Written by Madeleine Speed, the Pelvic Partnership. April 2015
New guidelines from the National Institute for Health and Care Excellence (NICE) suggest that the labour ward of a hospital may not be the best choice for women at low risk of complications.
Recent healthcare guidance from NICE reveals that traditional labour wards in hospitals are no longer the best option for women giving birth following straightforward, low-risk pregnancies. The new guidance states that it is just as safe for women to give birth in midwife-led units or at home and, in some cases, may be even safer.
NICE which advises the NHS, wants healthcare professionals such as GPs and midwives to encourage women with straightforward pregnancies to give birth in midwife-led units or at home. These are women who have previously given birth and who are expected to have low-risk pregnancies and the reason for this advice is that these options are safer for them than giving birth in hospital. There should be four options offered to all women who have had uncomplicated pregnancies and who are expecting an uncomplicated birth: home, a freestanding midwifery unit (separate from the hospital), an alongside midwifery unit, or an obstetric unit (the traditional labour ward or delivery suite).
The new guidance is based on evidence showing that the rate of interventions (e.g. the use of an epidural or forceps or caesarean birth) is lower and the outcome for the baby is no different when compared with a hospital labour ward.
About 45 per cent of women have a low risk of developing complications during the course of their pregnancy. A risk of complications can be attributed to factors such as being over 35, being over-weight or obese, having high blood pressure and bleeding after 24 weeks of pregnancy.
Home births, the guidance outlines, are also equally safe as those within a midwife-led unit and traditional hospital for babies of low-risk pregnant women, the exception being for first-time mothers. In a midwife-led unit or hospital ward, a baby born with serious complications might occur in 5 out of every 1,000 births but this rises to 9 in every 1,000 births for first-time mothers. However, women can still choose to give birth at home, as the risk to the baby, though slightly higher than other settings, remains a small one, and the advantages (in terms of better outcomes for women) remain the same as for other out-of-hospital settings.
The guidance suggests that all women in labour should have access to an obstetric service if they request an epidural or need to be taken to hospital for medical reasons.
The Pelvic Partnership welcomes these findings. As a charity that helps to support and provide information to women with pregnancy-related pelvic girdle pain, we are keen to encourage greater women-centred health care. It seems really important that women should be given information to enable them to make their own decisions about where they have their babies.
Professor Mark Baker, the Clinical Practice Director at NICE, acknowledges that women at low risk of complications should be able to give birth “in an environment in which they feel most comfortable.”
Professor Mark Baker, goes on to say that the “updated guideline will encourage greater choice in these decisions and ensure the best outcomes for both mother and baby.”
Giving women greater choice about where they have their babies has to be a good thing. However, at the moment in England and Wales, nine out of 10 babies are born within traditional labour wards within hospitals. So if the new guidelines encourage a greater interest in home births and midwife-led units from women with straightforward pregnancies, it will be a significant change in provision of maternity care for some organisations, although some already offer all four options to women.
In its article about the new guidelines, the Independent spoke to Cathy Warwick, general secretary of the Royal College of Midwives and who welcomed the new guidance, but pointed out that the NHS in England was still short of 3,200 midwives. Such a shortage in midwives currently means that in reality many women are not currently getting a real choice between hospital, midwife-led units or home birth. The worry is that if demand for a hospital birth is outstripped by the other alternatives, real choice may be even harder for women to exercise if there are not sufficient numbers of midwives to attend home births and midwife-led units. However, if women and babies experience more normal births, and are fit and well as a result, over time this should reduce the risks for future births, as fewer women will need long hospital stays and repeated c-sections, and babies will also need less extra care.
This guidance supports more women to give birth in comfortable, low-risk surroundings, supported by a midwife who is an expert on normal birth, and should improve the outcomes for mothers and babies in the future.