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Great Britain backs homebirth and midwifery.

The Report on Maternity Health Services issued by the Health Committee of the House of Commons (March, 1992) calls for the reversal of the 1970s trend in British medicine which promotes hospital delivery of all pregnant women. The report has come out strongly in favor of reorganizing maternity services to best serve the physical and psychological needs of the mother and baby, specifically supporting midwifery, birth at home and in small clinics, and women's freedom of choice.

The Health Committee began its investigation of maternity services in February, 1991, soliciting written materials and oral presentations of health providers and consumers, and visiting hospitals and clinics in the United Kingdom, Holland and Sweden. Six expert advisors, including two obstetricians, two midwives, one pediatrician and one general practitioner evaluated the evidence.

In her 1990 book, Safer Child-birth?, Marjorie Tew analyzed the statistics produced by government studies which sought to justify Britain's move to universal hospitalization. Tew's analysis showed, in fact, that statistics proved the greater safety of midwife-attended homebirth. Commenting on the implications of the Health Committee Report, Tew states that, "The relative strength of these bodies [local organizations] in arguing their case in the light of the Committee's recommendations will determine the extent to which the changes will be implemented. The Report deserves to stand as a landmark in the history of maternity care world wide."

---Sources for this article include Tew, Marjorie "Landmark Decision for British Homebirth & Midwifery," The Birth Gazette, Vol. 8 No.3, pp. 38-40 and Tew, Marjorie, Safer Childbirth? A Critical History of Maternity Care (London: Chapman and Hall, 1990).

Excerpts from the Report on Maternity Services in Britain by the House of Commons Health Committee

On the basis of what we have heard, this Committee must draw the conclusion that the policy of encouraging all women to give birth in hospitals cannot be justified on grounds of safety. [paragraph 33]

Given the absence of conclusive evidence, it is no longer acceptable that the pattern of maternity care provision should be driven by presumptions about the applicability of a medical model of care based on unproven assertions. [paragraph 33]

We conclude that there is a strong desire among women for the provision of continuity of care throughout pregnancy and childbirth and that the majority of them regard midwives as the group best placed and equipped to provide this. [paragraph 49]

We conclude that the choices of a home birth or birth in small maternity units are options which have been substantially withdrawn from the majority of women in this country. For most women there is no choice. This does not appear to be in accordance with their wishes. [paragraph 86]

We conclude that until such time as there is more detailed and accurate research about such interventions as epidurals, episiotomies, cesarean sections, electronic fetal monitoring, instrumental delivery and induction of labor, women need to be given a choice on the basis of existing information rather than having to undergo such interventions as routine. [paragraph 96]

We believe that the discussions we have heard about the case of providing continuity of care and the enabling of women to control their own pregnancies and deliveries have been far too heavily influenced by territorial disputes between professionals concerned for control of the women whom they are supposed to be helping. [paragraph 191]

Hospitals are not the appropriate place 10 care for healthy women. [paragraph 208]

We conclude that there is an established need for the professionals involved in the maternity services to address the issue of providing women with a wider choice of place of birth and to consider ways of organizing services to support that choice. More immediately there is a need to establish ways of providing a choice of a less medicalized pattern of intrapartum care, whatever the setting. [paragraph 230]

We conclude that there is universal agreement between all involved in maternity care that an increase in the level of breast-feeding is desirable. [paragraph 255]

We recommend that the policy of closing small rural maternity units on presumptive grounds of safety should be abandoned forthwith....We recommend that in considering any appeal against the closure of such a unit, the Secretary of State should make a presumption against closure unless the case is overwhelming, since we believe that there is a shift in attitude towards maternity care which can only be met by maintaining such units as a realistically available option. [paragraph 312]

We recommend that a hospital delivery unit should: afford privacy; look like a normal room rather than be reminiscent of an operating theatre; enable refreshments to be available for the woman and her partner or companions; ensure the feasibility of the woman being "in control" of her labor. All case notes should contain the woman's wishes for her labor; enable the woman to take up those positions in which she is most comfortable; enable the woman to have with her a midwife she has been able to form a relationship with during her pregnancy. [paragraph 328]

We recommend that the Department of Health vigorously pursue the establishment of best practice models of team midwifery care. [paragraph 339]

We recommend that the Department of Health take steps to impress upon all GP [general practitioners] their duty to facilitate the wishes of women, especially in their choice of place of birth and their right to midwifery-only care. [paragraph 349]

We recommend that it be a duty placed upon all GP practices to have in place arrangements for women to have home confinement with GP cover or midwife-only cover if they so desire. [paragraph 349]

We recommend that, in the area of postnatal care above all others, attention must be turned away from a medical model of care to a woman-centered approach which takes full account of their social needs. [paragraph 383]

We recommend that all maternity services be obliged to publish figures relating to operative intervention and stillbirth and neonatal mortality rates over the previous five years, and to make these figures available to women booking with that service. [paragraph 435]

We recommend as a matter of priority, that the Department of Health funds the establishment of extensive pilot schemes in the establishment of midwife-managed maternity units within or adjacent to acute hospitals. We further recommend funding of an extensive program of establishing small team midwifery using community-based clinics. [paragraph 440]

We recommend that the policy of closing small rural maternity units on presumptive grounds of safety should be abandoned forthwith....We recommend that in considering any appeal against the closure of such a unit, the Secretary of State should make a presumption against closure unless the case is overwhelming, since we believe that there is a shift in attitude towards maternity care which can only be met by maintaining such units as a realistically available option. [paragraph 312]

We recommend that a hospital delivery unit should: afford privacy; look like a normal room rather than be reminiscent of an operating theatre; enable refreshments to be available for the woman and her partner or companions; ensure the feasibility of the woman being "in control" of her labor. All case notes should contain the woman's wishes for her labor; enable the woman to take up those positions in which she is most comfortable; enable the woman to have with her a midwife she has been able to form a relationship with during her pregnancy. [paragraph 328]

We recommend that the Department of Health vigorously pursue the establishment of best practice models of team midwifery care. [paragraph 339]

We recommend that the Department of Health take steps to impress upon all GP [general practitioners] their duty to facilitate the wishes of women, especially in their choice of place of birth and their right to midwifery-only care. [paragraph 349]

We recommend that it be a duty placed upon all GP practices to have in place arrangements for women to have home confinement with GP cover or midwife-only cover if they so desire. [paragraph 349]

We recommend that, in the area of postnatal care above all others, attention must be turned away from a medical model of care to a woman-centered approach which takes full account of their social needs. [paragraph 383]

We recommend that all maternity services be obliged to publish figures relating to operative intervention and stillbirth and neonatal mortality rates over the previous five years, and to make these figures available to women booking with that service. [paragraph 435]

We recommend as a matter of priority, that the Department of Health funds the establishment of extensive pilot schemes in the establishment of midwife-managed maternity units within or adjacent to acute hospitals. We further recommend funding of an extensive program of establishing small team midwifery using community-based clinics. [paragraph 440]
COPYRIGHT 1992 Association of Labor Assistants & Childbirth Educators
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Title Annotation:includes excerpts from the report on maternity services in Britain by the House of Commons Health Committee
Publication:Special Delivery
Date:Sep 22, 1992
Words:1452
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