Dilemma...ethical perspective?
So, as many of you know, we'll most likely be ttc'ing sometimes later in the year.
And as you also might know if you read my UC thread, we're looking at how to go about birthing this potential baby already.
In the UK homebirth is officially available on the NHS but it can be quite hard to GET the homebirth. The slightest medical thing can be cited as "unacceptable risk", i know of several women who were phoned at 36 weeks and told they couldn't have their HB due to staffing numbers, the UK has a higher HB transfer rate than other european countries, indicating that many "attempts" are thwarted once labour has begun (i don't know of course how true this is, but we're as thorough as France in our prenatal care so why do 15-20% more of our HBing women suddenly need to transfer when labour begins?).
Last time around i got an NHS homebirth. However i would be lying if i said i found it completely satisfactory (though equally neither DD or i was injured by the experience) and when we realised we COULD afford a private midwife i was pretty thrilled.
However i have been talking to female friends, some with kids, some without. And now i am questioning the idea of using an IM at all.
I believe in choice. I believe the NHS SHOULD be providing homebirths for women who want them and are appropriate (i don't think midwives should have to go to catch premature babies or babies of mums with known, serious medical complications!).
So how will the system change if people (i.e. me) don't demand that change?
My two perspectives:
1) there are only 6 independant midwives working in Scotland, and only 2 in the central area. To avoid having 2 women labouring at once they each take on 11 births a year. That means they can cover 22 of the 58,000 births a year, about 3000 of which will be at home. I do not know how much DEMAND there is for IHBM (independant homebirth midwives) in this country. Perhaps there are only 6 because there's not enough work for 7? Should i be supporting this important service so that it continues to exist? We are not so rich that the costs is insignificant - indeed it is VERY significant, but it is attainable. Should i do now what i could not before and use a service that is filling a hole in NHS care?
2) there are plenty of women who cannot AFFORD an IHBM. Do they not deserve a good birth because they cannot afford that service? Shouldn't we be demanding change for EVERY woman and making the fat cats who make it so hard for the midwives working at the rockface to provide this care sit up and take notice of the demand? Also i was not harmed by my birth, merely mildly dissatisfied. What if i book the IM and another woman who was butchered and left with PTSD last time she gave birth cannot book, then has not option but to go back to the NHS when she is full of fear about her next birth and not able to fight like i would be, having already achieved her goal once before?
In some places in the South of England the HB rate in 2007 was 14%, and the vast majority of those births were NHS. In Scotland NO region managed more than 2.7% HB's in 2007 and overall the national HB rate for scotland was just 1.5%. WHY? Because women in this part of the country do not ask for and do not get homebirths.
I do not believe having an NHS HB will be a major sacrifice or too much stress. I at least know what i'd be getting into and have far more experience than i did before, and one successful HB behind me when the scare tactics are brought out. The stress involved will undoubtedly be far lower with an IM, but a big part of me wonders if that is an acceptable reason to dodge another opportunity to encourage change in the NHS which will benefit ALL women.
Anyone feel like helping me nut this one out?
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