Every mum and baby deserve the safest birth experience possible, no matter the place of birth. This means ensuring that all professionals, working in all environments, have the equipment and training to feel confident, competent, and valued. Nowhere is this truer than in the community sector.
1 in 50 women in England and Wales will give birth at home . Births in community settings, and community services in general, are gaining more attention as a better option for some low-risk mothers  , and to support continuity of carer .
Births in the UK are generally safe for first time mothers and for mothers giving birth again. For women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits to the mother . However:
- For mothers having their first baby, a planned home birth increases the risk for the baby when compared to obstetric units .
- In addition, research shows that nearly half of first-time mothers and 1 in 10 women having subsequent babies were transferred to an obstetric unit from a planned home birth .
Within our ‘Childbirth Emergencies in the Community’ training days, we were told repeatedly that there was no “essentials list” for equipment carried to community births, or a recognisable and efficient way of carrying it.
To investigate, Baby Lifeline conducted a survey and social media campaign “#HowDoYouCarryYours” with the Royal College of Midwives.
Results showed that around 1 in 3 midwives reported issues with the equipment they carried and whether it was safe for use, and the bag they carried it in:
- 30% reported that the bag/container used was not safe for use.
- 40% reported that their bag/container did not adequately meet their needs.
- 27% did not feel that they carried everything they might need to facilitate a homebirth in the community (including dealing with an emergency).
- 35% sourced and purchased the bag/container themselves using personal funds.
“Unfortunately, we have had to source our own bags…this has the potential to be unsafe in an emergency. Previous trusts I have worked for provided the bag and it was packed exactly the same way for all community midwives which meant that in an emergency we knew where everything was.”
– Community Midwife, reported to Baby Lifeline via survey in 2018
Improving Safety at a Home Birth – the Baby Lifeline Community Midwife Bag
In response, Baby Lifeline assembled an expert working group; including midwives, paramedics, obstetricians, pharmacists and neonatologists, to develop a gold standard for equipment and how it should be carried. The group was also guided by community midwives via survey responses.
The rucksack-style bag, with optional wheels, was designed to optimise safety; compartmentalised, and colour coded to make it easier to identify equipment quickly. It includes everything from scissors and towels to equipment used in emergencies.
We trialled the bag across the UK, and had great feedback:
“Other than the two items mentioned I think the bag is really incredible, it makes me feel safer at a home birth. It is really well organised and amazingly light considering.”
“I thought the bag was great on the whole. I like the idea that if this was standardised across our community team that when I arrive as a second midwife I would know exactly where to find anything I may need. Currently because we all pack our kits up differently I feel I need to spend time on arrival familiarising myself as to where everything is in my colleagues kit. This is clearly of benefit in the case of an emergency.”
Despite homebirth not being as rare as we think – 1 in 50 women will give birth at home – there is still not a list of essential equipment that should be carried by community practitioners during labour; this includes equipment needed in an emergency.
In response, Baby Lifeline convened an expert panel of health professionals, who put together a gold standard for equipment and the way it is carried. We then worked with community midwives to develop a bag that will optimise safety for those giving birth at home and the midwives assisting them.
NHS. (6th March 2018) Where to give birth: the options. Retrieved 10th April 2019, from https://www.nhs.uk/conditions/pregnancy-and-baby/where-can-i-give-birth/
National Institute for Health and Care Excellence (2014). Choosing place of birth: resource for midwives (CG190). Retrieved from https://www.nice.org.uk/guidance/cg190/resources/choosing-place-of-birth-resource-for-midwives-msword-248730877
Birthplace in England Collaborative Group: Brocklehurst P, Hardy P, Hollowell J, Linsell L, Macfarlane A, McCourt C, et al. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011;343:d7400.
NHS England (2016) National Maternity Review: Better Births Improving outcomes of maternity services in England A Five Year Forward View for maternity care London: NHS England.
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