UK tells women to have babies at home

Britain is making a radical change to its longstanding advice on childbirth.

A Wednesday announcement from Britain’s National Health Service proclaimed home births are safer than hospital deliveries for low risk pregnancies. The new guidelines, issued by the National Institute for Health Care and Excellence (NICE), replace the 2007 recommendations advising women to exercise caution about home birth, as conclusive risk assessments were lacking at the time. Now the regulator says delivering in a traditional maternity ward increases the need for surgical intervention leading to possible infection, so birthing with a midwife is considered the less risky option for healthy mothers-to-be.

“Most women are healthy and have straightforward pregnancies and births,” NICE clinical practice director Mark Baker said in a statement. “Over the years, evidence has emerged which shows that, for this group of women, giving birth in a midwife-led unit instead of a traditional labor ward is a safe option.”

Baker said research proves the safety of home births over hospital births for low-risk pregnant women—about 45 percent of the total—who have given birth before. He hopes the recommendations create “a shift away from hospitals,” but adds mothers should give birth in whatever environment is most conducive to their preferences. The Telegraph reports that only 3 percent of births currently take place outside the hospital, according to the latest figures.

A 2011 study conducted by Oxford University researchers found hospital births were more likely to involve episiotomies or culminate in cesarean sections. The likelihood of women receiving epidurals was also increased, resulting in pain relief but also increasing the possibility of damaged perineums and use of forceps.

The findings did indicate one exception: The risk of death or serious complications was slightly greater in home birth situations for first-time mothers. Five in 1,000 babies would experience serious complications in the hospital, compared to nine in 1,000 for babies born at home. But for women who had already had at least one child, chances of having a complicated or dangerous birth was lowest at a midwifery unit attached to a hospital, with two cases per 1,000 births.

Chance of serious medical problems for the child were the same, said the NICE, whether mothers gave birth in a midwifery unit or an obstetric unit, with five cases per 1,000 births. First-time mothers were also more likely to have a natural birth in a freestanding midwifery unit.

No doctors have expressed outrage over the new guidelines so far, though some critics remain doubtful. “Things can go wrong very easily and we do feel this advice could be dangerous,” Lucy Jolin of the Birth Trauma Association told BBC News. But the Royal College of Obstetricians and Gynaecologists welcomes the new guidelines, according to the BBC.

The U.K.’s universal healthcare system covers both hospital and home births. Subsequently, Baker told The New York Times, U.K. doctors have no financial incentives to deliver in a particular environment. Dr. Jeffrey L. Ecker— chairman of the committee on obstetrics practice for American College of Obstetricians and Gynecologists—told the Times he didn’t see the United States embracing Britain’s recommendations in the near future. Such guidelines would put doctors at risk of losing patients to midwives.

“We believe that hospitals and birthing centers are the safest places for birth, safer than home,” added Dr. Ecker.

Meanwhile, The Governing Council of the American Public Health Association supports a woman’s informed choice to give birth at home, saying qualified services and caregivers should be made available to them, according to the National Perinatal Association,

In the United States, the number of out-of-hospital births are still rare but steadily increasing. The Center for Disease Control and Prevention reports that in 2012, 1.36 percent of U.S. births took place outside a hospital, up from 1.26 percent in 2011.

Holly Powell Kennedy, immediate past president of the American College of Nurse-Midwives, praised Britain’s new guidelines, saying mothers in a hospital have less freedom to labor without interventions: “This is how the practice should be happening,” she told the Times.