Labour wards: not the place for most births?

New health guidelines say most healthily pregnant women should be encouraged to switch from the labour ward to a lower-key midwife-led unit for the birth

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Healthy women having ‘straightforward’ pregnancies should be encouraged to give birth in a midwife-unit unit or at home, rather than in a traditional hospital labour ward, say the government’s health advisers.

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That’s because, say experts at the National Institute for Health and Care Excellence (NICE), new evidence suggests that, if you have a ‘low-risk’ pregnancy, giving birth at home with a midwife present or giving birth at in a midwife-led unit are both just as safe as giving birth on a obstetrics ward overseen by a doctor.

Not only that, you’re also less likely to have a medical intervention, such as an episiotomy, a Caesarean section or delivery of the baby using forceps or ventouse.

“The outcome for the baby is no different compared to an obstetric unit,” says NICE in its new guidelines for the NHS in England and Wales, “and the rate of interventions is lower.”

Currently, most pregnant women give birth in consultant-led hospital obstetric units but, as the NHS starts to follow these new NICE guidelines, there’s expected to be a huge shift in patterns of childbirth, with many thousands of women choosing to labour at home or in a midwife-led unit instead.

“Every woman should ultimately have the freedom to choose where she wants to give birth and be supported in her choice,” says Christine Carson, clinical guideline programme director for NICE.

So what is a high-risk pregnancy?

Most pregnancies fall into a low-risk category but you may be considered higher-risk if…

  • You have certain medical conditions, such as heart disease, high blood pressure, severe asthma, diabetes and certain blood disorders.
  • You have certain psychiatric disorders
  • You have had complications in one or more previous pregnancies
  • You already have, or you contract during pregnancy, certain infections, including HIV, hepatitis B or C, genital herpes, chickenpox or German measles
  • You are expecting more than one baby in your current pregnancy
  • You develop complications during your current pregnancy, including placenta praevia, pre-eclampsia, gestational diabetes
  • Your baby is presenting in a breech (bottom first, rather than head first) position or is thought to be ‘small for gestational age’.

What’s different about a midwife-led unit?

Midwife-led units (sometimes called birth centres) are run by midwives and don’t have the medical facilities a hospital would have. Some midwife-units are sited within or near a hospital (so there is easy access to medical facilities, if necessary); others are geographically quite separate (meaning access to medical facilities, if needed, may take longer and may require an ambulance).

If you give birth in a midwife-led unit, you’ll usually find:

  • You’ll be able to stay in the same room, with your birth partner, from the moment you arrive to the moment you leave.
  • You’re more likely to be looked after by a midwife you’ve got to know during your pregnancy
  • You may feel more relaxed than you would in an obviously ‘hospital-like’ setting and you may well need fewer inventions (such as the use of forceps or ventouse to deliver your baby)
  • You won’t have access to an epidural for pain relief

What does this mean for you?

It’s hoped that the new guidelines will help us think about where we would most like to give birth – and not just assume that we need to go into hospital.

Critics claim this move towards more births at home or in a midwife-led unit is just a cost-saving exercise, as cuts hit hospitals hard. 

But the NICE experts beg to differ. “We’re supporting an individual, calm conversation about what is right for each individual in her circumstances,” says Susan Bewley, professor of complex obstetrics at King’s College London and chair of the NICE advisory group. “Women may choose between any birth setting and they should be supported in those choices, as that’s their right.’

So, would you prefer the more relaxed atmosphere of a midwife-led unit? Or would you feel more reassured in a hospital labour ward, with easy access to an epidural and emergency medical facilities? Please do let us know by writing a comment below…

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