Childbirth in the time of Covid-19

The lynch pin of society is the mental and physical health of women. When mothers are mentally and physically healthy, they bring up children who are mentally and physically healthy and it is more likely that they have partners who are mentally and physically healthy.

One of the key episodes in women’s health is childbirth. Women never forget their first birth, how they felt at that impressionable time, how they were treated, what people said to them and how they said it. Childbirth is immensely powerful. But now the spread of Covid-19 threatens even this most precious moment.

The 60-year-old charity the NCT (National Childbirth Trust) has, in the past five years moved from campaigning about conditions for childbirth to setting up help for new parents who have mental health issues. This is because the increasing medicalisation of childbirth has become so traumatic for so many women.

NHS England is trying to improve maternity services by setting up “continuity of carer” models — systems in which women can get to know the midwife who will care for her throughout pregnancy and also during labour. When tested, these models show huge advantages for women’s mental and physical health, birth outcomes are improved, babies are healthier and there is much less intervention.

Fortunately for us, mammals are a very successful species at childbirth. Unlike fish we do not spray our eggs on a rock and hope that a passing male will fertilise them. Unlike turtles we don’t lay our eggs and then leave them to their fate. All mammals conceive and nurture their young inside their body, tucked safely away.

In labour, the mammalian body produces hormones that soften and elasticise joints, tendons and muscles. The woman’s body becomes much softer and stretchier, her vagina and pelvic floor muscles become looser, her pelvis is much more mobile than usual, making more room for the baby’s head. When labour starts, women often go into an almost ecstatic state, flooded with hormones.

For this to happen all mammals need privacy. Sheep stop labouring if they are stared at, domestic dogs hide away in a cupboard, domestic cats sneak away under the bed. In privacy the hormones flow and the labour is eased gently to its healthy conclusion.

Covid-19 has caused several Health Authorities to close down their home birth services. All women are to come into hospital to be cared for by midwives dressed in hazard kit looking like creatures from outer space. Even worse, partners are not allowed to accompany the woman. This is utter madness and has enormous implications for women’s mental health.

The last place a labouring woman needs to be is in a hospital full of people with Covid-19. She will be much safer in her own home and it is likely that the midwife will be safer in her home as well.

Time after time, research has shown that birth at home is safe and often safer than giving birth in hospital — but women are not told this. The National Institute for Health and Care Excellence (NICE) has a fascinating paper that shows the outcomes for women booked for home birth compared to similar women booked for hospital birth. The home birth women always fared better, even if they transferred to hospital along the journey.

We are told that there is a shortage of midwives. This is not strictly true. The UK has more qualified midwives than any other European country. However, many are not working in the NHS because the over-medicalisation of childbirth has made it almost impossible to work fully as a midwife inside the health service.

Outside the NHS there are hundreds of independent midwives and midwives who have become doulas. The most recent example of using independent midwives in the NHS was the Albany Practice, which served a very high-risk group of women in Peckham from 1997-2009. Around 57 per cent of the women were from Black, Asian and Ethnic minority communities, and 43.5 per cent of all the women gave birth at home following a policy of “Decide where you want to give birth once you are in labour — see what the labour is like once it starts.” Their statistics were magnificent, their caesarean section rate was a third of the local hospitals.

Boris Johnson has managed to get thousands of volunteers to help in the NHS. Now is the time to get the midwives of the UK to attend the women who sensibly want to keep away from a hospital at such a sensitive time.