Caroline Flint is a UK midwife with nearly 50 years of experience, an author, and a birth educator. We tapped into her accumulated wisdom to discover what has improved in maternity care over time – and what hasn’t.

Starting with COVID-19, do you think we gained benefits for maternity care from the pandemic?

My initial reaction was to say no, we did not. COVID was an excuse for incredibly cold and unkind care and for partners being excluded. There was no sense being used at all.

The most sensible thing in a pandemic is for women to be encouraged to have their babies at home. They would be much safer, and their attendants would be much safer.

Instead, in the UK, all midwives were herded into the obstetric unit. Homebirths were stopped. It was just dreadful.

Partners weren’t allowed in for scans; they weren’t always allowed in for birth. So, women have suffered enormously during the pandemic.

For a woman, birth is a significant time and stays with her for the rest of her life. And if you mess it up – even if you have a pandemic as your excuse – you mess that woman’s life up for a long time.

When women are traumatised during birth, it stays with them forever. It affects how they feel about themselves, how they feel about their baby, how they feel about their partner, and how they feel about the world. It’s just shocking.

Do you have any reason to feel hopeful about the acceptance and availability of home births soon?

I wish I could say yes. But, as I’m sure you’re aware, women are never, ever told the truth. Nobody tells them what their options are. So that amazing metanalysis in The Lancet in 2020 was a massive piece of research. And they found that there were significant benefits if women were booked for a home birth – it was irrelevant whether they gave birth at home or were transferred to a hospital.

Benefits include:

• more than 40% less likely to need a caesarean
• more than 50% less likely to have an instrumental birth
• 55% less likely to have an episiotomy
• 40% less likely to have a third or fourth degree, and wait for it:
• 75% fewer had an infection.

So, the research showed that booking a home birth is safer for women, whether it’s your first baby or your tenth. It’s safer to book for a home birth, and are women told that? Are midwives saying that to everybody they meet? No, they’re not.

I feel like the lone voice. I’ve spent my life telling everybody [about the benefits of home birth]. It’s ridiculous because we’ve got this fantastic knowledge and should share it.

If the mothers are transferred to the hospital, that’s fine. They still get good outcomes by having booked a home birth and having a midwife come to them.

Obstetricians, I’m sorry to say, have completely taken over. In the UK, we are flooded with obstetricians. Obstetricians are very lovely and very necessary. But when you have too many of them, they control what’s happening. That isn’t good because they don’t understand how birth works. They don’t understand hormonal processes.

They think women are like a car’s engine. You turn it on, and you press the accelerator. Then, if it’s not working hard enough, you press the accelerator a bit more. They don’t understand that a hormonal process – which is what birth is – is all about feelings. It’s about the woman feeling sexy, soft, receptive, relaxed and happy. It makes a substantial difference to labour.

And so, if a woman’s feeling relaxed, then labour progresses well. If she’s got privacy and her beloved with her, it’s okay; it will work.

Mammals have been on the planet for zillions of years, and we’re incredible at giving birth. We’ve perfected it.

The occasional woman needs help, but we’re talking probably less than 10% of the population. The rest can do it on their own.

You have had experience in the field for 50 years. Are there things that we do better than when you first started?

Yes, we are doing better. I went to see a senior registrar last week in the hospital. And there were two medical students, and he said, “I hope you don’t mind having medical students”. I said, “That’s fine.”

He put out his hand and said, “Hello, my name is Nick”. I said to the medical students, “Blimey, that’s just wonderful. When I was a student nurse, we would all have called him “Sir”, we would not have known his first name, and you two would be standing up, you wouldn’t be sitting down.” When Sir was there you had to stand all the time, and it was complete nonsense.

So, I like how the relationships between doctors and midwives and doctors and nurses have improved. It’s much more casual and friendly. I think that’s important. And I believe doctors listen to nurses and midwives much more than ever.

Mind you; they always want to be the boss. They want to be in charge and tell you what to do. So yes, it’s good – but it also could be a lot better.

And what about the reverse – were there good practices that were common when you started that aren’t now?

When I had my first baby, 30% of women had their babies at home – one-third! It was a perfectly normal thing to do. It’s now about 2% in the UK, which is ridiculous.

We [UK health services] are having a whole series of reports compiled by a midwife called Donna Ockenden. Thousands, I mean, literally thousands of people are coming to her and saying, “This terrible thing happened to me in childbirth, and it has blighted my life.” Nobody ever thought, “Why are thousands of women traumatised?”

Is something wrong with these obstetric factories that process so many women on a conveyor belt? Maybe it’s not the right environment! If you’re having so many women traumatised, babies die who shouldn’t die; it is just ridiculous.

But obstetricians will not let go because we’re talking about jobs.

If you could choose one thing that should be a priority for improvement in maternity care, what should we focus our energies on?

I think we should be encouraging women to have home births or birth in midwifery-led units because you can always transfer to the hospital if you need to. And in my experience, which is nearly 50 years now, if you’re going to have an emergency, you can see it coming. You say, “I don’t like the look of this. I think we need to consider transferring to the hospital.”

I’ve only once in nearly 50 years – once – had to do an emergency transfer of a woman in labour to the hospital. It was a woman with a prolapsed cord and full dilatation. Of course, I’ve transferred many women to the hospital from home, but it’s never been an emergency.

Thanks so much for talking to me, Caroline

Australia, what a lovely country, and you’re all so lucky to live there. Give my love to Australia.

Caroline Flint’s midwifery career of nearly five decades included running the Birth Centre in London for over 20 years. She continues to provide antenatal education. Among her six books is Do Birth – A gentle guide to labour and childbirth, which helps women prepare for a comfortable and confident birth. Caroline has three children and supported the deliveries of nine of her twelve grandchildren.

Published 19th December 2023