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Women should be supported to give birth in midwifery led units or at home

Women should be supported to give birth in midwifery led units (primary units) or at home - the new NICE Guidelines from the United Kingdom (UK)

The National Institute for Health and Care Excellence (NICE) have just released an updated intrapartum care clinical guideline for the care of healthy women and their babies during childbirth

These guidelines now advise that giving birth at home or in a midwifery led unit is suitable for low risk women because there are fewer interventions yet the health outcomes for the baby are no different. The guidelines advise that maternity care providers should ensure that home birth and midwifery led unit birth settings are readily available for women throughout the UK and that maternity services should provide a model of care that supports one to one care in labour.

Using evidence from the Birth Place England study (Birthplace in England Collaborative Group, 2011) the NICE guidelines state that women who plan to give birth at home or in a midwifery led unit are more likely to have a normal vaginal birth than those planning to give birth in an obstetric hospital. Women who plan to birth in an obstetric hospital are more likely to have interventions such as an instrumental birth, caesarean section or an episiotomy. Primiparous women (first time mothers) should be advised that there is a small increase in risk of rare adverse outcomes for the baby if a home birth is planned. Due to the rarity of mortality a composite outcome was used by the Birth Place England group to define adverse outcomes and included, mortality, meconium aspiration, nerve injury and bone fractures. The UK NICE guidelines are developed by a multi-disciplinary group based on discussion and consideration of the evidence.

Women in New Zealand are able to access one to one care from a midwife during pregnancy and labour and birth. All women seek a safe place for birth with the majority giving birth in an obstetric hospital ‘just in case’ they need specialist support (Grigg, Tracy, Daellanbach, Kensington, & Schmied, 2014). New Zealand data has demonstrated similar outcomes to Birth Place England and reiterated that for low risk women giving birth at home or in a primary unit provides good outcomes for both the mother and baby (Dixon, Prileszky, Guilliland, Miller, & Anderson, 2014).

Women can be reassured that giving birth at home or birth in a primary unit reduces the risk of unnecessary intervention whilst providing safe options for them and their baby.

References:

Birthplace in England Collaborative Group. (2011). Perinatal and maternal outcomes by planned placeof birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ, 343d7400. Retrieved from doi:10.1136/bmj.d7400

Dixon, L., Prileszky, G., Guilliland, K., Miller, S., & Anderson, J. (2014). Place of birth and outcomes for a cohort of low risk women in New Zealand: A comparison with Birthplace England. New Zealand College of Midwives Journal, 50, 11-18.

Grigg, C., Tracy, S., Daellanbach, R., Kensington, M., & Schmied, V. (2014). An exploration of influences on women's birthplace decision-making in New Zealand: a mixed methods prospective cohort within th eEvaluating Maternity Units study. BMC Pregnancy & Childbirth, 14, 210. Retrieved from http://www.biomedcentral.com/1471-2393/14/210