Birthrights report into home birth provision UK wide.
Amanda Patterson-Crowley
Birthrights released their research on home birth from October 2023 to November 2024. It’s grim reading, but it’s what birth workers in the UK have experienced and known for some time.
Between Freedom of Information Requests and surveys of service users, health workers and independent birth workers have painted a stark picture of what home birth provision really looks like in the UK. Birthrights have said that since September 2024, the largest portion of enquiries to their service is relating to difficulty accessing home birth services. Finding that home birth services are closing because of:
“Poor planning, pressures on staffing and culture, policies and routine practices that fail to understand how human rights apply in maternity care.”
And that home birth service:
“Can be seen as an add-on which can easily be withheld at the first sign of a challenge.”
The report goes on to highlight that people are feeling backed into choosing unassisted birth - it is a viable and freeing option for some. BUT it shouldn’t be a last resort choice. While the Royal College of Midwives & the NHS are continually stating that they are concerned about the rise in freebirth, they are not addressing one of the root causes, lack of home birth provision, where people are choosing to birth at home because of previous experiences or fear of: “concerns about violation of rights, failures of healthcare professionals to seek or obtain consent, coercive practices, spurious social services referrals and previous traumatic experiences”
“In all of these cases, the right of individuals to make informed decisions about their body and their care is dismissed, resulting too often in physical or psychological trauma for women and birthing people, their families and wider communities.”
What the birthrights research found
66% of 118 Trusts have had either service suspensions, strict suspensions, or frequent interruptions between October 2023-November 2024. 18 Trusts have had blanket suspensions across the 12 month period, with suspensions ranging from 2 months to 4 years. In some areas home birth services have been dismantled and community midwives are overstretched.
Home birth services are frequently suspended last minute due to unforeseen circumstances like staff shortages, sickness, clinical safety concerns or dynamic risk assessment processes. Other times, while the trust shows that they are offering home birth services, blanket approach to guidelines and policy often restrict access to home birth for whole demographics or particular communities - or even to only “working hours 9-5” weekdays or particular postcodes.
Not only suspensions - but lack of communication regarding suspensions, and zero effort to proactively offer home birth as a choice, which “can present as a decline in interest in home birth in some areas, affecting planning and resourcing.”
Women and birthing people are left feeling tired from the fight to secure their home birth, only then for them to feel that they cannot rely on the services, and anticipate not having it because of “unforeseen circumstances”.
There is a disproportionate impact on marginalised communities, including black and brown skinned people, disabled or neurodivergent people and those of lower socio-economic means.
Women of black and brown skin are more likely (sometimes even automatically) to be put into a high risk category because of blanket clinical guidelines, meaning that home birth is immediately removed as an option
Birthers are being gaslit
The failures to provide home birth are systemic - the circumstances that require suspension are often classed as “last minute” and “unforeseen”. But they are down to poor staffing or not appropriately planning to support home birth provision, which shows more of a problem with service planning - rather than being unexpected or unforeseen.
Many people will plan a home birth, having fought for it - only to be told that no one is coming. Imagine this? There are intense catastrophe movies about that feeling of no-one coming when you call for help - yet women and birthing people are experiencing this feeling daily in the UK.
Imagine further that simply asking for a home birth results in a midwife calling social care on you, or using other scaremongering tactics to discourage a home birth - where you feel you would be most safe giving birth, you’re told that you are endangering you and your child's life by making this decision.
From the FOI requests:
31 Trusts (21%) were unable to send midwives to attend a home birth due to unforeseen circumstances on 5 or more occasions.
63 Trusts (44%) were unable to send midwives to attend a home birth due to unforeseen circumstances on fewer than 5 occasions. But, from intelligence on the ground 10 of these 63 have had frequent suspensions in the time frame requested.
“We know from our wider intelligence that of the 22 Trusts who did not provide an FOI response, five currently have suspended home birth services or have had suspensions in the 12 months period covered in the FOI request. We have reports that at least 11 of the 63 NHS Trusts who reported being unable to attend a home birth on fewer than five occasions have strict admissibility criteria to access midwife-led care, including home birth.”
Not to mention the fact that 22 Trusts failed to respond at all, and 9 were unable to provide the information because they do not record it - meaning there is NO legal requirement to record this.
Which begs the questions …
Do birthers KNOW they have a right to home birth?
Home birth is not actively discussed as a viable option for many birthers, and if it is they may still face a situation where their options are removed or restricted last minute. Women and birthing people are frequently encouraged to attend labour ward, or actively scared off home birth with fear mongering and coercive language. This further impacts the service as there is a perceived “lack of demand” for home birth, resulting in increasing restrictions and less prioritisation of service.
Not to mention the impact on marginalised communities
This is huge, there is so much about home birth that supports the safety of marginalised communities. From black and brown people experiencing the systemic racism rampant in the NHS, to hospitals not being a safe space for deaf, disabled, neurodivergent people or those with additional needs.
“We also heard from people who believe that some Trusts’ view of safety often prioritises its own interests over those of a woman or birthing person, making them feel even more unsafe”
All of this ultimately means that more and more women and birthing people, of all colour, class and ability, are being traumatised.
So what do birthrights recommend in the report?
First and foremost, birthrights are recommending the SAFE Maternity Care Act, which stands on 5 key principles:
“Home birth services must be recognised as a core part of maternity care, and must be widely available and accessible, with particular consideration given to women and birthing people with specific and additional needs.
Staffing resources must be planned to enable home births for all those who wish to access them - 24 hours a day, seven days a week.
Midwives must receive regular and appropriate training to enable them to support home births confidently and safely, including those deemed more complex such as breech or twin birth, and are trusted and supported by management to do so.
Women and birthing people must be supported to make informed decisions about where they give birth and their decisions must be respected
Clinical guidelines can only ever be guidelines – care must always be individualised and person-centred.”
There were others but standout to me included - “suspension of service for unforeseen circumstances to be recorded as a serious incident and monitored as key performance data.” And including “training to ensure that all staff are aware of human rights law and how it applies to maternity services”.
While many of the findings are what grassroots organisations representing women and birthing people have been saying for a very long time, the report is detailed, thorough, concise and well put together, removing the anecdotal, piecemeal nature of what we were pretty sure we knew about home birth around the country.
I thought that their recommendations are good, and achievable, and at least a small step towards making maternity care under the NHS better. It’s a start. What did you think of the report?
I hope that this is indeed the jumping off point that birthrights say it is. Let’s see what happens next!