Is recent advice urging women to consider homebirths appropriate or is further consideration required?
By Ali Cloak
I recently read the interesting draft advice from NICE, the National Institute for Health and Care Excellence, which encourages women to give birth at home or in midwife-led units, rather than traditional labour wards. But considering the inherent risks of child birth and the current shortage of midwives, is this advice sensible?
Christine Carson, the Clinical Guideline Programme Director for NICE, has stated that home births are just as safe as other settings for ‘low risk’ pregnant women for women who already have at least one child.
The organisation asserts that midwife-led units “are as safe as traditional labour wards for all ‘low-risk’ pregnant women and are more likely to result in a better birth experience with less medical intervention”. The change in approach could also result in significant financial savings for the NHS, given that births in an obstetric unit cost more than those in a midwifery led unit or at home.
The Royal College of Midwives and the parenting charity, NCT, welcome the proposals. However, others have raised significant concerns as to whether the guidance can be safely implemented in practice. The body which represents the UK’s maternity doctors, the Royal College of Obstetricians and Gynaecologists (RCOG), has warned that assessments as to which pregnancies are ‘low-risk’ are not always accurate. In any event, complications can arise unexpectedly, sometimes within a matter of minutes, which would pose a risk to the baby and mother if not managed appropriately. The RCOG have therefore sensibly emphasised the importance of ensuring that transport is available for those having a home birth to ensure that specialist obstetric care can be provided promptly if required.
From our experience in investigating birth injury claims, which is where a mother or baby suffers injury as a result of negligence during childbirth, it is clear that when complications occur time is of the essence. There is often only a small window of opportunity where intervention can occur without long term harm being suffered by the baby.
We investigate cases where there have been failures to properly recognise risk factors during the antenatal period. If pregnancies are erroneously thought to be ‘low-risk’ then it could be entirely inappropriate for them to deliver at a midwifery-led unit or at home. We are concerned that there could be unnecessary dangers posed if the suggested advice is implemented without making significant investment in to antenatal care and midwifery services, both in terms of facilities and training.
A further concern arises from the fact there is currently reported to be a national shortage of midwives and limited NHS funding available. For safety to be assured, there must be significant investment in midwife-led care and home births.
The perceived cost savings of the approach could well be a false economy if the incidence of birth injury claims increases. Where negligence is established then significant amounts of compensation may be awarded in cases where a child has suffered very severe injuries such as Erb’s palsy and cerebral palsy.
It is important that women are given the choice as to where they give birth, but the choice must be made on an informed basis with knowledge of the possible risks and anticipated benefits fully explained. Whilst it is pleasing to hear that home births and midwifery-led births are considered to be safer than they previously were, we remain conscious that many additional measures must be put in place before the proposed guidance is formalised so that expectant mothers can make decisions based on full and proper information.
If you have any concerns about treatment you have received during pregnancy or labour then please contact a member of the Clinical Negligence Team for further advice.