Here's a paper from the BMJ website. Go to the site to read the discussion.
J

BMJ  2003;327:249 (2 August)

Commons committee calls for more choice over home births
BMJ Upasana Tayal Clegg scholar

A House of Commons committee has criticised UK maternity services as patchy
and has urged more trusts to support women who want to give birth at home.

The health select committee published two reports last week, one on
inequality in access to maternity services across the United Kingdom and one
on choice in maternity services.

The second report urged healthcare trusts to support the option of home
births and to provide independent midwives where needed. The committee
estimates that up to 10 times as many women would want to give birth at
home, if given the choice, but that this choice was either not provided or
taken away.

"We heard evidence that women who chose home births had this option
withdrawn from them at a late stage in their pregnancies, on the grounds
that sufficient staffing could not be guaranteed to support the birth," says
the report. "We found this practice wholly unacceptable. We call on the
government to take action to stop this practice."

Also, women have little choice in the type of maternity service they want,
which the report blames on staffing shortages and the closing of smaller
maternity units. The committee calls on the government to "allocate
resources to maternity units so that staff can plan and implement change
without fear of further staffing shortages."

Julia Drown MP, chairwoman of the maternity services subcommittee, expressed
deep disappointment and frustration at the slow progress of change in the
maternity services. "A great many of our recommendations echo those made by
our predecessor committee in 1992 which were adopted as government policy
but which have not been implemented throughout the country," she said.

In its report on access to maternity services the committee says that not
all families across the country are getting access to the services that they
need.

The report identifies prejudice among maternity care staff relating to race,
class or disability. The Royal College of Midwives admitted to
institutionalised racism in the maternity services. The committee recommends
that trusts recruit midwives from a greater range of ethnic groups and
communities to redress the imbalance.

In particular the report highlights the problems faced by homeless women,
asylum seekers, women whose first language is not English, and deaf women.
It calls on the government to take action and recommends that "continuity of
carer" schemes are developed and that qualified interpreters are provided,
including British sign language interpreters.

Brian Dow, joint head of campaigns at the Royal National Institute for the
Deaf, welcomed the report. He said, "The institute is pleased that the
particular problems faced by many pregnant deaf women have been recognised.
Women rightly expect to exercise informed choice on all aspects of their
pregnancy—this right should extend, automatically, to deaf women."

Inequalities in Access to Maternity Services and Choice in Maternity
Services are at
www.parliament.the-stationery-office.co.uk/pa/cm/cmhealth.htm#reports




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