Thank you for speaking with me today.
What part of Great Britain do you live in?
How did you get started as a midwife?
My journey to becoming a midwife started when I was having my own children at home. My first son was born in 1989, and that was a very low year for homebirths in the U.K. In fact it was the lowest year ever for homebirth in the U.K. But I was lucky, and my son was born beautifully at home, and I was very inspired by that. I went on to train and become an osteopath, and over the years I was invited to various friends’ births; Some of them at home, some of them at hospital, but more and more I just became interested in birth. Eventually I decided to train to be a midwife and I qualified in 2014. In my first year working in the hospital, I moved into working in a team doing homebirth. And that’s what I’ve done ever since.
Why is your group called Olive?
It used to be called Valley, because it’s on Valley Road. Then they were making cuts at the hospital; We used to have 6 caseload teams that do homebirth, and they rearranged the service and reduced it to five and upset a lot of people. They thought because of all the changes they were making, that they would change the names of all the teams. They thought it might upset people less. But it didn’t, it upset people more. They chose new names for the teams that do homebirths.
So you don’t work at the hospital, you just do homebirths?
We do both.
Through the NHS?
How do your shifts work? Are you full time?
Yes, I’m full time. There’s seven of us, equivalent to six full time; We’ve got five full time and two part time on our team. It’s quite complicated, but basically we do twelve hour shifts. The vast majority of the time we have at least one person on call both during the day and night, although usually two. We also work together with the other caseload teams, so we share our emergency care. Last night I was the emergency midwife for the whole of the hospital area, which is quite big, so what happens is if for some reason somebody is sick, or the team doesn’t have good cover, then they can always call on whoever’s on emergency. My team is the emergency midwives every Monday night, so on Mondays we make sure we have good cover, in case we’re out helping other people.
In a four week cycle we have eight days off, so we don’t get weekends off like normal people, but we do get eight days off every four weeks.
I was wondering, why would somebody want to be an independent midwife?
If you’re independent, there are a few advantages. You tend to have a much smaller caseload. You really have a much closer bond with your women. The way I work, I have the women that are on my caseload that I look after antenatally. But when it comes to labor care, if I’m not on call the night they go into labor, one of my other team members will look after them. By the time they have their baby, hopefully they know most of the team. Most independent midwives work in a pair, and they commit very strongly to being with a woman at her birth. So that’s a whole different service than what we can offer.
I read that the rate of homebirths in England is 2-3%, in your specific area is homebirth at all popular or do most women in your area prefer a hospital birth?
Until this year, before the changes to my team occurred, our team had a 30% homebirth rate. We had built a culture of women having homebirth, by having homebirth workshops where they brought back women who’ve had homebirth to talk to women who were pregnant, and they promoted it a lot. The way they’ve made changes recently, we get quite a lot of referrals from women who are never going to have a homebirth because they’ve had previous cesareans or are high risk, so it’s caused a lot of upset with the recent changes, and our homebirth rate has gone right down now, it’s nowhere near 30% at the moment.
What changes were made to your team?
They reduced from 6 teams to 5 teams but we still cover the same area. They spread us further apart and then they said we need to take more women who are high risk women onto the caseload, because they need more input. But of course, by definition, those who are high risk are less likely to have homebirth. The way it used to work was they used to take women who were referred from the local areas until the caseload was full. They’d end up with a lot more women who were having normal pregnancies, who would be much more likely to opt for homebirth. So it’s really changed and we’re not happy about it. At the moment there’s discussion what to do about it.
Do you work closely with the obstetricians or is it just by referral, where they transfer completely out of your care if there’s an indication?
No, we work together. It’s called “shared care”. If something turns up and I don’t think the woman needs to see the obstetrician, I’ll book her into the clinic if I’ve got a particular concern, and I will email the obstetrician and discuss things together, so it’s a good collaboration.
At St. Thomas’s, which is the hospital I’m affiliated with, I think there’s a particularly good culture of respect between the obstetricians and the midwives, and the obstetricians treat us as equal.
Do you work with Anne Cobell?
Yes, she used to be my boss. Do you know her?
Yes, I actually just interviewed her as well. She’s lovely.
We used to work together. We were the team that got cut. When our team got cut, she was moved in one direction, and I was sent in the other direction.
It’s a pity.
She’s amazing. I love her.
Yes she really is. I figured what are the chances you’ll know her. You and Anne are the only midwives I’ve interviewed in the United Kingdom. She’s also really pro-homebirth. It’s a shame that the rate of homebirth is falling, especially in countries like Holland.
