Opting for delivery by your community midwives is not necessarily straightforward. Local health trusts vary in their enthusiasm for providing a home birth service, so that near neighbours may get a completely different service. The midwives, from the most senior, the director of midwifery services, downwards may feel obliged to deter you, either as a result of their own beliefs or because they are so instructed by their health authority policy. It seems likely that there would be many more home births if women were given a real choice in the matter, but all too frequently they find it difficult to ask for one or find that, if they do, they are further put off by the attitude of the midwife they first speak to.
It may be that the policy in your area is one of discouraging home birth and that a midwife knows that booking you for home birth will be frowned upon either by her seniors or by her colleagues. Even within an area which is well disposed to home birth, different community midwives feel differently about the subject. Some will really relish it and be positive about it. These midwives are keen to be present at the birth and will go out of their way to be there on the day. They are undoubtedly midwives who have experience of home birth and who have learnt through observation that birth goes better at home.
Others, either hospital midwives or those whose experience of community work is limited, or who work for an authority that positively discourages home birth, are likely to feel negative about it. Again, training is responsible.
Recently qualified UK midwives should have a degree in midwifery. Previously, some midwives went directly into midwifery training but the majority began their training after three years training to be nurses.
Another community midwife pointed out that midwives can be anxious about home birth because it is not adequately covered in their training. A midwife may qualify having been present at only one or two home births, if she is lucky. A qualified midwife can therefore find herself in the position of delivering a baby at home, never having done it before. Without an inherent belief in women’s ability to give birth unaided — a belief she will not gain in hospital — she, as well as the doctor, can be terrified by the prospect.
Not only might a midwife feel inadequately trained to cope with birth at home, but she, even more than a doctor, is also subject to hierarchical pressure. In terms of power and authority the midwife is almost at the bottom of the ladder (while the mother has not even got her feet on it) and she is answerable to her supervisor, the director of midwifery services, and to any doctor, consultants in particular. She also has to maintain a working relationship with her colleagues, whom she will still be seeing long after your baby is born. If the majority of these people see home birth as professional suicide, it is going to take a lot of courage to book you for home birth, even if she is basically sympathetic.
This is why you have to be adamant about your decision. Unless you only meet with a favourable response, you need to be completely firm about your decision. Although it is a pity not to have the opportunity to discuss the pros and cons freely with your midwife, you can only be sure of getting what you want by presenting an assured front.