New evidence released today shows midwife-led care to be safer than hospital for women having a straightforward, low-risk pregnancy.

Nearly 700,000 babies were born in England and Wales last year, with 9 out of 10 of them delivered in hospital under the ultimate supervision of obstetricians. But the National Institute for Clinical Health (NICE) wants women to be given greater freedom to choose where they give birth.

NICE has updated its guidance to confirm 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.

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.

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.”

‘Highly capable’
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.”

Oxfordshire mother-of-three, Sarah Fishburn, helped to develop the guidance. She said that clear, unbiased information would have benefited her greatly: “When I was first pregnant, the advice I was given by my GP about where I could give birth was limited.

“As a result, I had a traumatic and stressful birth experience. My second labour was slightly better, but it wasn’t until my third pregnancy when I received the support of an amazing, well-informed midwife and very supportive consultant obstetrician, that I felt confident in my body’s ability to give birth and had a very positive home water birth.”

Sarah, who audits maternity services and supports women who have had difficult pregnancies and births, added: “This guideline, which is based on evidence, facts and figures, will provide the information that was lacking for me during my pregnancies, and support women choosing where to give birth, whatever setting that might be. This will help to make birth safer for mothers and babies in the future.”

‘More choice’
Tracey Cooper, a consultant midwife at Lancashire Teaching Hospitals Trust and a member of the group who developed the updated recommendations, said: “By offering a variety of birth environments this will not only ensure women have more choice and be more likely to be satisfied with their experience, but it also ensures midwives have more choice in the way that they want to work.

“By having midwifery led settings, this increases opportunity for midwives to work in different ways, offering a variety that they can move in and out of depending on what suits them at that particular time in their life.

“It also supports midwifery led models of care, which can offer more opportunities for not only the woman to know her midwife but for the midwife to have increased job satisfaction by getting to know the woman herself, seeing her through her whole childbirth journey.

“As we currently have a shortage of midwives this will help us to recruit and retain staff and hopefully attract midwives, who have left, back into our profession.”