Home vs hospital: Where would you rather give birth to your baby?

The Health Secretary, Patricia Hewitt, says more women should do it at home, but experts warn they are still being denied the right to choose. By Sophie Goodchild

The debate over whether childbirth should take place away from the hi-tech environment of the labour ward or surrounded with as much pain relief and medical intervention as possible has divided feminists for decades.

Some experts argue that the doubling in Caesarean deliveries, which account for nearly a quarter of all births, is partly down to women exercising choice. However, others blame a shortage of midwives and the fact that women are given biased information about their choices for increased trauma rates among new mothers.

It is estimated that more than 200,000 women annually,a third of all who give birth every year, suffer some form of psychological distress as a result of having a baby, with at least 10,000 developing post-traumatic stress disorder (PTSD).

A report which is expected to be published later this year will warn that, more than a decade after the introduction of new measures emphasising the need for choice, there has been little change in how expectant mothers are treated.

Dr Caroline Gatrell, a leading sociologist, says women are disempowered and that choices such as whether they want to give birth at home or want pain relief are increasingly limited.

"As soon as you go through the hospital door the chances of having forceps are much higher and you are less mobile, which increases stress," said Dr Gatrell, of Lancaster University.

These concerns are reflected in a book published next month by Sheila Kitzinger, a leading pregnancy and childbirth guru, who warns that childbirth is one of the key areas of women's lives where they feel they have lost control and that it has become increasingly institutionalised.

In an interview with The Independent on Sunday, Ms Kitzinger said women are often processed "as if on a conveyor belt in a factory". "The fear that women have of childbirth is more the dread of other people overpowering them and taking control rather than the actual birth," said the author and campaigner. Women in the UK should be able to choose from a number of different birthing options, as well as decide whether they wish to use drugs to reduce labour pain.

When planning a home birth, the mother meets regularly with her GP and a team of midwives. Often it's a single midwife who assists with labour, and pain relief can be limited for home births.

Hospital birth is far more prevalent, with the possibility of having a vaginal, Caesarean or water birth. A team of midwives usually sees the mother through the birth, with obstetricians present in case of complications, and there should be pain-relief options.

But figures obtained by this paper show there is a huge regional variation in where and how women give birth. In the east of England, nearly 3 per cent of women have a home birth compared with less than half a per cent in Northern Ireland. The data also show a significant difference in the proportion of women who chose to have a Caesarean. In London, nearly 10 per cent of women undergo Caesareans but in the North-east the figure is just under 8 per cent.

The findings are based on research carried out between April 2003 to March 2004 by Dr Foster Intelligence, healthcare information analysts, and they also suggest some women are being denied water births because midwives are not trained to assist them. In the East Midlands just over half have training but in Wales it is less than a third. Updated figures are due soon.

The National Institute for Health and Clinical Excellence (Nice) is drawing up guidance based on the risks and benefits of a range of places for birth. Preliminary research has revealed that women who give birth at home or in similar settings are likely to have less interventions such as epidurals and may be more satisfied with the experience than those in delivery rooms. However, there may be a small increase in the risk of a baby dying when it is delivered at home.

Midwives argue women are victims of cuts in maternity staff and, with correct investment and care, many could benefit from home delivery.

Paul Beland was sacked by his NHS trust in 2004 after attending a woman who had booked him to help her give birth at home. His bosses had imposed a ban on home births because of staff shortages. "When you reduce staffing levels you compromise patient care. It's that simple," he said.

But the Royal College of Obstetricians and Gynaecologists also says that most medical interventions are necessary and beneficial. "If you have any complications then the safest place you can be by far is the hospital delivery suite," said Dr Maggie Blott, a spokeswoman.

However, Dr Blott acknowledges a "postcode" lottery exists over how childbirth is managed and that staff shortages are leading to an increase in Caesareans. "On the labour ward, a train of events takes place which often ends up in Caesarean, partly because of staff shortages," she said.

Additional reporting by Jonathan Owen and Megan Waitkoff

Home Choice: 'I felt like I was battling the NHS the whole time'

Michelle Barnes is due to have her second child this week. This time she's having a home birth with an independent midwife.

"After my first traumatic experience, I didn't know what was the right thing to do, so I put a lot of work and research into it," she said. "I decided a home birth would be safer."

Mrs Barnes became pregnant with her first child, Michael, in 2002. She decided to have a natural birth in her local Sheffield hospital, but things went wrong and an emergency Caesarean was ordered. "I had to have the procedure to save his life," Mrs Barnes said.

Having suffered post-traumatic stress disorder for several months afterwards sheasked the NHS about home birth options when the couple decided to have another child. "They said they'd let me do it, but they weren't very supportive," she said.

She and her husband invested £2,500 in an independent midwife for an increased sense of security.

"I just felt like I was battling the NHS all the time to get the birth acceptable to me," Mrs Barnes said. "I wanted to get to know somebody I could trust."

Megan Waitkoff

By the Numbers

10,000 women a year are estimated to develop post-traumatic stress disorder (PTSD) after childbirth

200,000+ women a year are estimated to feel traumatised by childbirth and develop some of the symptoms of PTSD

£1.6bn worth of clinical negligence claims have been made relating to obstetrics and gynaecology since 1995

23% of all births end in Caesarean

sections being performed, nearly three-quarters of which are done under local anaesthetic

41% of Caesareans are planned in advance and are not classed as emergency cases

46% of all hospital units provide mobile epidurals for women who want to be able to walk around

358 new midwife units are needed to satisfy the current demand for midwife-led units and home births

2% of births happen at home today, compared to 99 per cent at the start of the 20th century

1,765 midwifery posts are vacant and midwives are continuing to leave the profession

19% of women do not get one-to-one care from their midwife throughout labour

69% of birth units have an anaesthetist on site around the clock

20% of vaginal births involve the use of an epidural or spinal anaesthesia