Yesterday, the National Institute for Health and Care Excellence (NICE) published draft guidelines which recommend that more women experiencing 'straightforward' pregnancies give birth in midwife-led units or at home.
The major catalyst for this was the publication of the Birthplace report in 2011. This was an exhaustive look at how safe birth was for mother and baby, based on where they first received care during labour. These settings were hospital, midwife-led units (MLU) and home.
This is an important step from NICE. It marks the beginning of a shift, from a system that sees hospital births as the norm to one where births outside of hospital will hopefully be more common.
Currently around 96% of births occur in hospital. I'm not sure that this is the option 96% of women would make if they had a real choice – and real choice is important, because a woman has to be happy and comfortable with the environment in which she gives birth.
Some women may choose to give birth in a hospital in an obstetric unit led by doctors. Even there, most of the births and most of the care is delivered by midwives and maternity support workers. Others may want a MLU. These can be in hospital alongside obstetric units or can be stand-alone units out in the community, where the care is delivered by midwives without the involvement of doctors. There are doctors available to step in if any complications arise, but women will need to transfer to receive this care. Women report greater levels of satisfaction with MLUs than for hospital births: the care is often more personal and less medicalised, and women are less likely to have medical interventions such as caesarean sections.
Currently only about 2.3% of births take place in the home. Women giving birth at home are in familiar surroundings, often with family and their other children around. Being at home tends to help them relax more, which helps in labour.
All of these choices have pros and cons, which is why it's so important for women to know what choices are available and what they offer. Health professionals will help and advise, but ultimately it needs to be the woman's decision.
That's why it's essential to promote the benefits of midwife-led care and home births to women, and to dispel negative myths around them. Of course women will have concerns about giving birth outside of a hospital environment - for decades the official message has been that hospital is good and safe, and outside is unsafe. All births carry some risk wherever they take place, but the evidence shows that births in MLUs or at home are just as safe, possibly safer - for low risk women - due to the lower intervention rates. It also shows that although home births may not always be the best option for a woman having her first baby, the difference in risk between having a baby at home or in hospital is actually very small.
If a woman is having a home birth, the chances of transfer (before or after birth) to hospital in the Birthplace Study were 12% for women who had already given birth, and 45% for first time mothers. The vast majority of these transfers are not emergencies, they are controlled and organised. They are normally done because a birth is not progressing as quickly as expected or for pain relief. The same applies to births in MLUs (with rates of 9.4 and 36%). We have to remember that pregnancy is a normal body process - midwives are skilled at detecting potential problems and will take action early so that intervention, if needed, is at hand. In the study, even after transfer, most women did not need help to give birth.
Ensuring women are aware of these facts is one step in empowering them to make their own decisions around childbirth, but a number of other things also need to happen. Too often, the choices NICE recommends are not available to every woman, and too often, this is through lack of beds or midwives. There needs to be more investment in midwife-led care, midwife-led units and in home births. We also need to ensure that midwives in training get jobs when they qualify so that we have the right number of midwives to deliver these services. It is then that a choice that exists in theory will become a choice that exists in reality for all women.
Guest posts
Guest post: New birth guidelines - 'the idea of choice needs to become a reality'
MumsnetGuestPosts · 14/05/2014 10:45
This reply has been deleted
Message withdrawn at poster's request.
This reply has been deleted
Message withdrawn at poster's request.
This reply has been deleted
Message withdrawn at poster's request.
Don’t want to miss threads like this?
Weekly
Sign up to our weekly round up and get all the best threads sent straight to your inbox!
Log in to update your newsletter preferences.
You've subscribed!
To comment on this thread you need to create a Mumsnet account.