Fearful doctors stand in way of home births

Most family doctors still oppose home births despite Government support for them, growing demand from women for this type of delivery and strong evidence that the majority of such births are safe for mother and child.

A new study suggests that as many as 10 per cent of women would like a home birth but "had obstacles placed in their way" by GPs who felt it was an "inappropriate" request.

Almost a third of women in the study who had planned a home delivery were made to change their plans and go to hospital for the birth. In half these cases there was no medical reason for this change.

Less than four per cent of women in the study had a home birth which was supported by an enthusiastic GP, and one in ten women had to change practitioners in order to give birth as they preferred.

GPs, it was reported, had "reservations" about half of the booking requests for a home birth, and many actively discouraged their patients from this choice. Two thirds of women said they had not been offered any option about the place of birth.

One woman tried 12 different doctors but could not find one prepared to provide care during labour, despite the fact she was a suitable candidate, having given birth successfully at home previously without a doctor being present.

The study, carried out by a team at Newcastle University, concluded that the difficulty women face in obtaining a home birth is largely due to GPs' fear of complications influenced by their experience of problematic births during their hospital training. The availability of "flying squad" support in the event of a crisis and an emergency admission to hospital was also a concern.

Writing in tomorrow's issue of the British Medical Journal, the researchers say: "Probably [GP reluctance] also rises from a misunderstanding of their role and of the accountability of midwives as well as from an exaggerated idea of what is expected from general practitioners, who despite obstetric training are unlikely to have maintained their skills."

Midwives, who were also questioned for the study, reported a failure of professional support from doctors and a shortage of adequate equipment such as mobile phones, and cylinders of nitrous oxide anaesthetic gas.

Women told the researchers that they liked home birth because they felt in control and this positive feeling persisted even in those women who had to be transferred to hospital from home during labour.

In the 1960s a third of all births occurred at home but the incident fell to an all-time low in 1987 when it accounted for just 0.9 per cent of all deliveries. Nine years on, the figure has risen to just under two per cent, despite a groundbreaking Government report in 1993, Changing Childbirth, which suggested that it should be an option for all women.

The Newcastle researchers investigated 256 women in the Northern region who expected to deliver in 1993 and whose request for a home birth was known. Five miscarried. Of the remainder, 57 per cent delivered at home. There were 17 per cent Caesarean sections but no perinatal deaths. About 30 per cent of women were referred to hospital for delivery before labour, and 14 per cent were admitted from home during labour.

In a second study in the BMJ, the Northern Region Perinatal Mortality Survey Co-ordinating Group reviewed all perinatal deaths in the region associated with planned or unplanned births outside hospital between 1981 and 1994.

There were 134 deaths in 3,466 births outside hospital, about four times the death rate in hospital. However, 97 per cent of deaths occurred in women who were booked for hospital delivery or who had no pre-arranged delivery plan, confirming that unplanned home births were hazardous.

The perinatal outcome for planned homebirths was better for all women giving birth in the region, a finding confirmed by Swiss and Dutch studies of home birth in the same issue of the BMJ which conclude that home births is extremely safe for healthy women at low risk of complications. Women who opted for hospital births were at higher risk of induced labour, Caesarean section, forceps, vacuum extraction and episiotomy.