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Midwife-led units 'safer' than hospitals for low risk birth, confirms NICE

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Midwife-led units are a safer option than hospitals for pregnant women with low risk pregnancies to give birth in, the National Institute for Health and Care Excellence has stated.

There are also no additional risks in having a baby at home compared to midwife-led units or traditional labour wards for women who have already had a child, NICE added in its new guidance on care during childbirth.

Expectant mothers should in the future be provided with the data that these conclusions have been drawn from to encourage them to consider a wider range of choices before making a final decision about where to give birth, the new NICE guideline states.

The revised final guideline – called Intrapartum Care: care of healthy women and their babies during childbirth – which has been published today following a draft version in May, features new evidence that has been collected since the last time guidance was produced in 2007 on caring for women with uncomplicated pregnancies.

“Offering a variety of birth environments will ensure midwives have more choice in the way that they want to work”

Tracey Cooper

This includes data on rates of medical interventions for women across different birth settings and rates of babies born with and without serious medical problems at home, in midwife-led units and obstetric units.

Tracey Cooper, consultant midwife at Lancashire Teaching Hospitals Trust and a member of the group that developed the updated recommendations, said: “By offering a variety of birth environments this will not only ensure women have more choice and be more likely to be satisfied with their experience, but it also ensures midwives have more choice in the way that they want to work.”

She said that increased opportunities for midwives to work in midwifery-led services would also allow midwives to have more job satisfaction through getting to know the mother better.

“We hope this will focus providers’ attention on ensuring that women have a real choice about where they give birth”

Cathy Warwick

“As we currently have a shortage of midwives this will help us to recruit and retain staff and hopefully attract midwives, who have left, back into our profession,” said Ms Cooper.

Other updates in the NICE guidance include the circumstances in which midwives should consider transferring a woman in labour from her home or midwife-led unit to hospital and new recommendations on delayed umbilical cord clamping.

In addition, it makes greater emphasis on one-to-one care and recommends that maternity services should “benchmark services and identify overstaffing or understaffing by using workforce planning models and/or woman-to-midwife ratios”.

The Royal College of Midwifery welcomed some sections of the new guidance, including the recommendations around places of birth, but warned that other parts have failed to reflect the latest evidence available.

Cathy Warwick

Cathy Warwick

RCM chief executive Cathy Warwick said: “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.”

Professor Warwick said she also hoped the guidance would focus attention on one-to-one care for women during labour.

But she added that the college was “concerned” that it has not been possible to update the entire guidance. “Recent and important evidence on team midwifery and continuity of care has not been included,” she said. 

“The guidance as it stands suggests that team midwifery may not be the best model of care. However, recent research shows that team midwifery can help to ensure continuity of carer whilst also delivering other high quality outcomes,” she said.

Professor Alan Cameron, vice president of clinical quality for the Royal College of Obstetricians and Gynaecologists, said he welcomed the revised intrapartum care guidelines.

“For low-risk first-time mothers, we support the  recommendation considering a midwife led-unit, however, if a woman decides on a freestanding unit she should take into consideration the significant  transfer rate  and time to the nearest obstetric unit,” he said.

“The new guidelines recommend that women giving birth should have timely access to an obstetric unit if they need to be transferred to hospital for medical reasons. The close proximity of alongside midwifery units provides easier transfer and can therefore reduce stress and anxiety for the mother,” he added.

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Readers' comments (1)

  • Its not just a midwife led-unit that is safe for low risk mothers; you have to look at the skill mix in these units. Any unit is only as good as it's skill mix. Newly qualified midwives are being allocated to these units without the years of experience behind them. There needs to always be a good skill mix to work!

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