This BBC headline today comments on draft advice issued by NICE – the National Institute for Health and Care Excellence which suggests that healthy women experiencing a “straightforward” or “low risk” pregnancy should be encouraged to give birth in a midwife-led unit rather than a traditional labour ward.
While I am a wholehearted supporter of maternal choice of venue, when it comes to childbirth, the safety of the mother and her unborn child must be the paramount consideration of Government, obstetricians and midwives. When advising prospective mothers, whether they be first-time mothers or those having subsequent births, proper clear and accurate advice must be given about the risks that may be associated with the choice of venue, if mistakes, accidents and poor outcomes are to be avoided.
While labour wards are undoubtedly the best place for those identified as difficult cases, it is vitally important women understand that a “straightforward” pregnancy, or a second or subsequent birth, does not automatically guarantee a “straightforward” birth or delivery wherever their care is provided. An anticipated low risk labour can turn into a high risk situation within a matter of minutes. This would require swift access to the facilities, equipment, and obstetric and /or neonatal care that only a hospital setting, or possibly an alongside midwifery unit (AMU) can provide. Proper advice and accurate facts must be given to women regarding the limitations of the choice they are being encouraged to make.
At a time when the birth rate is rising rapidly and it is already recognised that there is a nationwide shortage of midwives, I would question the motivation behind any shift away from previous guidance which urged caution about the choice of home births or midwifery-led units where easy and quick access to labour ward facilities (i.e within a matter of a few minutes), is frequently not available.
When considering the costs associated with providing maternity services, whether they be in a hospital setting, an AMU, a midwifery unit, or at home, it is also important to consider not only the short term costs associated with providing the services themselves but also the long term costs associated with potentially adverse outcomes when birth related injuries may well give rise to a lifetime need for financial support. Not only from the NHS, but also from social services, the welfare state generally (in the form of benefits), and the families of the injured child.
Stakeholders apparently have until the end of June to submit their comments on the draft guidance issued by NICE and I very much hope that caution and good sense prevails when the final guidance is issued. Whatever form the final guidance takes, it can only be implemented safely with appropriate resources and adequate midwifery and maternity services being provided across all of the relevant settings.