The Daily Mail today reported on what it coins the NHS ‘obsession’ with doctor-free births which it argues put babies at risk. Its comments arise out of the tragic story of Rhiannon Davies whose daughter Kate sadly passed away just 6 hours after her birth at a midwifery-led unit at Ludlow Community Hospital in Shropshire.

Last week the jury at the inquest into the circumstances of Kate’s death found that she should never have been born in a midwife-led birth centre and that had she been born in a fully staffed hospital with doctors at hand to assist with complications during delivery it is likely that she would have survived.

The article calls into question the safety of midwifery-led units and the role of medical and surgical interventions in childbirth. This is a pertinent issue at the moment and something that we have blogged about before.

Midwife-led units

Midwife-led units are run by midwives without all the medical facilities of a hospital. They are intended for mothers who are classified as low risk during pregnancy as an equally as safe alternative to a hospital obstetric unit. They are championed by those who believe that pregnancy and birth are normal physiological processes and intervention and caesarean should be a last resort rather than first choice.

The problems with midwifery-led units arise when women such as Rhiannon are misclassified as low risk and the midwives at the unit do not have the requisite experience or knowledge to deal with any number of the possible complications that could arise during the labour and delivery of the baby.

Babies born in a poor condition at a midwife-led unit have to be transferred to hospital, often by air ambulance, and many do not survive the journey. The result is the death of babies just like Kate, who could have been alive today had she been born at hospital with doctors at hand to assist with her delivery and postnatal care.

Medicalisation of labour and childbirth

The increasing medicalisation of labour and childbirth is frequently viewed as a negative; midwife-led units are seen as a resistance to what has become unnecessary medical intervention to the natural childbirth process. However, we see all too often the devastating results of lack of intervention in pregnancy and labour and find it hard to see why we should not rely on the medical knowledge of doctors and the technology that has been developed to reduce the number of maternal and baby deaths and injuries.

This by no means involves discouraging the natural childbirth process, but there is a lot to be said for having doctors on hand to assist should medical intervention be indicated. Without doctors at hand to assist when needed, the outcome can be fatal, as evidenced by figures which show that the risk of adverse neonatal outcome is more than doubled for first time mums delivering on midwife-led units.