Trigger warning: please note that Thando’s story below includes mentions of birth trauma and baby loss.
“My name is Thando Zwane and I’m a birthkeeper and doula and founder of the birth group Birthing in Colour. I work all over London in my capacity as birthkeeper.
I have worked with home birth teams throughout London. My preference is for the whole team who will be attending the birth to meet in advance, usually at the 36-week home birth assessment.
“I’ve been doing this work for 12 years, but in recent years I’ve definitely seen a decline in two things: the availability of home birth midwives and the competence and training of midwives on home birth teams.”
This has led to some of my clients having unplanned free births, for example calling the home birth service once they have gone into labour and finding that the service is unavailable. More people have also been asking me to attend free births recently. With more than a decade of experience, I feel confident supporting my clients with whatever their decision is.
I worked with one client in London who had planned a home birth in an area where there was no community team for the home birth service, rather midwives from different teams would be sent to support home births. However with this particular birth, the midwives were lacking some equipment they needed, and they weren’t confident in running the home birth service. In this case, the baby unfortunately didn’t make it, which was extremely traumatising for the family involved.
“It was traumatising for me too. That home birth service was then shut down.”
Another client I worked with in the South London area had previous trauma from a hospital setting and was due to have a home birth. A new midwife was assigned and told she would have a full team for the home birth. However when she started the role, it was clear the team wasn’t available and they wouldn’t be able to provide a home birth service. The couple were willing to free birth at home rather than face the trauma at the hospital, although in the end they were given a private midwife.
My clients cannot afford to pay for independent midwives, but I have worked with some individuals who have ended up having private midwives assigned to them by the NHS Trust, for example in North London. This doesn’t seem sustainable – surely it would end up costing the NHS more than training and equipping a team.
“When it comes to Black and Brown women and birthing people, often home birth is not even a choice that is made available to them, if they don’t have a birthkeeper or doula there to advocate.”
A lot of Black and Brown people are not going to NCT classes, or ‘bump and baby’ classes. So they are often more reliant on their midwives, but some midwives are not even really giving them the option of home birth from the outset, they don’t even get the referral. I have to say I often see such a difference with white mothers who have registered for home birth, even if they get cold feet, the home birth team say they will support and provide continuity of care, and even still come to their homes in the early stages of labour when they then end up transferring to hospital later. This is a huge contrast to other situations where often Black and Brown women aren’t even given the option to consider a home birth.
In some cases, I have wondered about the competency and resources put into home birth teams in areas on the outskirts. For example, when you compare a home birth team in Chelsea and Westminster or Central London, more affluent areas, with a home birth team on the outskirts it is very different in terms of the training and support offered to the midwives.
“Some midwives in less affluent areas, areas where Black, Asian and Minority Ethnicity people are more likely to live — have not been offered adequate training or experience. This has resulted in unnecessary deaths of babies and trauma for all involved.“
With the earlier case I spoke about, when the baby died, the Trust just ended up closing the home birth unit entirely, rather than providing training to ensure this situation wouldn’t happen again.”
Read our report ‘Access Denied: Restrictions on Home Birth in the UK’