latest health care news

03.12.14

New NICE guidelines recommend home births for low-risk pregnancies

New guidelines from NICE could see thousands more babies born outside of hospital every year.

Nearly 700,000 babies were born in England and Wales last year, nine out of 10 of whom were delivered in hospital under the ultimate supervision of obstetricians, but NICE wants women to be given greater freedom to choose where they give birth.

According to NICE, the evidence now shows midwife-led care to be safer than hospital for women having a straightforward (low risk) pregnancy. Its 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 one child previously.

It said women should be offered the choice of a home birth, an obstetric unit in hospital, a midwifery unit next to a hospital or a midwifery unit in the community. In all circumstances there should be one midwife per woman in labour, it added.

NICE also found no difference in the number of medical problems in the baby between the different settings.

 Number of incidences per 1,000 multiparous women giving birth

 

Home

Freestanding midwifery unit

Alongside midwifery unit

Obstetric unit

Spontaneous vaginal birth

984

980

967

927

Transfer to an obstetric unit

115

94

125

10

Regional analgesia (epidural and/or spinal)

28

40

60

121

Episiotomy

15

23

35

56

Caesarean birth

7

8

10

35

Instrumental birth (forceps or ventouse)

9

12

23

38

Blood transfusion

4

4

5

8

FIGURES PER 1,000 BABIES OR PER 1,000 MOTHERS GOING INTO LABOUR. SOURCE: NICE

The updated NICE guidance says that 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.

The reason for higher rates of interventions in hospital is not known. It is speculated that it could be a combination of women feeling more comfortable in a familiar environment, being cared for by a midwife they have met before. There are also concerns that some doctors might be too keen to use clinical interventions.

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.”

Commenting on the guidance, Cathy Warwick, chief executive of the Royal College of Midwives (RCM) said: “It is very welcome to see the guidance reflecting the latest evidence around place of birth. For low risk women, giving birth in a midwife-led unit or at home is safe and reduces medical interventions.

“We hope that this will focus commissioners’ and providers’ of maternity services attention on ensuring that women have a real choice about where they give birth, be it in a hospital a midwife-led unit or at home. Women should be making their choices based on the best available evidence and with the help, advice and support of midwives. It is important that women feel able to make the choices that are right for them. 

But she told BBC News there would have to be significant changes in the way the NHS provided maternity care.

There are about 80 midwife-led units based on hospital sites and a further 60 located elsewhere.

"What the NHS needs to do is provide the facilities outside of hospitals that will allow about 45% of women expecting babies to plan their birth in different facilities.

"We need more midwifery-led units, then we may find that we don't need so many obstetric units."

(Image: c. David Jones/Press Association)

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