December 5, 2014 — Britain's National Health Service on Wednesday recommended that giving birth at home with a trained attendant or in a birthing center is safer than in a hospital for healthy women, the New York Times reports.
The recommendation is based on a guidance from Britain's National Institute for Health and Care Excellence, known as NICE, and applies to women with low-risk pregnancies, which includes 45% of pregnant women. According to NICE, these women have better outcomes when they give birth at home with a midwife than in a conventional maternity ward because hospital births have an increased likelihood of surgical intervention, which in turn increases the risk of infection.
Under the guidance, women with low-risk pregnancies facing their first deliveries will be advised that a birth attended by a midwife is particularly appropriate for them, according to Mark Baker, clinical practice director for NICE. Women who have given birth before will be told home birth would be safer for them than a hospital birth and that both settings are equally safe for the infant. Women are still able to choose freely which birthing option they prefer, he said.
Previously, NICE advised that women should be "cautious" about giving birth at home because of inconclusive research on its risks.
The new recommendations follow a 2011 government-funded Oxford University study that found that the risk of fatality or serious complications is the same for infants delivered in hospitals, birthing centers and at home. The only exception was among infants born to first-time mothers, for whom there was a slightly higher serious-complication rate in the home setting.
For women, the study found that those giving birth in hospitals had higher rates of cesarean sections, episiotomies and epidurals, which raised the chance of a prolonged labor involving the use of forceps and damage to the perineum.
Differences From U.S. System
The Times notes that most developed countries, including the U.S., do not have high rates of women who give birth in non-hospital settings. Jeffrey Ecker, chair of the committee on obstetrics practice for the American College of Obstetricians and Gynecologists, said he does not expect the U.S. to adopt similar guidelines.
He noted that the British integrated health system gives the nation "a process and protocol for ... getting [a patient] somewhere else." ACOG's position is "that hospitals and birthing centers are the safest places for birth, safer than home," for U.S. women, Ecker said.
Separately, Baker noted that the U.S. and British health care systems have different financial structures. "There are no financial incentives in the U.K. for doctors to deliver in a particular setting because there is no personal gain," he said, adding that childbirth is "effectively an N.H.S. monopoly."
However, more home births, which cost about $1,500 per delivery, could cost the NHS system less overall than hospital births, which cost about $2,500 per delivery (Bennhold/Saint Louis, New York Times, 12/3).