Low-risk pregnant women encouraged to give birth at home

Women are now better off giving birth at home or in midwife-led centres than in hospital where doctors are more likely to make interventions such as caesareans, a UK health advisory body has said.

The National Institute for Health and Care Excellence (Nice) in the UK has said new evidence shows women who have had straightforward pregnancies are safer in labour when cared for by midwives, both in specialist birth centres or equally in their own home.

While women who chose to give birth in traditional labour wards at hospitals, which make up 90 per cent of all births, undergo a higher rate of intervention by specialist obstetricians, including a birth by forceps, a caesarian or an episiotomy .

Sources said they suspected busy doctors wanted to progress slow labours before the end of their shift by carrying out unnecessary caesareans, in situations where midwives would be more patient.

The evidence found that outcomes for babies were the same across all settings, except for those being born at home to first time mothers where the risk of a serious medical problem is slightly higher.

Nice urged Clinical Commissioning Groups to ensure every area has enough services to offer all options to women so they can be in control of where they want to give birth.

Professor Mark Baker, Nice’s clinical practice director, said: “It’s very difficult to explain why this is happening but the closer you are to hospital and indeed if you are in hospital, the more likely you are to receive hospital care and surgical interventions.

“Surgical interventions can be very costly, so midwifery-led care is value for money while putting the mother in control and delivering healthy babies.

“We hope that commissioners will start to plan their midwifery and obstetric services in line with our guidance, a shift away from hospitals and towards midwifery-led care.”

Susan Bewley, professor of Complex Obstetrics at King’s College London, who helped develop the recommendations, added: “Some women may prefer to have their baby at home or in a midwife-led unit because they are generally safer — that is their right and they should be supported in that choice.

“But, if a woman would prefer to have her baby in a hospital because it makes her feel ‘safer’, that is also her right. Giving birth is a highly personal experience and there is no ‘one size fits all’ model that suits all women.

“What’s important is that women and their families are given the most up-to-date information based on the best available evidence so that they can make an informed decision about where the mother gives birth to her child.”

She said the recommendations had been developed in the best interests of mothers and babies and not in the best interests of the UK’s National Health Service purse.

The updated guidelines also recommended one-to-one care for all women in labour which Nice hopes will also result in better job satisfaction and retention of staff.

PA