is really like – without bikes, red hats and cardigans.
Only founded in 2019, the last two years have been particularly busy for the home birth team led by Laura.
While the ongoing coronavirus pandemic is partly responsible for more women considering home births – about one in 40 babies, or 2.4% of all births, is said to have taken place at home in the last two years – the numbers in Bradford are consistent stayed high.
‘In the beginning we had about 80 births a year,” explains Laura. “After Covid struck our case count went up to 192. Things have stabilized a bit now, we have between 150 and 160 women on the books at one time but we haven’t seen the numbers drop anywhere near to pre-Covid levels are .’
In addition to the pandemic — and resulting restrictions on birthing centers — Laura believes word of mouth about the more “personable” service a home birth team can provide may also have contributed to the surge.
“If you decide to have a home birth, you usually have the same midwife throughout your pregnancy,” she says. “We see women in their own homes and that allows us to form a picture of who that person is.
“When you went to the hospital for your appointments, you got a different midwife every time. But when it comes to a home birth team, we get to know each woman intimately. We know the name of your dog. We know what they make of their mother-in-law. We know that you bought a caravan three months ago. We understand who they are as a family unit and that can make a really big difference.
The care provided by the homebirth team extends beyond pleasantries, Laura adds, with each expectant mother arguably receiving more dedicated resources at home than compared to a maternity ward.
“At home, people have two midwives with them from start to finish… I don’t want to get into the political side of staffing in maternity wards, but it’s a luxury compared to the hospital,” she says. “That woman is the sole focus of these midwives and that’s really nice because it makes you feel cared for.”
Obstetrics in hospitals have been generally considered to be overburdened for some time. A 2020 survey by the Royal College of Midwives found that 83% of midwives do not believe their NHS trust or board is staffed enough to run a safe service. Elsewhere, 42% of workers said half their shifts were understaffed, and a third said there were significant gaps on most shifts.
“The biggest problem in the NHS is the staffing crisis,” said Sharon Salvage, a former NHS midwife of 30 years. “Funding for midwives has declined over the years and there are now over 2,500 unfilled midwifery positions.
“Constantly working in an understaffed environment also puts enormous pressure on midwives, who fairly regularly work long 12.5-hour shifts with no breaks to eat or use the loo. Understaffing can also mean that midwives are being stretched beyond their capabilities, leaving them feeling demoralized, fragile and exhausted.’
There is also an increasing number of mothers and midwives who believe that pregnancy and childbirth are too “medicalized”: basically, that medical professionals unnecessarily interfere too much with the natural birthing process.
Rebecca Wheelhouse, 28, was keen to have a more “natural” birth when she had baby Toby six months ago, although she and her husband Tim are both young doctors who are well acquainted with hospitals.
“In general, I’ve always liked the idea of having a baby at home because pregnancy and childbirth are so natural,” she explains.
“It was just so pleasant to be surrounded by your home comforts. I could ask Tim’s mum and dad to come and see Toby in less than an hour after he was born, which we simply couldn’t have done at the hospital.”
While their first son, Freddie, was born in a ward — with complications that meant Rebecca had to have an epidural, something only given in hospital births — Toby was the drug-free water birth she’d always wanted.
“It only took seven hours,” she recalls. “I was scared of the pain but being with my midwife just made me feel so relaxed. It was a completely different birth experience.
“In the hospital we really had problems with Freddie in the maternity ward. It’s a very different environment, it’s hectic, it’s noisy – we were both exhausted. The aftercare felt like an exercise to tick.
“But having the home birth team felt like having a friend visit. They really wanted to see how you were.’
Laura welcomes moves to “demedicalize” pregnancies and believes popular hospital series such as One born every minuteonly fuel fears about the birth.
“Most midwives hate it One born every minute‘ she admits. “It’s overly dramatized and tends to focus on things going wrong. It’s not a really good representation of what childbirth is like and can scare women.
“Birth is often just a physiological process for low-risk women – it’s really quite boring.”
While NHS guidelines suggest that home birth is generally as safe as giving birth in a ward, there are a number of scenarios where it is crucial that women give birth to their babies in a hospital.
For example, if it’s your first child, you’re pregnant with more than one baby, your baby won’t settle for a headfirst birth, or you’ve already had a cesarean, guidelines are generally consistent for your baby to be delivered in a medical hospital should be setting.
“Having a hospital birth means you have a variety of specialized units on site and more facilities and technology available when emergencies arise,” explains midwife Sharon Salvage. “You also have access to a multidisciplinary support team, such as midwives, obstetricians, paediatricians and anaesthesiologists, if you need it, and you have all the options for pain relief at your disposal. Therefore, hospital birth is recommended for women who are considered high-risk pregnancies.”
That’s not to say the home birth team isn’t well trained for cases where labor doesn’t quite go to plan.
In Yorkshire midwives on callwe meet Keeleigh Fisher – a 27-year-old pregnant with her fourth child and desperate to have a home birth.
“I’ve always hated hospitals, but with the advent of Covid I really wanted to give birth at home,” she explains.
Keeleigh had never been considered for a home birth before, as her last three children had all been born prematurely, although they were all a healthy size.
With baby number four, she was finally able to fulfill her wish and welcome her little one to her three children and her cousin.
“It was so relaxing,” Keeleigh explains. “My kids were free to tinker and I wasn’t nervous at all.”
Shortly after the birth, however, the midwives finally decided that Keeleigh needed urgent hospitalization as she had been bleeding and her bleeding would not stop.
“I was disappointed,” Keeleigh admits. “I cried, I really didn’t want to go to the hospital. The birth went so well. Luckily, my bleeding stopped soon after, so I was discharged after a few hours.
“If I had another one, I would definitely have a home birth again. The bleeding was just one of those things.’
Laura, who was one of the midwives present during Keeleigh’s labor, says it was “exceptional” that Keeleigh’s birthing experience didn’t go as she had hoped.
“Our training comes in when we have emergencies so we can take things easy,” she explains. “It’s hard to walk away and think oh god I hope she’s not too disappointed, I hope she’s not over this negative experience.”
For Laura, however, the more personal aftercare provided by the home birth team is crucial here.
“Our continuity can really help in situations like this,” she says. “We’ll pick them up when they get home. If they were in the hospital for whatever reason, we set up some kind of debriefing with them.
“Keeleigh was disappointed that she had to go to the hospital, but she still felt positive about the whole experience.”
With homebirth numbers set to remain stable even as we enter a post-Covid world, Laura believes Bradford could find a second homebirth team as numbers rise.
And while being a home birth midwife is often difficult, exhausting and stressful, Laura has nothing else she would rather be doing.
“One of the most rewarding things is making a woman feel like she was in control of her birthing experience,” she admits. “When I helped give birth to someone who felt like they had choices, did they feel in control and empowered? Then I know I did a good job.”
Do you have a story you would like to share? Contact us by email at Kimberley.Bond@metro.co.uk
Share your views in the comments below.
Yorkshire Midwives On Call airs Monday 18 April on BBC Two.
MORE: To all the parents out there, you need to start watching Bluey with your kids
MORE: The midwife who delivered Emmerdale star Amy Walsh’s baby worked with Toby Alexander-Smith on EastEnders
MORE : How not to be a bulldozer parent
https://metro.co.uk/2022/04/11/yorkshire-midwives-on-call-why-women-are-shunning-hospital-births-16417597/ Yorkshire midwives on call: why women avoid hospital births