MORE mums-to-be should opt for home births when deciding where to have their baby, according to the health watchdog.
NICE, the National Institute for Health and Care Excellence, would like to see more women give birth with only midwives present, away from labour wards where doctors are in charge.
Midwives should advise mothers-to-be who already have at least one child and whose latest pregnancy appears to be low risk to opt for a home birth or midwife led unit (MLU) when deciding where to have their baby, they urge.
The 40% of women giving birth, who are first-time mothers, should also be advised to choose either location, NICE is recommending in draft guidelines to the NHS in England and Wales released yesterday.
Both groups of women should select either location "because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit", NICE says.
If the NHS follows the new advice, it could lead to a huge shift in where women choose to give birth, with thousands more women choosing to give birth at home. Currently just 2% of the 800,000 births a year in the UK take place at home.
One in four hospital births ends in a caesarean-section delivery and a further one in eight involves the use of either forceps or ventouse.
NICE said it had revised its advice on place of birth, which had been in force since 2007, in the light of fresh evidence about the safety of delivery at home and MLU' s. The only stipulation it included, was that midwives should tell first-time mothers that "if they plan to birth at home there is a small increase in the risk of an adverse outcome for the baby".
The Royal College of Midwives (RCM) and the National Childbirth Trust (NCT),both welcomed the proposals. However, maternity doctors voiced some concerns.
The Royal College of Obstetricians and Gynaecologists (RCOG), which represents the 10,000 maternity doctors inthe UK, said it did not object to more women with low-risk pregnancies having a home birth. But it warned that transport had to be available to take such women to hospital at short notice if they developed complications or needed pain relief.
The RCOG urged women at risk of complications to avoid freestanding birthing centres, which are not located at hospitals, and use MLU units instead, where those whose labour becomes problematic can get almost immediate help from doctors. It added that assessments as to which pregnancies are low-risk are not always accurate.
Professor Cathy Warwick, the RCM's chief executive, said: "The evidence shows that for low-risk women, giving birth in a midwife-led unit or at home is safe; indeed may be safer than hospital." Women who birthed there usually had higher satisfaction rates and a better birth experience than in hospitals, she added.
NICE said local NHS organisations should ensure that women in their area could choose between all locations to give birth. She urged for more investment in home births and midwife-led care.
NCT chief executive Belinda Phipps said NICE's guidelines "are evidence-based and confirm what we have been saying for decades – that birth in a midwife-led unit or at home is a safe choice, especially for those expecting a second or later baby." But more midwives were needed to turn NICE's proposals into reality, she added.
