The National Institute for Health and Care Excellence (NICE) has recently issued a report on the management of labour for ‘low risk’ pregnant mothers which has received a mixed response.
NICE is keen to encourage the approach that every woman should have the freedom to choose where she wants to give birth. For low risk pregnancies, the focus is on encouraging home births or delivery at midwife-led centres. Currently, the percentage of home births in the UK is low and many women who indicate a preference for a home birth cannot have that option. In some cases that is due to risk factors specific to them but it is often a resourcing and support issue. The new guidelines aim to encourage women to have home births and for the appropriate support to be in place. For many women this will be a good thing as home or community births are often a more enjoyable experience for mothers, can reduce some of the risks of infection etc in hospitals and, obviously, save the NHS money. For the many people who support choice for mothers, the guidelines are a step forward.
There are, however, concerns about the suggestions. In the first instance, there is a question as to whether the resources are available to support more home births. Philippa Luscombe, partner in the clinical negligence team at Penningtons Manches LLP, comments: “In the cases that we see of injury to mother and/or baby during delivery, many result from staffing and resource issues on maternity units in hospitals. While the pressure on maternity wards will be reduced if more women have home births, this will only work if more staff are made available to provide support at home or in the community. Given that midwifery resources are already stretched, is this realistic?
“The second issue is whether encouraging home births could result in either women with risk factors being encouraged to give birth at home and/or more women and babies suffering injury following birth complications that can only be treated in hospital. Any delay in getting a mother in labour with complications into hospital could have a catastrophic impact on her and her baby.”
Professor Brian Toft OBE, Emeritus Professor of Patient Safety at Coventry University and patron of the Birth Trauma Association (BTA), has criticised the changes to the guidelines. He told the BTA that: “At present there is no robust evidence to justify NICE assuring low risk first time mothers that to give birth in a free standing midwifery unit is as safe as is a hospital. Indeed, there is evidence to suggest the contrary.”
Philippa concludes: “In order to implement the NICE guidelines safely, there will need to be significant investment in maternity staff in hospitals and in the community but also in emergency response teams and ambulances. If midwife-led units are to be encouraged, these units must have the option of swift access to obstetric teams at units nearby. It is also vital that there is a careful assessment of risk factors for each expectant mother when deciding where they should be having their baby.”