The Case for Expanding Access to Midwives and Out of Hospital Birth

out-of-hospital birth

Britain’s National Institute for Health and Care Excellence (NICE), an independent organization that advises the National Health Service, presented new guidelines in 2015 recommending that all women with low-risk pregnancies be presented with the options of midwifery care and out of hospital birth, such as birth centers. We already know from the landmark Listening to Mothers surveys, expecting women prefer to have an array of alternatives when it comes to their care; however, the NICE recommendations go beyond the argument of “choice is good.” The evidence-based report states that midwifery-led care is best for healthy pregnancies due to the achievement of equal health outcomes with lower intervention rates, when compared to physician-led care.

In the UK, under universal healthcare coverage, there is no financial incentive for providers to attend births in a particular setting; therefore, the UK’s Royal College of Obstetricians and Gynecologists is supportive of the idea of offering a variety of birth site options (i.e. home, birth center, or hospital). Also, in the UK, midwives tend to care for most low-risk pregnancies. Conversely, in the US, OBs care for most pregnancies, and may fear losing patients and income to small birthing centers if the same guidelines were adopted in the states.

Yet the truth is evident in the data. Maternal and infant health outcomes in the United States are not as positive as they should be, despite high medical intervention rates and relatively good access to care. Why? High intervention often leads to surgery (Cesarean section), which leads to infection and risk. In the US, 1 woman out of 3 ends up with a Cesarean section and is vulnerable to the associated risks of infection, blood clots, bleeding, and more. Midwives approach labor and birth with a more “high touch” philosophy, in which intervention is not considered unless medically necessary.

Midwives Bring Love into the Room

For these reasons, the American College of Nurse-Midwives is eager to uphold the recommendations of the UK report. Below is a portion of the ACNM summary of the NICE guidelines that are related to birth setting options:

Expanded Access to Midwife-Led Care and Out of Hospital Birth

  • Maternity care providers should explain to all women that they may choose any birth setting and support them in their choice. Women should have access to information about all birth settings, including local statistics.
  • Maternity care providers should advise all women at low risk for complications that midwife-led birth centers are particularly suitable for them (lower risk of interventions, outcome for baby no different than hospital).
  • Midwife-led birth centers and home birth are particularly suitable for multiparous women (women who have given birth at least once). Home birth has a small increased risk of adverse outcome for the babies of nulliparous women (women who have never given birth before).
  • When discussing a woman’s choice of place of birth, her maternity care providers should not disclose personal views or judgments about her choices.
  • Women should be assured access to all birth settings in all geographic areas, and timely access to transfer of care, if needed.

Until these recommendations for full disclosure of options become part of the US medical culture, expecting women will need to seek out information on their own. If you are pregnant, find out about the most recommended providers and birth centers in your community through word of mouth and online chats. Take a tour of each site and ask for intervention rates (at Baby+Company we offer frequent tours and orientations of our birthing centers where prospective clients can meet with a midwife and discuss our midwife-led birth center model of care). If you don’t live within reach of a Baby+Company birth center, attend “meet the provider” meetings and find the right fit given the choices in your area. Every bit of research counts, because you and your baby deserve the best care during one of the most important experiences of your life.

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