Midwifery units versus hospital care
The National Institute for Clinical Excellence (NICE) has published updated guidance advising that for pregnant women who are classified as low-risk and are likely to have a straightforward birth, midwife-led care is safer than hospital care.
This is based on statistical evidence showing that the likelihood of having an intervention such as the use of forceps, an epidural or a caesarean section increases in a hospital setting and yet, in either case the outcome for the baby is no different.
The guidance states that whilst women should be offered the choice of mid-wife led care or a hospital setting, they should be advised of these statistics when making that decision. Therefore, whilst the choice of setting remains with the pregnant woman, it is inevitable that many women will be swayed by these statistics towards midwifery-led care.
Midwifery led care can be provided in a free-standing unit away from a hospital with an obstetric unit or alongside a hospital with such a unit.
A potential problem with free-standing midwifery units is the time it takes to transfer a woman in labour to an obstetric unit should the expected straightforward birth prove to be more complicated.
Whilst the guideline states that all women giving birth should have timely access to an obstetric unit should they need to be transferred to hospital, no guidance is given on what is “timely access” or what information should be given to women about this when making a decision.
In our experience, women making these decisions need to know not only the statistics on interventions and outcomes but also, if complications occurred, how quickly would they need to get to an obstetric unit and, allowing for variations in traffic, what is the maximum time it could take to get to that unit.