National Institute for Health and Care Excellence (NICE) guidelines, updated in December 2014, evidence that midwife-led maternity care is deemed safer than hospital care for women having a straightforward, low risk, pregnancy. This is because the rate of interventions, such as the use of forceps or an epidural, is lower and the outcome for the baby is no different than in an obstetric unit. Around 45 per cent of women have a low risk of developing complications during their pregnancy.
Birthing centres or midwifery units are run by midwives without the medical facilities of a hospital. They can be next to a main hospital maternity unit or completely separate from a hospital. Because most women can give birth without needing medical interventions, these units can be a good choice as an alternative to hospital birth. However, if complications arise during the pregnancy or labour, an expectant mum may be advised to change her plan and give birth at an obstetric unit. Factors increasing the risk of complications during labour include being over 35, being overweight or obese, bleeding after 24 weeks of gestation, and having high blood pressure. Complications from a previous pregnancy can also increase the risk.
The NICE guidelines support a woman’s right to be informed about her options and choose where she wants to have her baby - be that in a midwifery unit, at home or on a hospital labour ward. They advise that giving birth at home or in a midwifery unit is particularly suitable for women with straightforward pregnancies, who have already had a baby. For women with straightforward pregnancies who are expecting their first baby, it is advised that a midwifery unit is suitable, but that there is a small increase in risk for the baby with a home birth.
The advantages of having a baby at a birth centre or midwifery unit may include:
- being in surroundings where the woman can feel more relaxed and able to cope with labour;
- a greater likelihood that labour will be managed by the same midwife who has cared for the woman during her pregnancy, and is therefore known to her;
- being able to stay in the same room for her whole stay, with her partner;
- a greater likelihood of a straightforward birth without medical interventions.
However, it should still be remembered that if a woman decides to give birth in a midwifery unit, she will not be offered any surgical or anaesthetic care, such as an epidural or a caesarean section. If she needs further care or if her labour is not progressing well, she can choose to be transferred to the nearest obstetric unit. This may be on the same site or may involve a journey by ambulance.
Alison Johnson, associate director at Penningtons Manches LLP, has recently represented a young man with hemiplegic brain injury and epilepsy after complications arose during his birth at a midwifery unit, where the facilities were limited and the main hospital was some distance away. It was alleged that:
- it was inappropriate for his mother, as a first time mother, to be booked into a midwifery unit that was nearly 60 miles from the nearest hospital, in a very rural location with slow roads, and that she was not properly advised of the risks of giving birth in such a unit before agreeing to go there;
- when complications arose during labour, she should have been transferred to hospital rather than allowing her labour to proceed in the midwifery unit;
- when birth was imminent and she was still at the midwifery unit, the birth was mishandled by a general practitioner, who was the only doctor available to carry out the delivery.
It was the young man’s case that had his birth taken place in the main hospital, where facilities included the use of CTG to monitor a baby’s heartbeat during labour, and an operating theatre where an emergency caesarean section could be performed, then he would have been born before he suffered the period of hypoxia (oxygen starvation) in the womb, causing his brain injury.
All of these allegations were denied by the defendant who maintained that the use of a midwifery unit was an acceptable choice to be offered to the mother. Penningtons Manches’ clinical negligence team was nevertheless able to succeed with the claim and ultimately the claimant received substantial damages to cover the cost of the care, therapy, adapted accommodation, aids and equipment he would need for life.
Alison Johnson commented: “Having a baby at a birthing centre or a midwifery unit can be the right option for many women. However, there are pros and cons which should be considered very carefully. Whilst offering expectant mothers the choice of birth environment is of course a good thing, the use of such units, particularly for first time deliveries, is controversial and politically sensitive. Whether midwifery units provide adequate facilities to deal with complications during delivery is difficult to assess. In this case, the various experts involved took very different views as to the adequacy of the level of care given to the claimant and his mother. His parents’ witness evidence throughout was that they had not been advised of any of the disadvantages of the midwifery unit and did not feel that they were ever in a position to make an informed choice, as they should have been.”