Task 1 part 3 (P2)
Carry out the primary research and collect and record data.
Once I had chosen my topic I looked at several midwifery websites, midwifery journals and midwifery books. I printed off pages from websites that I thought had interesting data or facts and I made notes of the website addresses that I looked at and wrote down the full http address of all the websites I printed pages from.
Task 1 part 4 (M2)
Review the research methods chosen in relation to the results obtained, any sources of bias or error and ethical considerations.
I have reviewed my chosen methods of research and I found that there are sources of error with the websites I visited such as the vast majority of studies were not recent ones or my own. The problem I found with bias is that I feel that I myself am bias as this is my own piece of work. I also think that because of my own past experiences I am too personally involved and therefore cannot give an unbiased opinion. I could not find any ethical considerations apart from the comment made by the midwife I know who seemed to be suggesting that only women in nice areas should have home births.
I chose mainly the Internet because there was more information such as websites especially for nurses and midwives. The websites I looked at also had chat forums where you could post a question and have it answered by a nurse or midwife.
I did interview a local midwife that I know to ask her opinion on home births who told me “home births are ok if you are going into a clean & safe environment. Unfortunately we have no control over where or how people live and I myself have gone into some very unsavoury homes.” This comment seems to be suggesting that only women in nice areas should have the right to a home birth.
On some of the websites I visited there was studies on home and hospital births as well as other nursing studies. Home births should be seen as a choice and not hospital verses home. Every woman has the right to have a home birth as well as the choice to change her mind at any time before the baby is born.
A more recent statistic published in April 2006 showed that more women are giving birth at home. Of the four countries that make the UK (England, Scotland, Wales & Northern Ireland) Wales had the biggest increase with an increase of 16.2 %.
The national childbirth trust is concerned that when it comes to where a woman gives birth it is a postcode lottery. The NCT wants the health minister to set targets for home births.
In April 2007 the health secretary Patricia Hewitt pledged that all women in England will be offered a home birth overseen by a midwife. The new plan is expected to be in place by 2009. “There are clearly far more women out there who would like to have a home birth and could do so safely, but aren’t at the moment getting that option”. The health secretary also went on to say “ (What we are doing is saying to the local NHS: you tell us what you think your shortfall is and then we will work with you to ensure over the next two to three years you can increase those numbers.” Guardian online).
According to the Department of Health in 2004/05 601,000 births took place in England. Of that figure only 2% were home births.
Task 2 part 1 (P3)
Present and report findings in a relevant format, identifying sources of bias or error.
Chart 1
This chart represents the causes of death in childbirth in the hospital.
Beverley Lawrence Beech
1 (1%) = anaesthetists
2 (49%) = hospital doctors
3 (1%) = paediatricians
4 (18%) = hospital midwives
5 (6%) = community midwives
6 (6%) = general practitioners
7 (2%) = pathologists
8 (7%) = others
9 (10%) = family
The error with this chart is there are no actual figures for it just the overall statistics.
Chart 2
These charts represent the complaints women had about hospital births.
1 = the room was too clinical.
2= the women that had no opinion.
1 = they had no control who came in and out of the room.
2= the women that had no opinion.
1= they didn’t have enough space.
2= the women that had no opinion.
1 = they could not control the room temperature.
2= the women that had no opinion.
1= they had no control over the lighting.
2= the women that had no opinion.
1 = there was not enough pillows, mats or beanbags to get comfy.
2= the women that had no opinion.
1= they did not like having to share bathroom facilities.
2= the women that had no opinion.
1= their birthing partners were excluded and made to feel in the way.
2= the women that had no opinion.
This report was done in 2005 and it was published on the national childbirth trust web site. It was based on a study of 700 women in the UK. The error with this report is it does not say where in the UK it was done.
The other problem with both these studies is they are both other people’s work and are also not new studies. Again my bias is that because I am a keen supporter of home births I am looking for anything that shows a hospital births in a negative way.
Task 2 part 2 (P4)
Discuss the findings of the research in relation to the original hypothesis.
Chart 3
This chart represents the number of home births in 1979.
1= women booked for home births.
2= women booked for hospital but birthed at home.
3= not booked for either but birthed at home.
4= place unknown.
