Women are now better off giving birth at home or in midwife-led centres than in hospitals where doctors are more likely to make interventions such as caesareans, according to new evidence.
Studies for the National Institute for Health and Care Excellence (Nice) show women who have had straightforward pregnancies are safer in labour when cared for by midwives, whether in specialist birthing centres or in their own homes.
Those who choose to have their babies in traditional labour wards at hospitals undergo a higher rate of intervention by specialist obstetricians, including caesarian section, episiotomy or delivery by forceps.
Sources said they suspected busy doctors wanting to speed up long labours before the end of their shift were opting for unnecessary caesareans in situations where midwives would be more patient.
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The findings showed outcomes for babies were the same across all settings, except for those born at home to first-time mothers where the risk of a serious medical problem is slightly higher.
Nice is urging clinical commissioning groups to ensure every area has enough services to offer all options to women so they can be in control of where they want to give birth.
Susan Bewley, professor of complex obstetrics at King’s College London, helped develop the recommendations.
She said: “Some women may prefer to have their baby at home or in a midwife-led unit because they are generally safer – that is their right and they should be supported in that choice.
“But if a woman would prefer to have her baby in a hospital because it makes her feel ‘safer’, that is also her right. Giving birth is a highly personal experience and there is no ‘one size fits all’ model that suits all women.
“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.”
The Scottish Government published its Keeping Childbirth Natural and Dynamic advice in 2009, which recommends avoiding medical intervention where possible.
Gillian Smith, Scottish director for the Royal College of Midwives, believes putting women with straightforward pregnancies into hi-tech medical surroundings could be spurring clinicians to find something wrong in order to justify them being there.
“Rather than letting a woman feel where she is with her whole pregnancy there is a tendency to want to interfere,” she said.
“There will always be some women who say they want to see an obstetrician because they are worried. That choice would never be removed.”
A Scottish Government spokeswoman said the priority is for the safety of mother and baby, and it is important that women are given information to make an informed choice.
The latest Scottish figures show a steady rise in caesarians since the mid-1970s, from 8.6 per cent to 27.3 per cent in 2013.
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