Yes, it dropped about ten years ago in Holland suddenly. There was a report released showing a higher neonatal death rate at homebirths, and the obstetricians reacted and encouraged women to go to hospital.
Yes, although I spoke to a Dutch researcher who told me they repeated the study twice and the numbers came back different, but it was the negative study that was popularized.
Unfortunately that’s what happens.
As a homebirth midwife and hospital birth midwife, do you personally feel homebirth is just as safe as hospital birth or do you feel it’s just about weighing the risks?
If it’s not your first birth, statistically you’re actually safer at home. The risk to the baby is the same as a baby born in the hospital, and the risk for the mother is less if it’s not your first at home. If it’s your first birth, in the U.K., statistically there’s a very slightly increased risk for the baby. But we can’t figure out why that is. And the thing is, those of us who do homebirths, we don’t take any chances. If we’re home with a woman and things are not going quite as planned, then we will transfer in. We don’t wait til it’s a whole disaster. I personally feel very confident that homebirth is a very safe option.
Do you feel the distance from home to the hospital makes a difference to the safety of a homebirth?
I work in London where, despite the traffic, no one’s very far from a hospital. We did a transfer once which took thirty minutes via ambulance, which was unusual. Normally it would be quicker, and it wasn’t a real emergency in that particular occasion. Had it been a real emergency, there was a hospital which was closer. But if we had gone there we wouldn’t have been able to stay with them, because it wasn’t our hospital. As midwives we can only work in the hospital where we’re employed. The area that I work in is Streatham. The nearest hospital geographically is St. George’s. But we work under St. Thomas’s trust. So if we’re home and we want to transfer in, and it’s not an immediate, life threatening emergency, we would go to St. Thomas’s, so we could stay with the woman. But if it’s a life threatening emergency we’d go to St. George’s, because it’s quicker.
Do you have any interesting homebirth stories you’d like to share?
Would you like to hear about my first one?
Sure, I’d love to hear it.
Back in ’89, I was considered completely mad wanting to have a homebirth, and wanting to have my baby in water. It was unheard of.
What inspired you?
A friend of mine had her third baby at home and was very positive about it, so that inspired me to have a baby at home. And then a television program, called Katie’s birth, which was above a private doctor working in Cornwall, and he used to travel around with a great, big birthpool on the roof of his car. It was a lovely little program and it showed this woman having her baby at home in water, and I just thought ‘that was nice’. It was very difficult to get them all to agree, but it was finally agreed three days before my due date.
To get your husband to agree?
No, my husband was all for it. He was great; He was the one who kept it going. We had problems with health authorities. The hospital I was under wouldn’t do it, and eventually I managed to persuade St. Thomas’s actually, the hospital which I now work for, to agree and they sent a midwife to help me. Then I had problems with insurance, they never had a woman giving birth in water before, and it was actually the first National Health Service water birth at home. We were even in the newspaper!
Wow! How did you get it approved?
Because I was having a homebirth, which was in itself unusual, I had to travel to see the doctor. The midwife who worked regularly with that doctor showed an interest when I told her what I was thinking of doing. So when my midwife turned it down, because the hospital that I was under wouldn’t allow it, I said to her, ‘Would you like to do it?’ She said, ‘I’d love to.’ And that was the beginning. She then had to get approval and we had to get the insurance sorted out, then she had to go on a course to train, because she had never done a water birth before. Yes it was an interesting journey.
How did homebirth become more popular since then in England?
It hasn’t really. The national rate is around 4%, but there are little pockets around the place where it’s much higher than that. I think the highest homebirth rate area in the UK used to be around Taunton in Devon, and then where I am now in Streatham, that was very high until this year. It really depends on the local culture. You need midwives that are keen, that will promote this. And then you need to set up a forum where women can communicate with each other, give each other confidence, enthusiasm, and set a culture where women feel confident to do it. Because all they hear in the media is danger and risk, and madness, so they need to be supported by other women who also think it’s a great idea.
How many women will ask you about having a homebirth and what their options are around birth?
I would say, this is just an impression, I haven’t studied it, but I would say most women have not thought about homebirth when they’re first pregnant, unless they know someone who’s had one. I did a homebirth recently which was her first at home, and she actually worked in the hospital as a midwifery support worker, and she had obviously looked at the situation, and she decided that she would like to have a homebirth right from the start. She came to me from the start because of that. Some will come to me with the idea and are quite open to it, while quite a lot of them come to it during their pregnancy, rather than at the beginning.