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Women should choose where to give birth after discussing the risks and benefits with their midwife or doctor, recommends draft guidance from the National Institute for Health and Clinical Excellence (NICE).
The latest version of draft guidance on care during labour being developed by NICE, which advises on treatments in the NHS, says that women should be offered the choice of planning to give birth at home, in units run by midwives (birthing centres or birth units), or in hospital wards run by consultant doctors.
Women should choose where they give birth, after being given the opportunity to discuss the risks and benefits of all settings with their midwife or doctor. They should be reassured that perinatal mortality during delivery is low in all settings, although the quality of information comparing the potential risks and benefits of each birth setting is variable.
The draft guidance sets out the information that women should be given when making their choice of where to give birth. This includes research showing that women who plan birth at home are more likely to have spontaneous vaginal birth, less likely to require caesarean section, and more likely to retain an intact perineum than those planning birth in an obstetric unit. Women giving birth in midwifery units have higher rates of spontaneous vaginal birth and intact perineum.
Women should be told that when unanticipated obstetric complications arise, either in the mother or baby, the outcome of serious complications is likely to be less favourable in women who labour at home than when the same complications arise in an obstetric unit.
The draft guidance recommends that NHS organisations should have clear local protocols and monitoring mechanisms to make giving birth as safe as possible regardless of the setting. These include pathways and guidelines on the indications for, and the process of transfer to, an obstetric unit for women who labour outside obstetric units. There should be no barriers to rapid transfer when required in an emergency.
The panel of experts and lay representatives developing the guidance found an important gap in the evidence available on place of birth and called for more research and monitoring at a national level to inform healthcare professionals' understanding of the risks and benefits of different settings.
They recommended establishing a national surveillance scheme comparing safety and cost effectiveness of all places of birth. National registries should be established to analyse the root cause of all intrapartum related deaths over 37 weeks of gestation. Further studies should compare outcomes for different places of birth, including qualitative data on women's experiences.
The latest recommendations follow consultation on a first version circulated in June 2006. A large number of comments from stakeholders led to changes in the section on places to give birth.
Andrea Sutcliffe, deputy chief executive at NICE, said: “The sheer volume of feedback and range of opinions we received on the first draft of this guideline shows how vital it is that we get the recommendations on places of birth right. It is essential we provide midwives and doctors with guidance so they can support women when choosing where to give birth.”
The new draft recommendations on place of birth are available for consultation by stakeholders until 3 May 2007. Comments will be reviewed before the final guidance is issued later this year.
The updated draft recommendations are available at www.nice.org.uk/PlaceOfBirthConsultation.