Women having their babies in a birth centre or at home may choose to labour and/or give birth in water. The Royal College of Midwives (2000) states that ‘women experiencing normal pregnancy, who choose to labour or deliver in water should be given every opportunity and assistance to do so’. Birth in water is considered a normal birth and just like homebirth it gives midwives a chance to practise autonomously, using their ‘with woman’ skills. Women have said that water birth has given a greater sense of control and movement as well as providing good pain relief (Garland and Jones 2000). Researchers such as Burns and Kitzinger (2001) have found water birth to be a safe option. Midwives have a responsibility to ensure they are competent and accountable for their actions and omissions, and all units should be developing guidelines for water birth. Midwives have a responsibility to refl ect on rules and ensure accountability for their own practice. One of the roles of the Super- visor of Midwives should be to help other midwives acquire and sustain their skills in water birth.
Table 3.1 provides a list for parents from Independent Midwifery records in order to be prepared for a homebirth.
Table 3.2 describes the contents of a hospital bag.
Midwifery wisdom
Remember to pack some food or drink. The midwife needs to be cared for too!
Midwifery wisdom
Remember, it is the woman’s choice to make. Count to ten before you ever hear yourself saying to her ‘you can’t’ or ‘you’re not allowed’.
Case Notes
Giving birth to my third child at home was an amazing experience for all of us. My older children were there to witness their little sister being born and my midwife was fantastic and so supportive. However, the best part was having a relaxing bath afterwards in my own bath and then snug- gling down into my own bed with my gorgeous new daughter!
Table 3.1 Homebirths and equipment Equipment for parents to provide
• Something waterproof (e.g. waterproof tablecloth, shower curtain) to protect carpet/
sofa/bed or wherever you end up (NB. Not all shower curtains are waterproof.
Plastic sheets available from garden centres are.)
• Old sheets or linen
• Bin bags
• Torch with spare batteries
• Nourishing, easily digestible food and drink, e.g. bananas, honey, sugary sweets, chocolate, yoghurts, glucose tablets, Lucozade, Ribena and fruit juices.
• Bendy straws to drink from
• Comfortable clothes, e.g. large, baggy T-shirt
• A large soft towel to cover mum and baby together after the birth
• Towels for the baby
• Sanitary pads (large maternity type)
• Two or three new face cloths
• Hot water bottle (to put on back for labour or tummy for after-pains)
• Snacks for your midwife to eat whilst you are in labour!
Optional
• Mirror so that you can see the birth
• Camera/video to record the birth and to take the fi rst pictures of your baby
• Lavender oil, homeopathy, alternative therapies Equipment provided by the midwife
• Large absorbent pads
• Sphygmomanometer (for reading blood pressure) and a stethoscope
• Thermometer
• Mobile phone in case of emergency
• Pinard’s and underwater sonicaid to listen to the baby’s heartbeat
• Baby resuscitation equipment, including oxygen, a bag and mask
• An adult bag and mask should oxygen be required
• Entonox (three cylinders) and mouthpieces
• IV fl uids, cannulae and giving set
• Syntometrine, syntocinon and ergometrine (drugs used to prevent heavy bleeding)
• Baby weighing scales
• Sterile cord scissors and clamps, episiotomy scissors
• Suturing materials, including local anaesthetics
• Warm electric pad
The majority of equipment provided by the midwife is there as a precaution and is rarely used.
of women throughout pregnancy, birth and for six weeks postna- tally, providing women with the care that they choose. This usually involves homebirth. Women choose independent midwives for a variety of reasons. One is to ensure continuity of care and knowing who will be supporting them at the birth. IMs usually support
women wanting a homebirth, but may also support her in the hos- pital if needed.
Any midwife can choose to work in this way whether she has just qualifi ed or has 20 years’ experience. IMs work using the Midwives Rules and Standards (NMC 2004) as their guide and the latest mid- wifery evidence to support their practice. IMs, like NHS, agency and bank midwives, have a named Supervisor of Midwives chosen from the local supervisory area that they work in.
Case Notes
I had complications in my fi rst birth, which left me feeling quite dis- tressed. I ended up suffering from post-traumatic stress disorder and it took me some years to decide to get pregnant again. I wanted to know my midwife in my next pregnancy and so we took out a small loan in order to employ an independent midwife to look after us. The visits all took place at our house and lasted at least an hour. I really felt that my midwife spent a lot of time listening to me and respecting my choices.
She did all the physical checks, such as assessing the growth of the baby, taking my blood pressure and testing my urine. She also took my blood to test my iron levels and screening tests.
Table 3.2 Suggested contents of a hospital bag
It is essential to have a hospital bag ready. If you do need to transfer to hospital there will be no time to wait for someone to pack!
• Two or three nightdresses or large T-shirts, dressing gown and slippers
• One pack of night-time or maternity sanitary pads
• Toilet bag with soap, toothbrush, toothpaste, etc., tissues
• Change for the public pay phone (minimum call charge 20 p), list of telephone numbers
• Clothes and shoes to come home in
• Lavender oil, homeopathy
• Large paper pants or old knickers
• Two face cloths
• Camera and several fi lms For the baby
• Towel
• Nappies
• Cotton wool
• Baby clothes, vest, babygrow and blanket (include warmer clothing for coming home in).
The Independent Midwives Association (IMA) has set up an audit of independent midwifery practice in the form of a database project registering clients at the time of initial contact to give the study cred- ibility. The ongoing study has consistently shown that IMs have a high rate of normal births even amongst women who have risk factors (Milan 2005). The IMs also have a 14 per cent caesarean rate compared with a national average of 22 per cent (Birth Choice UK 2007). This is with over 70 per cent of the clients that they book with one or more risk factors (Milan 2005). IMs give informed choice and often support women who have made diffi cult decisions.
The IMA are respected politically and have members who provide advice and guidance to the Department of Health with issues per- taining to maternity care. Currently, the IMA is proposing that the NHS Community Midwifery Model (NHSCMM) is implemented (Van der Kooy 2005). The NHSCMM proposes that when a woman becomes pregnant, she is given direct access to a list of midwives in her area. The woman then contacts them and chooses the one she feels most comfortable with. That midwife then enters into a stan- dard contract with the NHS who pays on a set fee per case basis.
The NHSCMM would be available to those women who want it, no matter where they live or what socio-economic class they come from.
There is much behind-the-scenes work that IMs do. Tables 3.3 and 3.4 are examples of the kind of letters that IMs send to various people/organisations.
I had not decided where I wanted to give birth but by the time I was 40 weeks chose to have a homebirth. My midwife respected my choice and had always said that it was up to us and she would support me wherever we chose to have our baby.
My labour with my daughter was quite long and tough, but my midwife was by my side the whole time supporting me. The birth of my daughter was so much better than with my fi rst child. I felt that having a trusting and continual relationship with my midwife made all the dif- ference. My midwife visited us for six weeks following birth and was really helpful with assisting me to establish breastfeeding (something I had not managed to do before). She was also able to reassure any con- cerns I had and check that we were coping psychologically as well as physically.
By the time I was discharged from my midwife’s care I felt I had laid to rest the ghost of my fi rst birth and could get on with family life. It was the best money I had ever spent.