In the UK, we hold our health service very close to our hearts. The National Health Service (NHS), founded in 1948, is tax-funded and free at the point of care, no matter who you are or how sick you are. Almost everyone here is born and dies under its care. Almost everyone can recall an NHS nurse or doctor who felt like a guardian angel during one of the hardest times of their life. In short, if you ever find yourself enjoying a room-temp pint in a British pub, don’t start a debate over the NHS. For Brits, it’s not just our history, it’s our hearts (sometimes literally).
Sure, we know the NHS is far from perfect. But not because of some fundamental flaw in the system. Instead, this is the result of chronic underfunding, understaffing, and, right now, massive pressure caused by the pandemic. Our hospitals and family doctors (we call them GPs, for “general practitioners”) are currently facing worse staff and resource shortages than ever before.
The usual confidence with which Brits say that we have “the best health service in the world” is wavering. Relentless grim headlines are unnerving the nation. People are dying or will suffer permanent health setbacks either because they’re waiting hours for ambulances or are queuing inside them in the carparks of overwhelmed hospitals. It could become the issue that loses Boris and his cronies the next election.
Pregnancy care happens under the NHS, and it is suffering, too. In my district (population, roughly 700,000) in South East England, our network of half a dozen hospitals was reeling from a scandal over avoidable baby deaths even before staffing levels were decimated by a perfect storm of low recruitment and Covid.
Usually, home birth through the NHS is relatively common and straightforward in the UK, where it is also associated with lower rates of medical intervention and complications. When you’re in labor, you can ring a local hospital to request a midwife come to you, rather than to let them know you’re coming in to them. A midwife might not be immediately available, and the one who rocks up might not be the person you got to know through your pregnancy— but both these things might also happen in the hospital. With most home births, there is more advance planning, and an increasing number of local NHS trusts have dedicated home birth teams who look after people throughout their pregnancies. But it’s fine for it to be a last-minute decision. And of course, giving birth at home without NHS midwives is also perfectly possible and legal.
When I first registered for NHS prenatal care at around 10 weeks pregnant, I requested the home-birth team. I was excited to have this choice for my second pregnancy. Birthing trans people often see laboring and birthing in the private, predictable environment of home as the safest option. No data exist for this (surprise!) but I’d bet my pregnancy pillow that trans and queer parents request home births at relatively higher rates than cis straight parents.
But NHS-assisted home births in my area are currently “suspended.” I put this in scare quotes because I don’t think it’s strictly true, or even allowed under NHS policy. But people are being told that home births aren’t possible right now due to staff shortages on labor wards and birthing centers (known as midwife-led units in the NHS, these can be self-contained or part of a hospital that also has a traditional labor ward). However, I’ve also been in touch with a family who challenged this blanket ruling on the grounds that a home birth can only be denied for medical reasons. They successfully secured home birth care.
Our local NHS home birth team was still new when it was suddenly suspended alongside home birth care in general. Its midwives were sent back to low-staffed labor wards, apparently devastated to let down families they’d been working with and to walk away indefinitely from a specialism they felt called to. Ours was one of those families.
When I was pregnant with my three-year-old, SJ, my only option was the traditional NHS community midwife system. We didn’t have a dedicated home birth midwifery team in our area, which meant that while you could aim for a home birth and be supported, it was markedly unusual and no effort was being made to normalize or equalize it as an option.
Community midwives work “in the community” on the principle of “continuity of care.” All being well, you’ll see your assigned community midwife throughout pregnancy and maybe even birth – usually in hospital but sometimes at home – as long as they’re on shift. They handle all prenatal care, so you never see a doctor unless there’s a specific medical need and even then it's technically still optional.
But for pregnant trans people, it’s total luck of the draw. Don’t get me wrong, it happened to work out well for me then. I struck gold with my community midwife, Jo: totally unflappable and as open-minded as she is open-hearted. Jo went out of her way to help me feel safe and seen in prenatal care. Lots of community midwives work out of hospital-based clinics but I, like others with additional needs or considerations, was offered appointments at home. I didn’t have to brave busy waiting rooms or puzzled looks from hospital admin staff whenever I needed a checkup. Ultrasound scans were less flexible, but even then, Jo would call ahead to prep the sonographer, and once tracked down the only queer sonographer in the area to see me.
SJ’s birth, in a pool at the nearest midwife-led unit, was a mostly wonderful experience, even though Jo herself wasn’t working that day (you can actually watch the birth, captured beautifully by Jeanie Finlay for our documentary, Seahorse). Even so, this time around, I figured that if I could be at home not just for appointments, but for the birth itself, it might be even better. I say “might” because I know that nothing in pregnancy or birth is guaranteed but, as far as planning goes, this was my hope.
Initially, however, I was assigned to the regular community midwives. It turns out the home-birth team is so popular, it was temporarily oversubscribed. Still, I could plan for a home birth with community midwives, they reassured me, as was the case before a dedicated team existed. Fine, I thought, and I was glad to meet Martha, a community midwife about my age who had looked after several pregnant friends of mine, including one who’d given birth at home.
Then, about a month later, I caught wind of the home-birth team being less busy and I requested to switch. “No problem,” said Martha, understanding my desire for that specific kind of care. And yet, I only got one telephone appointment with a dedicated home-birth midwife before their service was suspended and the entire team sent to bail out a dangerously short-staffed local hospital.
Since then, everything has changed again. Not with local pregnancy care—despite the national picture for the NHS still deteriorating by the day—but with my plans. I’m not having a home birth. I’m not even having an NHS or a UK birth. It’s a pretty amazing story, but one, in all honesty, I have very mixed feelings about. Sorry for the cliffhanger but, I promise, the next installment of Dad Bod will bring you right up to speed.