Chart 4
This chart represents home births in 2004.
1= home births.
2= hospital births.
My original hypothesis was why are home births no longer encouraged? Both these charts show the difference in home births over the last 26 + years. In 1979 91% of babies were born at home compared to only 2% in 2004.
Task 2 part 3 (M3)
Analyse the findings of the research in relation to the original hypothesis.
All women have the right to a home birth and it should be both an option and encouraged. A home birth is also more financially beneficial. I went to my local antenatal clinic and spoke to two midwives there and asked them for their views on home births. The first midwife told me “I am a keen supporter of home births but due to a short supply of midwives in the community I very rarely get the opportunity to encourage women to opt for them. I am also a keen supporter of water births and held fund raising events for a local hospital to have the floor strengthened so it could have the existing one re-opened.
(Midwife 1) “I am a newly qualified midwife of 3 years but have only attended 2 home births. I can honestly say that both the home births that I attended were without a doubt the best two births I have attended.” (Midwife 2)
Midwife 1 suggested a website for me to look at that contained information on all local hospitals maternity units. I went on the web site and I looked at local hospitals within a 20-mile radius, which were 10 in total.
The Hospital Births Home births Booked home
births
Bishop Auckland 374 65 65
North Durham 2539 23 30
Darlington 2318 64 65
North Tees 1996 23 00
Hartlepool 1640 20 15
Sunderland 3298 07 08
James Cook 3787 34 02
Queen Elizabeth 1630 16 06
Royal Victoria 5262 49 83
South Tyneside 1449 00 15
Of the 10 hospitals there were a total of 24293 births in the financial year April 2005 to March 2006. Of that figure 316 were home births, but only 289 were planned home births. These figures break down as follows
Chart 5
1 = the number of births in total
2(11)= the percentage of booked home births
3(13) = the percentage of actual home births
My original hypothesis of why are home births not encouraged has not been answered fully because my hypothesis was a question. However what I have done is look at several pieces of research that has already been done especially the reasons (see chart 2) why women want home births in the future.
Task 2 part 4 (P5)
Outline any possible improvements to the research, referring to any relevant implications and ethical issues as appropriate.
I believe that I conducted my piece of research in a professional and ethical way. I have maintained anonymity throughout and without breaking any ethics such as causing people stress, all people involved gave their consent and all those that did give their consent were of sound mind and able to do so.
I do believe that there are improvements to be made such as at the first antenatal appointment women should be told of the option to give birth in their own home. I also think that women should be shown encouragement not discouraged to have home births. Women who birth at home are likely to suffer less pain, are less likely to have a postpartum haemorrhage, baby more likely to breastfeed, more privacy, more in control, other children if applicable can be involved and one to one midwife care.
With a home birth you can plan a water birth with the safe knowledge that it will be available at all times, it will be clean, you don’t need anyone’s permission to use it and you do not need to get out even if the midwife says she doesn’t have enough experience. Although with the latter the expectant mum needs to be confident and be aware of the issues involved.
The health secretary Patricia Hewitt has made plans to improve the maternity services for all expectant mothers. These plans include all expectant mothers to be given a full range of birthing choices by 2009.
Task 2 part 5 (M4)
Discuss the possible implications that the research results may have on current practice.
There are people who do have a genuine fear of hospitals because of a previous experience. What I’m concerned about is the shortage of midwives and the loss of choice to have home births. Although the health secretary has outlined plans to change this I’m worried that because of the shortage of midwives it wont happen anyway.
The results (chart 3 & 4, page 11) show for themselves the difference in home births. Only 26 years ago 91% of babies were born at home compared to only 2% in 2004.
Geographically the above figures vary for example in the North East there were about 13% of the total figure that gave birth at home and in Devon the figures were around 6%.
It has not been possible for me to find out the full implications of my research results as my research was secondary and it was a question that I personally wanted the answer to. However if the health secretary had not stepped in then women might have been at risk of loosing the right to have a home birth for good.
My evidence does show that there are many pluses and benefits to having a home birth such as
- A less painful labour
- Knowing the midwives who will be at the birth
- One to one care
- More privacy
- Reduced need for medical intervention
- Baby more likely to breastfeed
- Lower rate of postnatal infection
- If you have other children they can be involved as much as you want them to be.
