AIMS's letter to the UKCC was considered by the Midwifery Committee on the 27th October 2000, but it was not until February 2001 that, after some prompting, AIMS received a reply from Jill Steene, the UKCC's Professional Officer, Midwifery:
"...members agreed at the October meeting of the Committee that they wished to seek further legal advice about the position statement and also the position of women who decide to give birth unattended at home.
The Council's solicitors provided very detailed advice to the Committee having considered all the points raised in your letter. It was their view that paragraph nine of the statement could benefit from some rewording to make it clear that while a woman has a common law right to have her baby at home rather than in hospital, she does not have a positive right to medical or midwifery support at home for the birth. The solicitors conclusion was that the position statement still represents "... an accurate account of the law as it affects home births and one from which the UKCC should not likely(sic) depart.
In the light of the legal advice received, members of the Midwifery Committee agreed that a footnote should be added to future editions of the position statement to clarify the points about the right to have a home birth that I have referred to in the above paragraph. Members did not consider, however, that there was any need for further amendments to be made to the position statement."
Jill Steene's letter provoked a further response:
I note that:
1. Your committee acknowledges that the following Position Paper statement is incorrect:
"It appears that many women believe that they have a legal right to have a home birth and that an NHS trust cannot refuse to support a woman who wishes to have her baby at home. Equally, many midwives believe that they have a professional responsibility to attend any woman in any circumstances if they are asked to do so by the woman. The specialist legal advice given to the Council's Midwifery Committee does not support either contention."
2. You accept that the statement needs to make clear that "while a woman has a common law right to have her baby at home rather than in hospital, she does not have a positive right to medical or midwifery support at home for the birth" and, therefore the above statement needs "clarifying".
3. The Midwifery Committee is not going to do anything to inform the extensive list of recipients who received the original statement that the UKCC advice was incorrect.
The mental gymnastics of your solicitors are noted. Having admitted that the position statement needs 'clarifying', in other words correcting, your lawyers then indulge in a perfect example of mental gymnastics by claiming that the Position Paper is "... an accurate account of the law as it affects home births and one from which the UKCC should not likely depart"'.
The original statement was widely distributed to Heads of Trusts, Midwifery Managers and Supervisors of Midwives and many others. As a result of this inaccurate and misleading document women, all over the country, are now being told that home birth is illegal. The Committee has a responsibility to correct the error and properly inform those it has misled.
At the very least, a mailing should be done to all the original recipients informing them of the correction, and I would appreciate it if you would place this letter before the Midwifery Committee so that they can reconsider their previous decision.
Finally, I note that you did not include a copy of the proposed footnote, I would be grateful if you would send me a copy as soon as possible.
Jill Steene did not send a copy of the proposed footnote, but another letter:
".... Rather than add a footnote to the original position statement we have decided to alter paragraph 9 which is the paragraph which the Council's solicitors suggested would benefit from clearer wording. In the future copies of the position statement ... will read as follows:
The specialist legal advice given to the Midwifery committee makes it clear that while a woman does have a common law right to decide whether to have her baby at home or in hospital, she does not have a positive right to insist on medical attendance at home. It is well established that nobody has a right to dictate how a health care professional should exercise his/her judgement about how to treat or not to treat.
It is the view of members that this new paragraph will make the position clear."
Leaving aside a potential discussion about professional's exercising their judgement (otherwise even more correspondence would be generated), another letter was sent:
".... This amendment is unacceptable and still inaccurate, for the following reasons:
1. "a woman does have a common law right to decide whether to have her baby at home". A woman has a right to give birth at home. It is not a question of her having merely a "right to decide".
2. "she does not have a positive right to insist on medical attendance at home". Why is the UKCC suddenly focusing on the woman's right, or otherwise, to insist on "medical attendance"? The argument has involved the responsibility of midwives, and Trusts, to provide a midwife when called.
Paragraph 7 of the Position Paper states: "she (the midwife) also has a professional duty to provide midwifery care for women and would not wish to leave a woman in labour at home unattended, thus placing her at risk at a time when competent midwifery care is essential".
Paragraph 18 states: "if her (the woman's) decision is to continue with the planned home birth, the midwife should not withdraw care but should report the decision to her supervisor of midwives and seek advice".
Paragraph 14 states: "A midwife would not be in breach of her professional duty if unable to attend a woman requesting a home birth by reason of her employer's decision not to provide such a service".
This contradictory advice is of no assistance to the midwife who works for a Trust that does not support home birth, and allows clinical decisions to be made by lawyers and administrators. In February, I was contacted by a doula who was supporting a woman in labour. The woman had telephoned for a midwife and the labour ward sister had refused to send one, on the grounds that the labour ward was short staffed. The doula rang for an ambulance and ended up delivering the baby with the ambulancemen.
Until the time when the Trusts realised that the midwives rules did not obligate them to attend a woman in labour, the Trusts had no difficulty in being over-ruled by the midwife and conceding to what everyone thought was a clause in the midwives' professional code.
The midwife is an independent practitioner who has the right and duty to care for individual women on her own responsibility. While the 1977 Act restricts anyone other than a midwife or doctor from attending a woman in labour the midwifery profession has an ethical duty to attend. Just as the GMC sets the ethical standards for doctors, it is the job of the UKCC to set the ethical standards for midwives which are independent of and supercedes the requirements of employers now, and in the future. This is what being a professional actually means.
Your Council persists in refusing to re-instate the midwife's obligation to attend a woman in labour, and by its failure to act it is betraying women and babies and putting them at unnecessary and avoidable risk. Before long we shall have a tragedy entirely of the UKCC's own making.
Every week we are faced with requests for help from women who are now considering giving birth at home unattended, and some of them end up doing so. We lay the responsibility for any future tragedies firmly at the door of the UKCC".
Beverley A Lawrence Beech
Note: The Midwifery Committee is due to meet again in April and re-consider this issue. Who knows, perhaps by then they will be able to bring themselves to face up to their responsibilities and grasp this particular nettle?
If you have been told that you are not "allowed" to have a home birth, do let us know what reasons you were given, and what part of the country you live in.
See also 'Home birth alert', and Choosing a Home Birth: Full text of the AIMS booklet by Pat Thomas.
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