Choices – maternal healthcare in the UK and abroad…

While reading the updated guidance on where women in this country with “low risk pregnancies” are “safest” to give birth, my mind was drawn to another recent story at the opposite end of the spectrum – the lack of maternal healthcare in Kenya, which is the subject of Christian Aid’s Christmas Appeal.

Other than the obvious, it might not seem like these two stories have much in common but actually they both come down to the same thing – choices.

In rural Kenya, women have almost no choice where they give birth. Hospitals are often long distances away along bumpy dirt roads and transport is practically non-existent so it is normal for babies to arrive at home. At best there might be an untrained village elder to oversee things. As a result, labour and birth can turn into a dangerous ordeal  – even with what would be considered minor complications in this country – and women are “almost 40 times more likely to die in childbirth than women in the UK”.

Had I been in Kenya when I gave birth last year, my daughter would probably not be alive today and chances are I would not be either. Luckily for us, I was in hospital and already pushing when it became apparent that Freya was “presenting brow”, or facing up to you and me, and showed no signs of being able to turn (at 10lb 3oz I wonder she had room to do much at all in there).

If all had gone to plan Freya would have entered the world in a wonderfully warm pool of water with low lighting and soft music playing in the background in the cosy Midwife-Led Birthing Unit. As it happened, the nearest I got to the birthing unit was sitting in the waiting room. Short of staff and beds I was transferred to the delivery suite where, after 29 hours of labour, we were rushed to theatre in a matter of minutes when it became clear Freya was struggling. She was born by emergency c-section at 11.45pm on August 26. Perhaps the lack of a bed in the special unit was a blessing in disguise? Although, most likely, Freya would still have arrived safely under MLBU care.

My point, I suppose, is that while in Kenya there is no choice, in this country we have all the choices – or at least appear to.

The updated guidance from the National Institute for Health and Care Excellence (NICE) states that:

“…the evidence now shows midwife-led care to be safer than hospital for women having a straightforward (low risk) pregnancy. Its updated guidance also confirms that home birth is equally as safe as a midwife-led unit and traditional labour ward for the babies of low risk pregnant women who have already had at least 1 child previously.”

This is great. Amazing, even. How lucky are we that no matter where we give birth it is likely our babies will survive? However, even though I am thankful for this, I have a selfish but…

My fear is that, while this guidance takes in what is safest and best medically for mum and baby it doesn’t necessarily consider what is right emotionally – other than thinking that mums to be will be less stressed at home.  Having lost two previous pregnancies, the first truly horrendous, from the moment those two lines appeared for the third time I was sure something would go wrong. Even when we hit 40 weeks I knew we weren’t out of the woods and the only place I wanted to be when things kicked off was hospital. Unfortunately, you’re told to stay home as long as possible and the impending sense of doom grew until we (I) couldn’t stand the strain anymore and just went in anyway.

Of course, they were frantically busy on a bank holiday weekend and understandably didn’t have time for a woman in the early stages of labour, even with my history, so, as it turned out, I didn’t feel much safer there than I did at home but at least I was there should anything have gone wrong.

Even though my pregnancy was medically considered low risk, emotionally I was high risk. And while the new guidance appears to open up more choices for women, I hope it really does so and they are not steered towards something that might not be right for them in other ways.

Each year, instead of buying Christmas cards, we donate what we would have spent on them and the cost of postage to charity. This year we will be giving that money to the Christian Aid Appeal, which will be used for, among other things, providing ambulances to make sure women in Kenya can get to hospital in an emergency. I have been fortunate enough in my day job to see first hand the brilliant work the charity’s partner organisations do on the ground in India and South Africa so I know this money will really make a difference.