NICE recently made significant headlines as it published its draft proposals for changes to the Intrapartum Care clinical guideline, which was last published in 2007. And although you wouldn’t have been able to tell from the media coverage that ensued, the draft guideline actually set out to rectify the following: “Uncertainty and inconsistency of care has been identified in a number of areas, such as choosing place of birth, care during the early (latent) phase of labour, fetal assessment and monitoring during labour (particularly cardiotocography compared with intermittent auscultation), and management of the third stage of labour” (NICE 2014:3).
The draft proposals concerning how midwives discuss place of birth with women garnered the most publicity and new recommendations included:
- ‘Advise low-risk multiparous women to plan to give birth at home or in a midwifery-led unit (freestanding or alongside).
- Advise low-risk nulliparous women to plan to give birth in a midwifery-led unit (freestanding or alongside).
- Commissioners and providers should ensure that all 4 birth settings [obstetric-led unit, midwife-led unit (alongside), midwife-led unit (freestanding), and home] are available to all women (in the local area or in a neighbouring area)’ (NICE 2014:10).
In a media statement, the RCM’s Cathy Warwick sensibly pointed out: “To achieve this a number of things have to happen. The choices recommended by NICE have to be commissioned at a local level by clinical commissioning groups. There also has to be more investment in midwife-led care, in midwife-led units and in home births. […] It is then that a choice that exists in theory will become a choice that exists in reality for all women.”
Perhaps unsurprisingly, some sections of the UK media decided to spin a new angle on the draft guidance, ranging from: ‘a cynical cost-cutting measure based on flawed and out-dated research’, which would ‘spark [a] war between mothers’ (Davies 2014), to ‘a home birth could have killed my baby’ (Vine 2014) and a deeply sad feature on the This Morning television programme with a couple whose baby had died after being born at a rural freestanding birth centre in Shropshire.
Sensationally spiralling out of control, many of the newspaper articles — some of which were staggeringly inaccurate on various points — resulted in the news morphing into a different story, and most articles lost sight of the original point behind the draft guidelines from NICE. That week the birth politics debate raged on Twitter with #birthtrauma and #informedchoice clouding the original issue even further. Our own post on MIDIRS Facebook page resulted in over 10,000 views, helped by nearly 100 shares of the post.
We shouldn’t laugh, but the Daily Mail even managed to attribute the reasons behind NICE’s draft proposals to… immigration, because the link between women being
able to choose midwife-led care and the number of people choosing to come to the UK is obvious, isn’t it?! What the media has either forgotten, or plain ignored, is that the proposals from NICE are just that: draft proposals which don’t automatically become policy; they are guidance. It remains the responsibility of commissioning boards and individual health trusts to act on the guidance and apply it within their own area.
Surely the recommendations can only be a good thing for stand-alone birth centres, which sometimes struggle to attract enough women to give birth there. Until those responsible for the initial conversations on place of birth start recommending midwife-led care, whether that is birth at home or in a freestanding birth centre, women — particularly first- time mothers — will often choose a hospital birth.
We will wait and see whether the media backlash has any effect on the proposals…
Davies B (2014). How the NHS push for home births will spark war between mothers. Daily Mail, 13 May. http://goo.gl/83VQdj [Accessed 31 May 2014].
NICE (2014). Intrapartum care: care of healthy women and their babies during childbirth. Draft for consultation, May 2014. http:// goo.gl/fvv8Vc [Accessed 29 May 2014]. Vine S (2014). ‘A home birth could have killed my baby’. Daily Mail, 14 May. http://goo.gl/nWWGOP [Accessed 31 May 2014].