With home births on the increase I thought it would be useful to find out what is expected from your midwife and what you can expect in the way of support.

It is the right of every woman to choose where to have your baby but sometimes you have to take into account other factors, such as your own health, the risks to the baby and you and if the local authority have enough resource to provide this option.

What is expected from the midwives

Midwives are required to work within the NMC Midwives Rules and Standards 2004 as well as the NMC Code of Professional Conduct. As a member of a self-regulating profession, as well as working within the law, a midwife is responsible for meeting the ethical standards set out in the Code and the Midwives Rules. This applies to all midwives.

Government policy in the UK is to promote choice for women in relation to their pregnancy care and place of birth. This includes being able to access midwifery care for birth at home. However, there continues to be queries from women and midwives who are concerned that women are having difficulty in accessing home birth. The most common barriers are:-

• confidence and competence of midwives
• perceived conflict between risk and a woman's choice
• resources

Confidence and Competence

Your midwife is an expert in normal birth and they should be competent to support you to give birth normally in a variety of settings including in the home.

A midwife must possess the knowledge, skills and abilities for lawful, safe and effective practice without direct supervision. This includes care throughout antenatal, intranatal and postnatal periods.

Each midwife is responsible for maintaining her own competence. This includes any professional updating in relation to provision of care at a home birth.

Although a midwife must not provide care that she is not competent to give, it is not acceptable to refuse to care for you on this basis without taking further action.

Having a home birth is physically no different from birth in hospital. It is accurate to say that if there is a deviation from normality, it may demand a different approach to a hospital birth where assistance may be immediately available.

If a midwife does not have the experience to care for you at home, in order to fulfill her duty of care she may:-

• take action to update her own knowledge and skills to get the experience to support the woman
• seek help from a manager or superviser to gain the support she needs
• if time is limited, she can refer the care of you to colleagues who have the competence and then take action to update herself to become competent.

Risk and women's choice

Your midwife is responsible for providing care, and regardless of the setting, she must identify any possible risk and pre-plan to minimise those risk through her approach to care, knowledge of local help and communication with you and your family, as well as her colleagues

Over the last couple of years research has shown that home birth is at least as safe as hospital-based births for healthy women with normal pregnancies. Midwives are provided with very clear categories of women that would be positively recommended a hospital birth. There is also an "intermediate" category who have factors associated with themselves or their pregnancies and their babies, which potentially increase the risk of an adverse outcome.

You have the right to make the choice for a particular place of birth at any stage in pregnancy. The risks involved during your pregnancy and labour may change and your midwife will continually assess the advice she gives to you about the best place for you to give birth.

Risk is a complex issue, and conflict can arise about whether to make a choice for a home birth or hospital. However, there is no system that completely illiminates risk and a decision should be based on the factors of you and your pregnancy, as each situation is unique.

Sometimes this can cause some anxieties to both midwive and you, as your choice versus the perceived risks of caring for you in a home setting arise. If there is a clash then the midwife will continue to give care but can seek support and advice from her supervisors.

The supervisor will discuss options to reduce any risks with the your choice of a home birth, and it is good practice for the midwife and you to agree a plan of care and any actions that will be taken should problems arise.

It is your midwife's duty to ensure that all the options and choices are clear to you in respect of your choices and to respect your choices if you are legally competent to make that choice. The midwife will document the advice she gives in your maternity record.

Resources

It is very difficult for the midwives to balance the regulatory requirements, needs of you and the demands of the service provision. Where there is time, most problems that relate to resources are avoided with good planning.

Your midwife will let you know, if you are making a choice for a home birth, and if she has concerns about providing a service for this. She has a professional duty to provide midwifery care for you and is professionally accountable for any decision to leave you in labour at home unattended, thus placing you at risk at a time when midwifery care is essential.

If you wish to seek advice in relation to your wish to have a home birth, you may get advice from the local supervising authority (LSA) midwifery officer. LSA Midwifery officers, supervisors of midwives and managers who are registered with the NMC Register have a duty to support midwives to work within their professional standards and codes, which includes the choice of home births.

Your midwife has the same duty of care to attend you, whether you have chosen a home birth or hospital setting. Withdrawel of a home birth service is not less significant to you than withdrawel of services for a hospital birth.

Conclusion

All midwives have a responsibility to ensure all women receive care based on a partnership between you and your individual needs, along with your family. You have the right to make your own decisions on this issue, and if a midwife is competent to do so, to provide care in respect to your choice. You have a right to expect safe and competent care from any midwife who holds a registration in the UK. Midwives will provide evidence based information to you so that you can make choices for care including place of birth. The standards are in place to protect women and at the same time protect midwives by providing a sound framework for their practice.

The Nursing and Midwifery Council (NMC) is the UK regulatory body for the nursing and midwifery professions. The NMC maintains a register of around 670,000 qualified nurses, midwives and specialist community public health nurses.

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Eau Baby! was established by Paula Lee Sims to meet the needs of women choosing to birth their babies with the help of water. She has an extensive knowledge of water births, partly through delivering both of her sons in a birth pool, at home, and partly from her training at the Active Birth Centre in London.

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