How Has Home Birth Changed? A Journey Through Policy, Practice, and Belief
11 November 2024
Every pregnancy and birth is a unique journey, shaped by a mix of medical, emotional, and personal factors, which is why personalisation is so important. This focus on personalisation has guided the development of Version 4 of The RealBirth Workshop. In this latest version, we’ve worked to support women with specific health conditions, such as Obstetric Cholestasis (OC) and Low PAPP-A. These conditions often require specialised medical advice and adjustments to birth plans. With Version 4, we’ve integrated evidence based, digestible information into the workshop, helping women feel informed and empowered throughout their pregnancy and birth.
This article will explore some of these conditions and the role of individual health needs in shaping birth plans, emphasising the importance of awareness, informed decision-making, and respectful, collaborative care to empower pregnant women and people throughout their journey.
Balancing Medical Recommendations with Emotional Well-being and Birth Choices
Obstetric Cholestasis (OC): This liver condition increases the risk of complications like preterm birth or stillbirth, particularly if bile acid levels are high. Medical guidance often includes closer monitoring during pregnancy and recommendations for an earlier birth (e.g., induction around 37–38 weeks for severe cases). Many women with OC feel anxious about their baby’s health or overwhelmed by symptoms, our steering groups showed that many women and people including those with OC, feel nervous about birth options in these circumstances, and in some cases that they have none.
Low PAPP-A: This condition may be linked to restricted placental function, potentially leading to fetal growth restriction or preterm birth. Pregnancies with Low PAPP-A often involve extra scans and discussions about birth timing to minimise and potential risks. Being a condition that is identified during early pregnancy screening, it can cause feelings of anxiety and concern for a sustained period of time. Yet most women with low PAPP-A in the UK have healthy pregnancies and babies.
For individuals with these conditions, medical advice may include interventions such as induction, continuous fetal monitoring during labour, or planned caesarean births. However, while these recommendations are made with safety in mind, they must be balanced with the individual’s values, preferences, and rights.
Why Awareness Matters
Understanding how conditions like OC or Low PAPP-A may shape birth options is crucial for several reasons:
Uncertainty during pregnancy can cause stress or fear, but knowledge can help reduce these feelings. When women and people understand how their condition might impact their pregnancy and birth, they are better able to set realistic expectations and make informed choices. This awareness not only empowers them but also encourages a sense of control and confidence in navigating their journey.
Awareness encourages better communication between women and healthcare providers. By understanding their health needs, individuals can actively engage in discussions about their care plans, supporting a collaborative approach to decision-making.
Knowledge empowers individuals to take an active role in their care by asking questions, exploring alternatives, and understanding the benefits and risks of interventions. This informed approach allows them to make decisions that align with their personal values and circumstances, providing more confidence and autonomy during their pregnancy and birth journey.
The Right to Consent and Autonomy
In the UK, consent is a cornerstone of healthcare. Under human rights laws, including the Human Rights Act 1998, individuals have the right to make decisions about their medical care, including the right to accept or decline any recommended treatments or interventions. This applies equally to maternity care, where decisions about labour and birth should always involve informed consent.
Healthcare providers have a legal and ethical duty to:
Explain Options Clearly: Present information in a way that is easy to understand, avoiding medical jargon where possible. For example, explaining that continuous monitoring with a CTG might be recommended for OC due to higher risks, but also discussing how this might affect other outcomes for example, CTG’s are linked to higher rates of intervention or how changing birth positions should still be encouraged but there will be additional considerations to think about on a more technical level.
Respect Decisions: Whether a pregnant woman or person accepts or declines medical advice, their choice must be respected without coercion.
Provide Balanced Information: Discussions should include both the benefits and risks of interventions, ensuring individuals can make truly informed choices. Discussions around Induction of Labour should focus equally on how each procedure can affect them or their baby even if the reason behind an induction recommendation is to support health.
Supporting Individual Preferences in Birth Plans
For individuals with OC or Low PAPP-A, birth plans and choices might differ from their initial hopes. For example, a homebirth may not be recommended for someone with these conditions, or induction might be suggested to reduce risks. However, even when adjustments are needed, it’s essential that care plans remain collaborative and respectful.
When supporting pregnancies complicated by conditions such as Obstetric Cholestasis (OC) or Low PAPP-A, early engagement and personalised care planning are critical for optimal outcomes. Initiating discussions about how these conditions may influence birth options early in pregnancy allows maternity teams to address questions and collaboratively shape care plans. This allows time for questions and adjustments.
Birth planning and choices should carefully balance medical safety, if present, with respect for the individual’s preferences. Tailored plans should incorporate their needs, ensuring that autonomy is upheld while managing clinical risks which includes the rights to not choose a medicalised pathway.
Acknowledging the emotional impact on pregnant women and people from any suggested medical limitations, such as the inability to pursue preferred options like water birth, is essential. Emotional support and clear communication can encourage a better trusting relationship between women, people and healthcare teams.
Healthcare professionals must strive to balance safety with autonomy. Medical guidance should empower patients with informed choices rather than dictate care. Respecting individual rights while managing risk is key to ensuring both physical and emotional well-being.
The goal is not to diminish the importance of medical advice—healthcare professionals bring invaluable expertise—but to ensure this advice is shared in a way that empowers women, people, partners and birth partners to make confident, informed decisions about their care.
Conclusion
Awareness of individual healthcare needs, paired with a commitment to informed consent and respectful care, creates the strong foundation for a positive birth experience. For pregnant women and people with conditions like OC or Low PAPP-A, understanding how these conditions may shape their birth can be very empowering.
In the UK, every person has the right to make choices about their birth, supported by compassionate care and clear information. By prioritising collaboration and respect, we can ensure that they feel in control, valued, and confident in their journey to parenthood.
