Women with low-risk pregnancies are to be encouraged to have non-hospital births under new NHS guidelines, which could see almost half of mothers-to-be planning to deliver their babies away from traditional labour wards.
Guidance from National Institute for Health and Care Excellence (Nice) says that midwife-led care has been shown to be safer for women and recommends that all women with low-risk pregnancies – 45% of the total – should be advised that giving birth in a midwifery-led unit, whether attached to a hospital or not, is “particularly suitable”.
The changes, published on Wednesday, have been made because women who give birth under midwife-led care have less chance of being asked to undergo medical interventions such as episiotomies, caesareans and the use of forceps or ventouse.
Susan Bewley, professor of complex obstetrics at King’s College, London, and chair of the Nice advisory group added that infections were more common in hospital wards.
“We’re supporting an individual calm conversation about what is right for each individual in her circumstances,” Bewley said. “They may choose any birth setting and they should be supported in those choices as that’s their right.”
The NHS body also advised midwives not to clamp and cut a baby’s umbilical cord until at least a minute after birth in the absence of complications, and generally within five minutes.
The announcement reverses decades of NHS policy and its own advice from 2007 recommending “early clamping and cutting of the cord”.
Research suggests that early clamping and cutting may leave newborn babies deprived of vital blood from the placenta, risking anaemia.
In separate guidance on postnatal care, Nice said parents should also be informed about the association between falling asleep with their baby on a bed, sofa or chair and sudden infant death syndrome until the baby is 12 months old.
The change represents another significant change to the guidelines, issued in 2006, which only applied to babies up to the age of six to eight weeks. Parents should also be informed that the association may be greater if parents use drugs or have recently drunk alcohol, or if the baby was of low birth weight or premature.
Nine out of 10 of the 700,000 babies born in England and Wales each year are currently delivered in hospitals under the supervision of obstetricians. Nice added that commissioners should ensure that women have all four possible options for giving birth available to them: hospital care, midwifery units in hospitals, midwifery units based in the community and at home.
Professor Mark Baker, Nice’s clinical practice director, said: “It’s very difficult to explain why this is happening but the closer you are to the hospital, and indeed if you are in the hospital, the more likely you are to receive hospital care and surgical interventions.
“Surgical interventions can be very costly, so midwifery-led care is value for money while putting the mother in control and delivering healthy babies.”
The outcome for the baby is the same in different settings except in the case of first-time mothers giving birth at home, where there is a “small increase” in the risk of serious complications – nine in every 1,000 compared with five in every 1,000 in the other settings – which the guidance says mothers should be advised about. Home births are the cheapest, followed by midwife-led units and then hospitals but Bewley said costs did not come into the equation.
Cathy Warwick, chief executive of the Royal College of Midwives (RCM), said: “For low-risk women, giving birth in a midwife-led unit or at home is safe and reduces medical interventions.
“We hope this will focus commissioners’ and providers’ of maternity services attention on ensuring that women have a real choice about where they give birth.”
The RCM has been campaigning for about 5,000 extra midwives to be recruited. Warwick said the new guidance would not stretch existing medical staff further but ensure they were better employed, as more women would have births without interventions, which require more resources.
Elizabeth Duff, the senior policy adviser for the NCT (National Childbirth Trust), welcomed the advice and urged the NHS to “put these guidelines into practice as soon as possible and make home and community birth, a real, not just theoretical, option”.
Community midwife units have lower medical intervention rates and rates of transfer to obstetric wards than those in hospitals but many have been closing recently. For women not giving birth for the first time also have a lower rate of transfer to an obstetric ward than mothers who planned to give birth at home.