Big push for home births: Too many babies are being born in hospital, say doctors

    * Maternity wards are 'not necessarily the safer option'
    * Third of women should give birth without seeing a doctor, say medical experts

By Sophie Borland
15th July 2011

Women should no longer assume they will give birth in hospital with a doctor on hand.

In a watershed moment, leading medical experts declared that mothers should be given more opportunity to have babies at home because a maternity ward is not necessarily the 'safer option'.

A report by the Royal College of Obstetricians and Gynaecologists suggests that as many as a third of all women should give birth 'without a doctor going anywhere near them'.
Big push: Medical experts are urging more women to give birth at home

House call: Medical experts are urging more women to give birth at home

It calls for a radical shake-up in the NHS which could lead to thousands more women having babies at home, as was the case 50 years ago.

In 1959, more than a third of women gave birth at home but by 1988 this had fallen to a low of 0.9 per cent. By last year this had risen only slightly to 2.4 per cent, figures from the Office for National Statistics show.

 
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The report states that only women most at risk of suffering complications – such as those expecting twins or triplets, the obese,  diabetics or those in their 40s – should have to give birth in hospital.

In addition it calls for dozens of maternity wards in smaller hospitals to be closed or merged into 'super units' to ensure those most likely to suffer complications receive the best care.
Midwife: A third of women should be able to give birth without seeing a doctor, according to a new report

Midwife: A third of women should be able to give birth without seeing a doctor, according to a new report

It warns that currently there are too many maternity units but not enough top-level consultants able to intervene should there be problems during the birth.

Often they are looked after by junior doctors with limited experience, particularly at nights and weekends when there are fewer staff on duty.

There are also concerns that maternity wards are becoming increasingly less safe because a shortage of midwives has left them at breaking point.

The report says that expectant mothers who are unlikely to need an emergency caesarean or suffer life-threatening complications such as pre-eclampsia should be offered the chance to have their babies in local birthing units or in their own homes.

At present, just three per cent of women give birth at home.

A further seven per cent use midwife-led units – which are small centres designed to provide a more homely environment than hospitals.

Senior health experts warn that the present system is 'not acceptable, nor sustainable'. The number of women going into labour every year is a fifth higher compared with a decade ago.

And higher proportions are suffering complicated labours due to rising levels of obesity and women delaying motherhood until their late 30s and 40s.

Anthony Falconer, president of the RCOG, said: 'Too many babies are born in the traditional "hospital" setting'.

He added: 'There is a perception among patients that they still see the hospital birth as the safer option. The use of some of these midwife-led units is not as great as it should be. These places are very safe and appropriate to have babies.'

Dr Falconer said: 'Roughly a third of women need a doctor, roughly a third need midwives and roughly a third might need both.'

David Richmond, vice president of the RCOG who wrote the report, said that most women could have their babies in a local birthing centre 'without a doctor going anywhere near them'.

'Do they need to be in an institution that can do MRI scans and renal transplants and brain surgery? Probably not. So we need to have this network of care where the woman is guided to the right part of the network to receive her care.'
Low tech: Most women giving birth do not need the high tech facilities offered by hospitals

Low tech: Most women giving birth do not need the hi-tech facilities offered by hospitals. (Posed by models)

Earlier this year the Royal College of Midwives warned that maternity units were 'at breaking point' due to a shortage of around 3,500 midwives.

Cathy Warwick, general secretary of the RCM warned that unless staffing levels were drastically increased women and their newborns would be put at risk.

In response to the report she said: 'It clearly supports local care for women who do not need specialist support and supports midwife-led maternity units, informed choice for women about options for childbirth, and women-centred care models. The RCM thoroughly supports and endorses all these aspects of the report.'

But campaigners warned that putting pressure on women to have their babies in local birth centres could also put them in danger. They also pointed out that as these centres don't administer epidurals – strong pain-relieving injections – women would be forced to suffer unnecessarily.

Maureen Treadwell of the Birth Trauma Association said: 'The problem with maternity care at the moment is that women can appear low risk at the start and develop horrendous problems during the birth.'

She also warned  home births could become an expensive business for the Health Service.

She said: 'If a woman wants a home birth, she will need two midwives and an ambulance – and there simply won't be enough resources for this to happen on a large scale.

Last November a damning report by senior midwives said mothers and newborn babies were being put at risk by cuts to maternity services. It found that at least one in three labour wards were being forced to axe staff as part of belt-tightening.

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