Homerton Hospital: Stop the reduction in the home birth team and maintain home birth as a real choice for women in Hackney
For the last two years Homerton University Hospital has provided a dedicated home birth team of six midwives. This service will be drastically cut as of the end of this year leaving it unable to provide an adequate provision for home birth in Hackney.
The service has seen a growth in home birth rates and has been hugely popular with women in the area providing a caseloading service, one-to-one care, excellent statistics (9% caesarean rate against 26% in Homerton itself), real choice of place of birth and a respect for women's right to autonomy during pregnancy and birth.
Without warning or rationale the service is now being reduced to four midwives. At this reduced capacity they will be unable to provide the level of service the women of Hackney need and deserve and will be unable to promote the further growth in home birth rate.
The reduction in the service is all the more questionable in light of recent robust evidence from the Birthplace in England 2011 study (and others) that giving birth at home dramatically reduces unnecessary medical interventions whilst being the most cost-effective place of birth for NHS Trusts.
This decision needs to be reversed urgently to ensure Homerton keeps choice of place of birth, a commitment to respectful, personal, continuous and responsive maternity care and the importance of 'normal birth' at the centre of its philiosophy for the maternity services provided to the women of Hackney.
- CEO, Homerton University Hospital NHS Foundation Trust
- Divisonal Operations Director
RE: The Homerton home birth service
I am writing to express my objection to the reduction in the Homerton home birth service and petition for a full-service to be re-instated.
As I am sure you know, the home birth service is very popular with local mothers and more women are choosing to have their care outside of hospital thanks to the service.
The midwives work tirelessly to promote healthy pregnancies and births for the women they support and the service has a remarkably low caesarean rate, at 9% compared with 26% at the hospital. Although some women who access the service go on to have their babies in hospital, their need for care delivered by a midwife they know and trust, delivered outside of the hospital setting, is often more important to them than the birth itself.
I understand that the home birth team is going to be reduced from 6 midwives to 4 at the end of this year. Midwife Angela Barry has been rotated out of the team against her will. She is an incredibly popular midwife who has received great feedback from Hackney mothers.
Angela's removal from the team and the resignation of another midwife who is not going to be replaced means that the home birth team will no longer be able to provide a full 24/7 service staffed by midwives dedicated to and experienced in home birth with an existing relationship with the women they care for.
Angela will be unable to support the women booked with her for the rest of their pregnancies, births and postnatal periods. The decision to reduce the team was taken, to our knowledge, without consulting the home birth midwives or the leader of the team. It has not been raised at an MSLC. There is no rationale to justify reducing a thriving service with excellent outcomes that guarantees that women in Hackney have real choices over their maternity care.
I would draw your attention to Homerton Univeristy Hospital's Maternity 'Philosophy of Care' which states that: "Our philosophy of care is based on respect for pregnancy as a state of health and childbirth as a normal, healthy, physiological process. Pregnancy and birth are very significant events in a woman’s life and that of her family. The care we provide will aim to respect the diversity of women’s needs and the variety of personal and cultural values that women, families and communities bring to these events. Care will be continuous, personal and responsive to a woman’s health, social and emotional needs. We aim to keep women informed at all times of the progress of their pregnancy and likewise any issues that arise during their care. We will encourage decision-making as a shared responsibility between the woman, her family and her care givers. To facilitate this, care provision must include evidence based information, education and counselling support to enable the woman to make informed choices."
The decision to reduce the service and the lack of communication with and regard for the midwives involved and the women they have built relationships with, appears to be in direct opposition to this 'Philosophy of Care' . The decision also appears to be in direct contradiction to the Department of Health NHS mandate which clearly states that the NHS will:
-offer women the greatest possible choice of providers
-ensure every woman has a named midwife who will make sure she has personalised, one to one care throughout pregnancy, childbirth and during the postnatal period, including additional support for those who have a maternal health concern
-reduce the incidence and impact of postnatal depression through earlier diagnosis, and better intervention and support
I would be grateful for your urgent response to my concerns.
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