MIDIRS received the following message from Dr Bryan Beattie, a consultant in fetal medicine at University Hospital of Wales in Cardiff, on its Facebook page.
Dr Beattie is also medical director at Innermost Healthcare, a private clinic in Cardiff.
The message – which is publicly visible – was sent to us in response to last week’s updated NICE guidelines concerning home birth being safer than hospitals for low-risk mothers. It has been reproduced verbatim and in full below.
You may be aware that on 3/12/2015, NICE issued guidelines recommending that many more women would be better off giving birth at home with lower rates of intervention such as caesarean section, forceps, epidural and episiotomy but with no disadvantages to their baby.
As one of the UK’s leading practitioners of fetal medicine, Innermost Healthcare is extremely concerned by these recommendations being misinterpreted by the media and by pregnant women and we would strongly caution GPs and pregnant women to be careful in how they interpret this advice.
Home births are definitely not a safer option for first time mothers even if they are deemed low risk, as there is double the chance of having a dead, damaged or handicapped baby.
This is not the case if they deliver in hospital or a midwifery led unit. I have personally issued a response to the NICE suggestions, the basis of which cautions that in such cases, they should deliver in a midwifery led unit alongside a hospital maternity unit so to ensure safe clinical backup if urgent complications arise bearing in mind about 35-45% will transfer to hospital in labour.
This is distressing for pregnant women and their partners and with stretched ambulance services, transfers may take longer.
The suggestion by NICE that 45% of all women are at low risk of complications during pregnancy is also unhelpful, as it is impossible to classify someone as low risk using conventional antenatal care based on feeling and measuring a bump.
Part of being low risk assumes the baby is also low risk i.e. it is well grown, head first and has a normal amount of amniotic fluid in its sac. This cannot be checked without a 36 week scan. Feeling a bump misses a third of breech babies, and at least half of the babies who are not growing well. Assessment of amniotic fluid without a scan is even less accurate.
All “low risk” mums who are considering a non hospital birth should have a 36 week scan to make sure their baby is ALSO “low risk” and ready for a normal birth, which the NHS is not currently offering. Only then can they make an informed decision about place of birth. Unfortunately, NICE has not made this recommendation, and this is of concern.