July is set to be a month of celebrations. Not only will it be the NHS’s birthday that month, but it will be the 40th birthday of Louise Brown, probably better known as the world’s first “test-tube baby”.

Louise’s arrival, by caesarian section shortly before midnight on 25 July 1978 at the Royal Oldham hospital, made headlines around the world, marking as it did the birth of the first human to be conceived using in-vitro fertilisation.

Her birth was a sensational medical breakthrough. It was also a watershed moment for NHS maternity services, which for the past 70 years have been characterised by change – both in policy and technological advances – with hospital admissions becoming the norm.

For the first time, the one in six couples who would otherwise be childless were offered medical interventions such as IVF. Meanwhile, new techniques in antenatal testing and monitoring, notably ultrasound, became routine in antenatal care. In 2016, 96.5% of all babies delivered in England and Wales were born in hospital.

Seven decades on, more change is planned in an attempt to make services safer, more person-centred and family friendly, as the NHS struggles to meet the needs of a rising number of births, an increase in older mothers, and rise in those with complex needs.

In some respects this move towards more person-centred care will be turning back the tide of history. Since the founding of the NHS, expectant families have increasingly been encouraged to have hospital births, a trend accelerated during wartime. This medicalisation of maternity services was a cornerstone of the NHS’s stated emphasis on care from the cradle to the grave.

Despite this, and improvements to maternal and infant mortality rates, there was never any clear universally agreed vision for maternity care too often overseen by a male-dominated medical profession, according to medical historian Angela Davis, from Warwick University. This “state of confusion” led to a recommendation in 1959 that 70% of all births should take place in hospital, followed by a target of 100% in the Peel report in 1967.

The result? Women reported being left in corridors and men were banned from the delivery rooms, and only allowed to visit at pre-ordained times. This was the experience of former art teacher Audrey Evans, who gave birth to her first child, Robert, in June 1958 at Darlington memorial hospital. She went on to have four more children – two more in hospital, followed by two home births for her youngest children, helped by a community midwife and supported by husband Bernard.

“The beds were in a corridor because it was so busy,” recalls the 84-year-old, who now lives high above the harbour in Newlyn, Cornwall. “We had to form an orderly queue and then were pretty much left on our own. Robert was a bit stuck and had his arm over his head so they had to use forceps. I was given an injection, so I don’t remember much. Bernard was allowed to see me in the evening. I was in hospital for 10 days.”

Between 1985 and 1988 home births fell to 0.9%. By 1994, the government published Changing Childbirth – a vision of future maternity services, which was meant to put women at the centre of care. However, the rhetoric was not matched by reality and a second report Better Births, released in 2016, highlighted a huge variation in maternity services. Too often women were told what to do and rarely saw the same professional twice.

Two years on, the government has published an implementation plan aimed at personalising care and breaking down barriers between professionals. Ministers have also promised an extra 3,000 training places for midwives and maternity support staff over the next four years.

According to Prof Jacqueline Dunkley-Bent, head of maternity, children and young people at NHS England and national maternity safety champion for the Department of Health, the key to improving services is continuity of care from the same one or two midwives. Figures show women who saw the same one or two midwives throughout their pregnancy are less likely to lose their baby or experience pre-term birth. By March 2019, one in five women is expected to benefit from the continuity of carer model. This will be rolled out to the majority of women by 2021.

Looking forward, Dunkley-Bent says: “Being a recipient of continuity of care … is very different to experiencing the care delivered through more traditional models of midwifery, which in some areas can mean meeting a different midwife at every appointment. Becoming comfortable with someone, building a relationship with them, which grows and deepens over time, enables trust to develop and women begin to share their deeper anxieties and insecurities as well as enjoying the more positive aspects of growing knowledge and confidence through a supported journey of discovery.”

The measures mean change is afoot again, although, there is acceptance that some maternity providers would move faster than others. However, there are signs this time round that change may be lasting. Dunkley-Bent insists progress will be closely monitored and says: “Regardless of the pace, sustainability is key.”

‘Once I got on it, the home birth system was brilliant’

Emily Pinkerton had her first daughter in hospital. Here, she explains why she opted to have her second at home

Building up a good relationship with a community midwife was critical for 34-year-old Emily Pinkerton as she prepared for a water birth at her home in Woodford, East London.

Having had a successful water birth in Whipps Cross hospital, north-east London, for her first baby, Pinkerton, now 37, felt confident home was the perfect place for her second. Her daughters Hannah and Lucy are now aged six and two.

“The worst bit about having a baby in hospital was waiting 12 hours after the birth to come home,” she recalls. “I had never met the midwife who delivered my daughter, Hannah. However, the birth itself and care I received was very good. I just felt that I didn’t need to be there. Both Hannah and I were fine.

“When I was pregnant for a second time, I was very keen to have a home birth. My husband, Robert, was a little worried, but he felt as if he was in control as he organised getting the pool ready.”

Pinkerton remembers her antenatal care and births as if it was yesterday. Persuaded by her doctor to have a hospital birth first time around, she had regular hospital checkups. However, during her second pregnancy, antenatal checks were made by a dedicated home-birth team during home visits.

“There was a bit of bureaucracy getting on the home-birth system, but once I did it was brilliant,” says Pinkerton, who works part-time for the Financial Conduct Authority.

“I built up much more of a relationship with the midwives than I did before. When I went into labour with Lucy, my husband put Hannah to bed, and one of the midwives who I had seen through the pregnancy came to the house with a community midwife. They sat and watched and let nature take its course.”

She has this advice for other pregnant women. “Do what you feel comfortable with and don’t be afraid to ask questions. Do your own research and get support from other mothers.”

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