Midwife-led care during labour for women with a low-risk pregnancy should be safe, according to guidelines published today.
Currently 90% of babies born in England and Wales are delivered in hospital under the ultimate supervision of obstetricians.
The National Institute for Health and Care Excellence (NICE) said it was in favour of greater freedom for women to choose where they give birth.
The updated evidence concludes that midwife-led care is at least as safe as being in hospital, when the mother is at low risk. Home birth also appears to be as safe as midwife-led units and traditional labour wards for low-risk women having their second or subsequent baby.
If this advice is implemented, thousands more of the 700,000 babies born each year in England and Wales could potentially be born in a midwife-led unit or at home.
"Where and how a woman gives birth to her baby can be hugely important to her," says Professor Mark Baker of NICE. "There is no reason why women at low risk of complications during labour should not have their baby in an environment in which they feel most comfortable."
Professor Susan Bewley, professor of complex obstetrics at King’s College London, UK, led the group compiling the recommendations and said women will not be disadvantaged without an obstetrician.
She said: "Midwives are highly capable professionals and can provide amazing one-to-one care to pregnant women in labour, whether that’s in a woman’s own home, a midwife-led unit or a traditional labour ward. What’s important is that women and their families are given the most up-to-date information."
But Cathy Warwick, chief executive of the Royal College of Midwives, claimed the advice is not fully up to date.
"Recent and important evidence on team midwifery and continuity of care has not been included," she states.
The Royal College of Obstetricians and Gynaecologists welcomed the guidelines.
Vice-president Professor Alan Cameron said: "The RCOG acknowledges the findings that selected home birth could be considered for low-risk women who have previously had a child. However, the revised guideline outlines that for first-time mothers planning to have a home birth, there is an increased risk of poor outcomes for the baby.
“The guidelines also give clear advice on cord clamping and timing. RCOG guidelines state that the cord should not be clamped earlier than is necessary, based on a clinical assessment of the situation. Delayed cord clamping may benefit the neonate in reducing anaemia, and particularly the preterm neonate by allowing time for transfusion of placental blood to the new-born infant.
"The RCOG recognises that some aspects of care were considered outside the initial scope of the guideline revision, particularly with regard to perineal protection and techniques used in operative delivery to reduce the morbidity of 3rd and 4th degree tears. We look forward to contributing to the evidence base in any future revision."
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