An Open Letter To East Kent Hospitals Trust

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Dear East Kent Hospitals Trust

I am writing this Open Letter on behalf of several of my East Kent clients who have recently had their option of homebirth removed in response to Covid-19.

Whilst I fully understand that these are unprecedented times and that the NHS is under extreme pressure, I also feel that to ban all homebirths under the East Kent NHS Trust is a disproportionate response to the current situation and does not take into account the risks and benefits of birth place to each individual.

You state on your website “Please be aware that in the current unprecedented situation with Coronavirus, our local ambulance service is under significant pressure. This means that support for all conditions from the ambulance service, including complications that can arise during home births, will be stretched.

This means that giving birth at home may present a higher degree of risk to women and babies than it would ordinarily. The safety of mums and babies is our priority, so we have taken the decision to suspend the home birthing service at this time.”

I have had many home birth clients over the past 13 years and I can only recall 2 where they transferred by ambulance. In the majority of hospital transfers, my clients went under their own steam.  Hence I feel to ban all NHS home births is a disproportionate response.

I would like to share (with permission) a few brief details of just some of my clients who have been told they will no longer be supported for a home birth:

Client A is pregnant with her third baby. Her previous 2 births were very speedy straightforward planned homebirths.  Her last birth was a BBA (born before arrival of the midwife) ably assisted by her husband, 40 minutes after the midwife came and left, saying ‘you are nowhere near delivering this baby yet’.

She chose a home birth for her first baby as her mother had very speedy labours and she was concerned that she might not make it to the hospital.  It turns out she was right to be concerned as she would not have made it to hospital with either of her births, given that labour suddenly ramped up without the usual warnings.  If an experienced community midwife cannot tell that this women is about to birth her baby, how is she to know when and if it is safe to leave her nest and make the 45-60 minute journey to her nearest hospital?

Unsurprisingly then that she is also planning a homebirth with baby number 3.   

Her family unit of 4 have been self-isolating since the Government advice on the 23rd March to do so. They are complying with the advice as it seems very sensible to follow what the scientists are telling her is the safest thing for pregnant women to do.

We are all being encouraged to attend hospital if we have an accident or are unwell, and rightly so. However, pregnancy is not an illness and for the majority of low risk mothers, with previous homebirths under their belt, hospital is not safer, particularly at this time. Therefore the last thing she intend to do is attend a hospital full of sick people and where she will encounter very many more midwives and hospital staff (and possible Coronavirus carriers) than she will by staying at home under the continued care of one or two midwives. Going to hospital would negate all the self-isolation.

Moreover, she has no desire to increase the risk to her and her baby by possibly giving birth in the car on the way to hospital. Or on the way back if she is turned away with a dismissive ‘go home, you are nowhere near to giving birth yet’.

Fortunately with the help of many friends and family, she has now secured the support of local Independent Midwife Claire.

Client B was planning a home birth with baby number 2; family also in isolation since March 23rd. She was so distressed at hearing the news that her imminent home birth would no longer be supported, that her husband contacted me immediately.  Fortunately by raiding their saving, borrowing money from relatives, and negotiating payment terms with our lovely understanding local Independent Midwife Kay Hardie, they were able to opt out of NHS care.

Baby was born this week in a very speedy homebirth, 6 minutes after arrival of the Independent Midwife.  Mum did not know that ‘this was it’ until 28 minutes before her baby’s arrival.  Had she have been forced to birth in a hospital, should would not have made it.

How is this safe for those that cannot afford or borrow money for an IM?

Client C is another isolating 2nd time mum, who chose to birth at home before, because that is where she feels safest. She has a few more weeks before her baby’s estimated due date.  She is hoping and praying that the home birth service will be reinstated before then.  An IM is not an option for them, so hope is all she has.

And now to a friend of mine: Another 2nd time home birth mum. She is from a very low income family, they don’t have saving to draw on or family to support them financially to help with an IM. She is now planning to freebirth at home.

These are just a few examples of the women who I have spoken to over the past few weeks and it is heart-breaking to hear their level of distress over this decision.

I’d like to thank East Kent midwives Kay and Claire for working together with other IMs in Kent to cover each other and offer as many women as possible the hope of a home birth.

I know there are many midwives who want to continue to support women at home. I cannot understand how a withdrawal of home birth is considered safe practice.

I also know home birth presents many challenges for the NHS at this time; but if several trusts are managing it, why not all?  Some trusts have never felt the need to withdraw the service.  Other trust who initially withdrew home birth, have now reinstated it.  So please East Kent, look to these trusts and see how they have achieved it. 

I feel we should be asking our community midwives to isolate at home and only to attend homebirths, where families have also been isolating.  This surely has to be the safest option for both families and midwives?

This seems like a time when we should be encouraging low risk women to stay at home and keep the risk low.  Instead we are introducing an additional risk of contracting a potentially deadly virus.     

That in itself could put an even greater strain on the NHS.  Not to mention taking up a bed space, when they could be in their own bed at home, whilst continuing to isolate with their new baby.

Personally, I feel that to ban all homebirths is a disproportionate response to the current situation and does not take into account the risks and benefits to each individual.

Indeed a Facebook post from The University of Leicester Home Birth Team on the 1 May showed that their home birth rate for April 2020 had increased from 2.5% to 5.7%, with 43 babies born at home.  That is what I had hoped would happen in East Kent.  

“We are very proud of this month’s statistics. To put this into context the number of babies born at home in Leicester, Leicestershire and Rutland prior to April was in the region of 2.5% (TBC) and our average home birth rate in the last 12 months has been 18 per month (range 7-28). We are glad that so many more families are opting to birth at home during current circumstances and are hopeful that this has a long term impact in raising awareness of birth place options. Thank you to our wonderful community midwifery colleagues for your ongoing support and promotion of our service, we could not have achieved these results without you!”

