Home births in Highlands cancelled due to midwife shortage

Cover for home births has been restricted to Monday to Friday from 9am to 3pm, which means many women will require to go into Raigmore Hospital to have their babies. 

Figures show almost one in two babies (45%) was born by caesarian section at the hospital last year.

In one case an expectant mother was 39 weeks into her pregnancy when she was told her planned home birth could not go ahead.

Maternity experts said the situation had led to mothers considering unassisted birthing, which carries risks for mother and baby.

Figures show that at the end of June there were more than 6,000 nursing and midwifery vacancies across NHS Scotland – up from 4,845 in June 2021, a 24% increase.

The lack of available housing in the Highlands and Islands, where there are high numbers of short-term lets and second homes, is affecting recruitment, according to the health board.

Two women offered positions in Skye had to turn down the jobs because they could not find anywhere to live.  Inverness is facing the same challenges.

"The concern from women and from any of us supporting birth is that this is not temporary," said Daisy Dinwoodie, of the Scottish Doula Network, who has supported around 150 women to give birth.

"A shortage of midwives is a major issue but for women that's not their concern.

"We absolutely have a right to birth where we want and it's the job of maternity services to take care of that.

"If you restrict hours then you are pretty much telling women they will probably have to go into hospital which gives them the same level of reassurance as having no service at all.

"There aren't thousands of women in the Highlands trying to give birth at home so it must be possible to staff it."

She said she had supported women who thought they had midwives on call for them and were being told "at the 11th hour" that they would require to go into hospital.

READ MORE: Scotland's birth trends - from home births to C-sections

She said: "This story is much more about who decides what women do with their body and when.

"When it comes to being forced to get into a vehicle to go into hospital to give birth to your baby that really is contravening article 8 of the human rights act [which includes the right to choose your place of birth and choice of birth companion]."

Ms Dinwoodie said the staff shortages were also affecting career choices saying she was aware of one community midwife in the Highlands who was "very supportive of home births" but had been re-deployed to hospital work.

She added: "Already, maternity services are pretty dire in the Highlands with one major hospital.

"In Edinburgh you could go to the Royal Infirmary, you could go to the Borders, you could go to Fife or Falkirk. In the Highlands you've got one.

"I've got three children and getting into a vehicle even for 20 minutes in labour is unbearable. In the Highlands women have to do it for three or four hours.

"You can understand why someone would say, I'd rather give birth to my baby at home."

One expectant mother who was due to give birth at home said she had been left "extremely frustrated and upset" after she learned it could not go ahead. 

She said: "I purposely chose a home birth as my last birthing experience in a hospital environment was incredibly traumatic.

"I feel really disappointed about what's available in the Highlands.

"I understand it's a large geographical area, and there is an ongoing staffing crisis.

READ MORE: 'It was just so much nicer and easier to be in your own home'

"But as a woman about to give birth, it's not my problem to try and fight with the NHS, I just want to be able to give birth at home and be cared for by my midwives."

Gemma Kennedy and her partner decided on a home birth because she wanted the birth to "unfold naturally without medical intervention" and had been told she was low risk.

She said: "It required a lot of investment from me and my partner, including paying for hypnobirthing and yogabirth workshops, and hiring a doula to support me mentally and physically before, during and after the birth."

At 39 weeks pregnant she was told the home birth couldn't go ahead due to staffing issues and after a medical kit including gas and air had been delivered to her home. She decided to opt for an unassisted birth.

She said: "Fortunately, my body waited until the end of week 41 to go into labour, by which time the matter had been temporarily resolved for me, but only thanks to the fight put up on my behalf by both my midwife and doula, who attended a meeting with the Highland Maternity Voices Partnership and spoke up about their concern."

Things did not exactly go to plan. After four days of labour an ambulance was called because midwives were becoming concerned about her baby's heart rate.

However, her daughter was born before the paramedics arrived.

She said: "I truly believe that I only managed this feat because of the amazing support the midwifes' showed me, and the dedication they had to giving me the homebirth I really wanted

"A woman has the right to choose where they give birth, and causing anyone unnecessary stress at such a late stage of pregnancy does not show the care that you expect from a health service."

Figures show that 613 babies were born at home during 2021 — equivalent to 1.3% of the live births that year.

NHS Grampian said there were no restrictions on its home birth service currently.

According to the group Birthrights, NHS boards have a duty to ensure there are enough staff to provide the services it has promised and should have contingency plans in place, including providing an independent midwife.

A spokeswoman for the group said it has written to NHS Highland and wa awaiting a response.

Jaki Lambert, Director for Scotland at the Royal College of Midwives said: "This will be a real disappointment for the women who were planning to have a homebirth, this is a difficult decision to make but when faced with shortages maternity services must do what is needed to ensure all women receive safe care. 

"This is not a new problem and underlines the urgency for the Scottish Government to address staff shortages.

"Work on this is already underway, but we must see a doubling down of efforts to tackle these mounting issues."

Kate Forbes, MSP for Skye, Lochaber and Badenoch, said affordable housing was under "immense pressure" in Skye and Lochalsh.

She added: "I have been facilitating discussions between NHS Highland and the local housing association about creative solutions.

"Local people have often come forward to help too when a clear need is communicated."

A spokeswoman for NHS Highland said: "As a service we want to be in a position to offer a home birthing service however this is not always possible.

"Staffing is being considered in detail and a risk assessment will be completed to ensure that services offered are safe for women, babies and the midwives in our teams. 

She said the board was undertaking significant work to respond to midwifery workforce challenges, including pursuing international recruitment.

She added: "One of our biggest challenges is around the availability of accommodation both to rent and to purchase and the affordability of that accommodation. 

"That is something that we need to work in partnership with our public and private sector colleagues to address, as part of our infrastructure plans for the region."