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03/12/2014
The guidance, which has been updated, claims that midwife-led care could actually be safer for women having a 'straightforward, low-risk pregnancy', than hospital care would be.
However, NICE added that it is important women are given all the information they need to help them decide where they would like to give birth, and the final decision should be made by the mum-to-be, and supported by the relative healthcare professionals.
Around 700,000 babies are born each year in England and Wales, nine out of 10 of which are delivered in doctor-led obstetric units in hospital. Under the new guidelines, it has been said that 45% of women are at a low risk of complications during their pregnancy and therefore may be better off giving birth somewhere else.
Mid-wife led units for example, can be based at hospital sites next to obstetric units, or freestanding and based away from a hospital site, and it is thought these are safer because the rate of interventions – such as an epidural – is lower, and therefore the outcome for the baby would be no different compared with an obstetric unit. It is not clear why the rate of intervention is lower.
Elsewhere, the report found that home births are also just as safe for low risk pregnant women, except for those first-time mothers. In a midwifery unit or a hospital, a baby born with a serious medical complication might occur in five out of every 1,000 births, NICE has said, but this figure increased to nine in every 1,000 for home births, for first-time mothers.
It added that in all circumstances, there should be one midwife appointed per woman in labour.
Professor Mark Baker, NICE's clinical practice director, said: "Where and how a woman gives birth to her baby can be hugely important to her. Although women with complicated pregnancies will still need a doctor, there is no reason why women at low risk of complications during labour should not have their baby in an environment in which they feel most comfortable.
"Our updated guideline will encourage greater choice in these decisions and ensure the best outcomes for both mother and baby."
Some have raised concerns that by encouraging women to give birth in midwife-led centres or at home could "force" women to give birth without doctors, thereby putting them at greater risk of harm, but the updated guidelines have been welcomed by the Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG).
Cathy Warwick, RCM, commented: "It is very welcome to see the guidance reflecting the latest evidence around place of birth. For low risk women, giving birth in a midwife-led unit or at home is safe and reduces medical interventions.
"We hope that this will focus commissioners' and providers' of maternity services attention on ensuring that women have a real choice about where they give birth, be it in a hospital, a midwife-led unit or at home.
"Women should be making their choices based on the best available evidence and with the help, advice and support of midwives. It is important that women feel able to make the choices that are right for them."
Susan Bewley, Professor of Complex Obstetrics at King's College London, who chaired the group responsible for developing the updated recommendations added: "Midwives are highly capable professionals and can provide amazing one-to-one care to pregnant women in labour, whether that's in a woman's own home, a midwife-led unit or a traditional labour ward.
"What's important is that women and their families are given the most up-to-date information based on the best available evidence so that they can make an informed decision about where the mother gives birth to her child."
(JP/IT)
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Midwife-Led Care Is Safe – Report
A new report by the National Institute for Health and Care Excellence (NICE) has said that women should be encouraged to give birth at midwife-led units, rather than traditional labour wards.The guidance, which has been updated, claims that midwife-led care could actually be safer for women having a 'straightforward, low-risk pregnancy', than hospital care would be.
However, NICE added that it is important women are given all the information they need to help them decide where they would like to give birth, and the final decision should be made by the mum-to-be, and supported by the relative healthcare professionals.
Around 700,000 babies are born each year in England and Wales, nine out of 10 of which are delivered in doctor-led obstetric units in hospital. Under the new guidelines, it has been said that 45% of women are at a low risk of complications during their pregnancy and therefore may be better off giving birth somewhere else.
Mid-wife led units for example, can be based at hospital sites next to obstetric units, or freestanding and based away from a hospital site, and it is thought these are safer because the rate of interventions – such as an epidural – is lower, and therefore the outcome for the baby would be no different compared with an obstetric unit. It is not clear why the rate of intervention is lower.
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Elsewhere, the report found that home births are also just as safe for low risk pregnant women, except for those first-time mothers. In a midwifery unit or a hospital, a baby born with a serious medical complication might occur in five out of every 1,000 births, NICE has said, but this figure increased to nine in every 1,000 for home births, for first-time mothers.
It added that in all circumstances, there should be one midwife appointed per woman in labour.
Professor Mark Baker, NICE's clinical practice director, said: "Where and how a woman gives birth to her baby can be hugely important to her. Although women with complicated pregnancies will still need a doctor, there is no reason why women at low risk of complications during labour should not have their baby in an environment in which they feel most comfortable.
"Our updated guideline will encourage greater choice in these decisions and ensure the best outcomes for both mother and baby."
Some have raised concerns that by encouraging women to give birth in midwife-led centres or at home could "force" women to give birth without doctors, thereby putting them at greater risk of harm, but the updated guidelines have been welcomed by the Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG).
Cathy Warwick, RCM, commented: "It is very welcome to see the guidance reflecting the latest evidence around place of birth. For low risk women, giving birth in a midwife-led unit or at home is safe and reduces medical interventions.
"We hope that this will focus commissioners' and providers' of maternity services attention on ensuring that women have a real choice about where they give birth, be it in a hospital, a midwife-led unit or at home.
"Women should be making their choices based on the best available evidence and with the help, advice and support of midwives. It is important that women feel able to make the choices that are right for them."
Susan Bewley, Professor of Complex Obstetrics at King's College London, who chaired the group responsible for developing the updated recommendations added: "Midwives are highly capable professionals and can provide amazing one-to-one care to pregnant women in labour, whether that's in a woman's own home, a midwife-led unit or a traditional labour ward.
"What's important is that women and their families are given the most up-to-date information based on the best available evidence so that they can make an informed decision about where the mother gives birth to her child."
(JP/IT)
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