It is safer for women with uncomplicated pregnancies to give birth at home or in a birth center, rather than a hospital, a British regulator advised earlier this month.
The recommendation, which includes information that these healthy women are better off in the hands of midwives than hospital doctors, marks a significant change in the guidelines offered by the National Institute for Health and Care Excellence (NICE). Around 45% of British women have a low risk of developing complications during their pregnancy, according to the guidelines.
Given the important differences between the British and American health care systems, it is also important to note that the move will likely have little impact on similar recommendations in the United States.
Still, the evidence cited by the institute presents a picture where low-risk mothers-to-be are less likely to undergo surgical intervention during delivery when a midwife at a home birth or a birthing center leads the care than when a doctor at a hospital treats them. Delivering in a traditional maternity ward increased the likelihood of infection because of the greater chance of surgical intervention, NICE noted.
“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,” said Professor Mark Baker, NICE’s clinical practice director, in announcing the changes to the guidelines. “Our updated guideline will encourage greater choice in these decisions and ensure the best outcomes for both mother and baby.”
The new recommendation noted that the rate of interventions, such as using forceps or having an epidural, is lower when a midwife is in charge, and the outcome for the baby was no different when compared with outcomes when delivery occurred in an obstetric unit.
While the guidance suggested home births were equally safe as a midwife-led unit and hospital obstetric unit for low-risk pregnancies, this was not true for first-time mothers. Instead, first-time mothers were better off in a birthing center or at a hospital. In a midwifery unit or a hospital, a baby born with a serious medical complication occurs in 5 out of 1,000 births, but rises to 9 in 1,000 births for home births for first-time mothers, the report said.