‘Sure! We will be more than happy to support your homebirth!’ (A common response to a request for a home birth! Yey!)
However, it is usually followed with:
‘Unless, of course, there are not enough staff on that day. In that case you will have to come into the unit.’ (Not so yey…)
Fortunately its very simple, repeat after me…
‘NOT MY PROBLEM.’
It is not your job to consider the staffing logistics of your local trust when you are deciding on your place of birth. Wether you are assigned to a busy city centre unit or you live rurally and your local trust is practically a long weekend trip away you simply don’t have to concern yourself with this particular issue.
Fundamentally it is your right to choose where to birth.
“All people* should have an appropriate level of choice in relation to place of birth and there are a number of choices that should be available to all people in Scotland including birth at home, birth in an alongside or freestanding midwifery unit, and hospital birth.” (Gov.Scot - https://www.gov.scot/publications/best-start-five-year-forward-plan-maternity-neonatal-care-scotland-9781786527646/)
The factors you take into consideration as you make this decision are yours to choose. You are free to research as much or as little as you wish. My personal belief is that knowledge is power and the more you understand your rights and choices in birth the more confident you will feel in your interactions with your care team. However, in short - you are always in control.
If during your care you are told that you ‘will not be allowed’ a home birth due to staffing levels you are well within your rights to contest this. To support your case you may firstly like to draw your trust’s attention to their National Institute for Health and Care Excellence (NICE) guidelines which state:
“they may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support them in their choice of setting wherever they choose to give birth”
(NICE - https://www.nice.org.uk/guidance/cg190/chapter/recommendations)
You may then consider highlighting the complaint of Mrs Jane Reeve. Mrs Reeve was forced to hire independent care when her trust refused to provide home birth services to her. Her complaint was upheld and it was found that the suspension of home birth services was unreasonable.
It is also helpful to understand that the NMC code itself states
“You put the interests of people using or needing nursing or midwifery services first. You make their care and safety your main concern and make sure that their dignity is preserved and their needs are recognised, assessed and responded to. You make sure that those receiving care are treated with respect, that their rights are upheld and that any discriminatory attitudes and behaviours towards those receiving care are challenged.”
(NMC - https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf)
Is refusing home birth support a breach of the NMC code? When multiple contingency possibilities are ignored then I believe that it is indeed a breach & grounds for a complaint.
Ultimately though this is not your concern, you are simply not the one being paid to consider staffing logistics. We have people in our system with the means to do this.
I would strongly urge anyone who is currently experiencing issues with home birth provision to contact the following people/organisations:
*I have amended this for inclusivity reasons.