We all know that women consider very carefully their choice of birth place (and that sometimes baby chooses).  It is not a choice made on a whim.  They weigh up the risks and benefits to them personally, given their circumstances and they make an informed choice.

There are many reasons why women choose a home birth and some are outlined in the stories above.  In addition, some will have chosen a home birth because of a previous birth trauma in a hospital setting and wild horses wouldn’t drag them back there.  Others have a history of sexual abuse and they only feel safe in their home setting.   Some have a fear of hospitals.  And we know that fear is the enemy of the birthing room.

Our hypnobirthing clients are fortunate in that they have a set of tools and techniques to help them navigate any changes in their birth plan. But these are usually made in response to changes in their own personal risk or circumstances.  To have the rug pulled from beneath their feet when they are healthy and low risk and be told they have to travel to a high risk environment, with the added risk of an unattended car birth, seems particularly cruel and hard to make sense of. 

Birthrights have written to several trusts in recent weeks. Here is an extract of that letter:

“We understand that the decisions faced by Trusts in order to run a safe and effective service are not easy in the current pandemic, and that the situation is constantly evolving. We believe the best way to ensure decisions are evidence based and robust is to ensure that Trusts are open and transparent in their decision making. This will ensure that their reasoning is well understood and easily communicated, and that disparities across the country can be properly examined.

 We are very conscious of the huge amount of valuable time being spent by a large number of organisations, Maternity Voices Partnerships and concerned individuals, trying to establish: the risk assessment undertaken to reach a decision, whether all the relevant factors were looked at, what weight was given to each factor, who made the decision (including whether service users were involved), and when the decision will be reviewed. Trusts are required to provide details of services that have been withdrawn to the Department for Health and Social Care on a weekly basis and are required to notify any escalation plans that include withdrawing services to NHS England & Improvement. We ask you to publish these details as soon as possible as a first step towards transparency, and to continue to publish updates as they are received. We are asking you to do this on an informal basis but you will be aware that these documents would be subject to Freedom of Information requests.

We are keen to do all we can to support services to make lawful decisions that place women at their heart, whilst also respecting the exceptional pressures on services at the present time, and would be pleased to discuss this further with you.”

At the time of writing, our own MVP is still awaiting a reply from East Kent Trust.

I ask you East Kent Trust, please give this your urgent attention for the sake of all pregnant mums in your area who are planning a homebirth and for your community midwives, many of whom I’m sure would like to continue to support mums in the community.   

Our pregnant clients and friends need you more than ever now.

Stay safe,

Jacqueline @ The Positive Hypnobirthing Company

I sent this letter to Ursula Marsh Head of Midwifery & Gynaecology. Here is her reply on the 13 May 2020.

Dear Jacqueline,

Thank you for your email on 3 May sharing your concerns and those of your clients concerns about the current change to our Homebirth Service. As you can appreciate this has been an exceptionally busy time and I do apologise for not responding to you sooner.

Enabling women to make the right birth choice for them is extremely important to all of us involved in our maternity service. We want to do all we can to support women and their families to have a healthy baby and the best possible birth experience.

We share your disappointment at not being able to support women to give birth at home during these worrying times. The Covid-19 pandemic has created unprecedented challenges, requiring us to make temporary changes to our service to keep everyone safe, as with many other parts of the NHS nation-wide.

We have taken the difficult decision to temporarily suspend our Homebirth Service after careful consideration with our midwives, doctors and ambulance service. We believe this is the safest approach at this current time for women, babies and our staff.

There are a number of factors involved in this decision including:

  • Covid-19 has put our ambulance service are under considerable pressure. Due to the increase in demand for ambulance resources, combined with their reduction in workforce because of Covid-19, they have been unable to fully guarantee support when a transfer to the maternity unit is required in emergency situations.
  • Our midwifery workforce has also been affected during this time. Some are required to self-isolate or have become unwell, which along with the unprecedented clinical demands on our hospitals, means that we are currently unable to send two midwives to a home at this time.
  • In order to protect our patients, families and staff against the spread of infection, we must ensure full infection control procedures, advice for PPE, and limited contact guidance is adhered to. All these are significantly more challenging in the home environment.

We review this decision weekly, together with our colleagues in the ambulance service, Clinical Commissioning Group and other maternity services in Kent and Medway. We all look forward to resuming the Homebirth Service as soon as it is safe to do so.

We recognise the additional concerns that women may have in accessing the hospital services and we continue to actively communicate reassurance that all staff are following the national guidance on infection control precautions in our hospitals.  All staff are wearing and have a full supply of the appropriate Personal Protection Equipment (PPE). In addition a number of women have shared their positive stories of feeling safe and well cared for during this time.  

Women continue to have the choice to give birth at the Midwifery Led Units (MLU) at Queen Elizabeth Queen Mother (QEQM) and William Harvey Hospitals (WHH) for low risk deliveries, and the consultant-led Maternity Units at these hospitals. Please can I ask you to encourage women to discuss their concerns with their community midwife so that we can work together to provide the best possible support and to alleviate concerns raised.

Thank you for the support you are giving families that you are working with and I would be happy for you to share my letter with them, so that they can contact me directly if they choose to. Please be reassured we are working together to reinstate our homebirth service as soon as this is safe to do so.

Kindest regards,

Ursula

Ursula Marsh,

Head of Midwifery and Gynaecology

So please do contact Ursula directly to share your particular concerns. Email: ursulamarsh@nhs.net

Let’s all hope that East Kent follow the lead of other trusts and reinstates our much valued Homebirth service very soon.

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