13th May 2014 – Healthy women experiencing a 'straight forward' pregnancy should be encouraged to give birth in a midwife-led unit rather than a traditional hospital labour ward, according to draft advice.
The National Institute for Health and Care Excellence (NICE) is also provisionally saying that a home birth may be just as safe as hospital for women who have had at least 1 child and whose pregnancy is defined as 'low risk'.
The Royal College of Obstetricians and Gynaecologists says it welcomes the proposals, which apply in England and Wales, subject to satisfactory arrangements being put in place so that women can be transferred to hospital in emergencies.
At present, NICE recommends that women should be given the choice of where they want to give birth, but urges caution if a home birth or delivery in a midwife-led unit is planned. The Institute is now revising its recommendations in light of new evidence.
In a statement, Christine Carson, clinical guideline programme director for NICE, says: "Since we published our original guidance, more evidence has come to light about the benefits and risks associated with giving birth at home, in an independent or hospital-based midwife-led unit and on a traditional labour ward.
"We now know that these 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 evidence also highlights that home births are just as safe as other settings for low risk pregnant women who already have at least 1 child, but not for women expecting their first baby.
"However, every woman should ultimately have the freedom to choose where she wants to give birth and be supported in her choice."
The proposed changes could affect hundreds of thousands of births. Around 729,000 babies were born in England and Wales during 2012 – a rise of about 20% from 2002.
The key recommendations from NICE include:
Telling women that giving birth is generally very safe for both the woman and her baby
Ensuring that midwives explain to the woman that she may choose any birth setting (at home, in a freestanding or hospital-based midwife-led unit or hospital labour ward) and support her in her choice
Ensuring that midwives advise low risk women who have already had at least 1 child to plan to give birth either at home or in a midwife-led unit
Advice from midwives to low risk women who are expecting their first baby that they should plan to give birth in a midwife-led unit. This is because women tend to have a better experience in this setting than a traditional labour ward.
Where low risk women expecting their first baby are considering a home birth, midwives should advise that giving birth at home increases the risk of problems for the baby.
The draft guideline also updates current recommendations about when a baby’s umbilical cord should be clamped and cut. Following a review of available evidence, it says that once midwives have delivered the baby and administered oxytocin to deliver the placenta, they:
Do not clamp the cord earlier than 1 minute after the birth of the baby unless the baby’s heartbeat falls below 60 beats/minute or there are concerns about the cord
Should clamp the cord within 5 minutes to deliver the placenta manually (controlled cord traction), if the final stage of labour is being ‘actively managed’.
Should support a woman’s choice if she asks for her baby’s cord to be clamped and cut later than 5 minutes.
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