Pregnant women deemed at low risk should be allowed to choose home birth, according to official guidance published today – and disputed by obstetricians.
The guidance from the National Institute for Health and Care Excellence says low risk women should have a "full choice" of birth settings, including home, hospital or free-standing midwife units.
But the Royal College of Obstetricians and Gynaecologists said there was an "increased risk" for first-time mothers who opt for home birth and called for safety to be the priority.
The proposal is set out in a new set of quality standards from NICE.
The standards do not give a definition of a low risk patient but say that most women have a "straightforward" pregnancy and birth, stating that 40% of those giving birth are first time mothers.
However one of the developers agreed that home birth was only suitable for a second or subsequent child.
The standards say that low risk women should also be "spared" unnecessary medical procedures, including cardiotocography and the use of medicine to speed up labour.
They also call for one midwife for each woman in labour and for women to have skin contact with their baby as soon as possible after birth.
And they say the baby’s umbilical cord should be left for one minute before clamping and cutting.
But the guidance failed to gain support from the Royal College of Obstetricians and Gynaecologists.
Professor Alan Cameron, from the RCOG, said: “Putting patients at the centre of care is paramount. However, safety should always be the principal focus when making decisions around maternity care and childbirth.
“The RCOG has always supported appropriately selected out of hospital birth. However, evidence has shown that first-time mothers wishing to deliver at home have an increased risk of poor outcomes for their babies and have significant transfer rates to hospital, often for pain relief.
"We have encouraged first time mothers to deliver in a hospital setting and, if of low risk, in an adjacent midwifery unit.
“Childbirth is unpredictable and can quickly require emergency care, therefore timely access to an obstetric unit is vital."
He added: "Whilst we do not support unnecessary medical intervention, it is important to remember that some interventions are life-saving for both a mother and baby."
He said recent inquiries into maternal and perinatal mortality had emphasised the need for safety to be the principal focus of care.
Professor Gillian Leng, from NICE, said: "The quality standard includes statements for obstetricians and midwives on what care is most important, from initial checks to appropriate procedures. It also highlights the support which should be provided to women to help them make informed choices and make sure they cope well immediately after a birth.
“What we want is to support maternity services across the country to provide consistent, safe and high quality care for women and babies throughout their labour.”
Midwife Tracey Cooper, who helped develop the guidance, said: “For women who are not expected to have complications, we know that giving birth in freestanding or alongside midwife-led units is safer than hospital and that home birth is equally as safe as a freestanding or alongside midwife-led unit for the babies of low risk pregnant women who have already had at least one child previously.
"Women should have the ultimate choice and this quality standard highlights the importance for women to have the right information about their local services to help them make that choice."
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