Midwife-led care tends to be safer than hospital for women having a straightforward (low risk) pregnancy, according to the NICE evidence. The organisation’s updated guidance also confirms that home birth is equally as safe as a midwife-led unit and traditional labour ward for the babies of low risk pregnant women who have already had at least 1 child previously.
Nearly 700,000 babies were born in England and Wales last year. Nine out of 10 babies are delivered in hospital under the ultimate supervision of obstetricians, but NICE wants women to be given greater freedom to choose where they give birth.
The updated NICE guidance says women should be given this information to help them think about where they would most like to give birth, but that the final decision should be made by them and supported by healthcare professionals.
Professor Mark Baker, NICE’s clinical practice director, said: “Most women are healthy and have straightforward pregnancies and births. Over the years, evidence has emerged which shows that, for this group of women, giving birth in a midwife-led unit instead of a traditional labour ward is a safe option. Research also shows that a home birth is generally safer than hospital for pregnant women at low risk of complications who have given birth before.
“Where and how a woman gives birth to her baby can be hugely important to her. Although women with complicated pregnancies will still need a doctor, there is no reason why women at low risk of complications during labour should not have their baby in an environment in which they feel most comfortable.
“Our updated guideline will encourage greater choice in these decisions and ensure the best outcomes for both mother and baby.”
Some organisations have voiced concerns that encouraging women to give birth in midwife-led centres or at home would “force” women to give birth without doctors, putting them at greater risk of harm.
But Susan Bewley, Professor of Complex Obstetrics at King’s College London, who chaired the group responsible for developing the updated recommendations said this would not be the case: “Midwives are highly capable professionals and can provide amazing one-to-one care to pregnant women in labour, whether that’s in a woman’s own home, a midwife-led unit or a traditional labour ward.
“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.”