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13/05/2014

Women Should Choose Where They Give Birth - NICE

New draft advice from the National Institute for Health and Care Excellence (NICE), published today, has suggested that women should choose where they decide to give birth.

The guidelines suggest that a healthy woman experiencing a "straightforward" pregnancy should be encouraged to give birth at a midwife-led unit, rather than a traditional labour ward, while a home birth could also be just as safe for those with a low-risk pregnancy.

It added that hospital labour wards with doctors should be used for more difficult cases, otherwise there is a risk of "over-intervention".

NICE said new evidence meant it needed to update its recommendations for England and Wales. Previously, it said that women should be given the choice of where they wanted to give birth – but cautioned against home births as well as deliveries in midwife-led units. It now argues that the evidence suggests giving birth is safe wherever it happens.

The Birthplace study, which looked at the safety of various maternity settings, found that of the almost 65,000 births in England alone, midwife-led care was just as safe as doctor-led hospital care for low-risk deliveries. It also revealed that while a home birth carried a higher risk for first-time mothers, the risk of harm was still small.

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Christine Carson, Clinical Guideline Programme Director for NICE, is quoted as saying: "Every woman should ultimately have the freedom to choose where she wants to give birth and be supported in her choice.

"We're pleased we are now able to propose more definite advice to help pregnant women choose the best option for them. We now want to hear what others think so that we can ensure the final, updated guidance will promote the safest possible care for women and their babies."

The Royal College of Midwives said it welcomed the change in guidance.

Cathy Warwick, Chief Executive, commented: "The evidence shows that for low risk women giving birth in a midwife-led unit or at home is safe, indeed, may be safer than hospital. Women also tend to have higher satisfaction rates and a better birth experience when giving birth in these environments.

"The Government have stressed that women should have a choice about where they give birth. It is at the heart of their maternity strategy and too often this choice is denied to women."

However, she added that more investment in midwifery would be needed to implement the changes.

The Royal College of Obstetricians and Gynaecologists (RCOG) said: "We support choice for low-risk women who have had successful previous births to give birth at home, provided transport arrangements are in place for hospital transfer in the event of an emergency or should there be a request for pain relief.

"Based on the findings from research, there are issues around the risk assessment of pregnant women and the RCOG is in favour of alongside midwifery units (AMUs) for women who may need multi-disciplinary care during delivery."

AMUs are located at a hospital that also has a labour ward.

According to figures, around 15 women in every 100 have an unplanned caesarean, while 10 in every 100 births are planned caesareans. Home births are around two in every 100, while approximately 40 in every 100 deliveries are "normal" births. These are women who spontaneously go into labour and do not require any real intervention other than support and pain relief.

(JP/IT)

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"New draft advice from the National Institute for Health and Care Excellence (NICE), published today, has suggested that women should choose where they decide to give birth."