The television presenter Davina McCall was quoted as saying, “I had both my daughters at home and both experiences were truly amazing. I cant believe so many woman are not told about the benefits of giving birth at home and so don’t consider it as an option. Being able to give birth in my own home at my own pace meant I didn’t need any medical pain relief. Having a home birth was also great for my husband, as he felt comfortable and could share fully in the experience. I believe that it is really important pregnant women arm themselves with loads of information about the types of birth that are available to them” (NCT website)
Davina McCall was recently on the Paul O Grady show and so I sent the show an email asking for details of how to contact her. I received an email back giving me her agent’s details. I contacted her agent via email asking (as she had recently had another baby at home) if Davina would be willing to give me a quote on her reasons why she chose home births and what support did she get. Two weeks later I had a phone call from Davina’s personal assistant saying that Davina was unable to talk to me personally due to a very busy work schedule but gave a quote for her assistant to read out. “ I recently gave birth at home for the 3rd time to beautiful baby boy. I enjoyed all three of my home birth experiences tremendously. I had the same midwife for all 3 births, which I chose privately. I am an avid supporter of home births and believe every expectant woman should experience at least one home birth. I have been guest speaker on several occasions at conferences held by the home birth society in the hope that it will encourage more women to opt for a home birth.”(This quote is accurate to the best of my ability)
Task 2 part 6 (D1)
Discuss how the methodology of the research project could be altered to reduce bias and error.
The vast majority of the research methods that I have used to do my project have come from websites. The problem with this is I will have been biased from the beginning, as I will have been looking for evidence that shows hospitals in a negative light. There could also have been error on the original researchers part as they could have altered the figures to make them say what they want them to. The research could also have been altered to reduce error and bias on my part, by doing an original piece of research myself.
If I had carried out my own piece of research I could have asked similar kinds of questions to the ones asked in the research that I have used. I would then be able to collate the results of my own research and compare it with the research used from the web. By doing this I could check and find out if there were any correlations between the research used and my own findings. Obviously, my own research would be local to the area where I live and would not be anything like as big a sample as the Internet research that I have used. However, there should still be some evidence of correlation as the figures when represented, as pie charts should bare some resemblance to the Internet research.
If I were to carry out this type of project again then I would change the way in how I did my research methods. I would use a questionnaire, which I would take to my local and surrounding antenatal clinics. I would also set up a pre-arranged interview instead of just turning up at my local antenatal clinic on the off chance that there is a midwife around to have an informal chat with me.
“It is important if you go looking for the research evidence on home birth that you look at research on planned home birth. Sometimes the studies that are done have their results skewed by including figures on unplanned home births, some of whom will include very high risk mothers who unexpectedly had a birth at home or young mothers with concealed pregnancies. It is also important to look at research done on births in modern, industrialised countries like ours, which have an effective health service. Studies from the Netherlands for example, where there has been a high number of home births for many years, are very useful in giving us high quality, high volume statistics. This sort of research shows very convincingly that home is a great place to be.
A National Childbirth Trust study in the United Kingdom done in 2001 showed that if you book a home birth you halve your chances of needing to have a Caesarean, ventouse, or forceps delivery and significantly that you are less likely to have a bad tear or need an episiotomy. The benefits are not just for you though: babies who are born at home are less likely to have infections after birth and are much more likely to breastfeed successfully. The numbers of babies in this country who die at birth or who are injured at birth are, thank goodness, very low but there are sufficient numbers to show categorically that you do not increase any risk to your baby by choosing a home birth. In fact, the figures are so compelling that the Royal College of Obstetricians, the Royal College of Midwives, the Royal College of General Practitioners and the Department of Health all agree that ALL low risk mothers-to-be should be told that home birth means better births and healthier mothers and babies.” (the good birth)
Bibliographies
Alexander, L., 2006. Nursing & Midwifery Uncovered. 2nd Ed. Richmond: Trotman
Green, S., 2002. Research Methods. Cheltenham: Nelson Thornes Ltd.
Langley, P, 1994. Doing Social Research. Lancashire: Causeway Press Ltd.
Manning, V., 2006. Health Promotion In Midwifery. 2nd Ed. London: Hodder Arnold
