This week the NHS watchdog NICE (National Institute for Health and Care Excellence) has updated their birth care recommendations for mothers due to ‘new evidence coming to light’ around the safety of midwife led units and home births. Previously NICE had said that families needed to exercise caution when considering a home delivery or a birth in a midwife led unit. The changes have come as a result of recent findings from the Birthplace Study carried out by the National Perinatal Epidemiology Unit. The study looked at the safety of the different types of delivery settings across 65,000 births in England and shows that care led by midwives for low risk deliveries is just as safe as doctor led care. The study also found that a home birth was just as safe as a hospital birth for women who have already given birth at least once before. The risk factor did remain for new mothers though with a 1 in 100 chance of complications developing during a home delivery.
Many are sceptical about the changes and believe that they are simply a cost cutting exercise on the part of the NHS. A hospital birth costs the NHS an average of £1651 whilst a birth at a midwife led unit costs £1450 and a home birth £1066. We have previously reported on the current midwife shortage within the NHS with the Royal College of Midwives estimating that an additional 4,800 midwifery staff are required. With women now being pushed more towards midwife led care in dedicated units the NHS must ensure that these units are properly staffed to safeguard women and their babies. These guidelines coincide with a survey of Scottish maternity services where 1 in 5 women reported that they were left alone during labour at a time that worried them and 44% said that they were not given enough information to help them make a confident decision on where to go to give birth.
The provisional NICE guidelines say:
‘Midwives should explain to the mother-to-be that she may choose any birth setting… and support her in her choice. Midwives should advise low-risk women who have already had at least one child to plan to give birth either at home or in a midwife-led unit. Midwives should advise low risk women who are expecting their first baby to plan to give birth in a midwife-led unit. This is because women tend to have a better experience in this setting than a traditional labour ward.’
The Royal College of Midwives have said that they believe more investment in midwifery would be needed in order to implement the proposed changes. The Royal College of Obstetricians and Gynaecologists have said that they would support the recommendations as long as emergency back-up and pregnancy risk assessment issues were ironed out. Many believe that despite being offered a wider choice of delivery locations, many women will still chose a hospital birth just in case something should go wrong and emergency care be required.