In December 2014 the National Institute for Health and Care Excellence unveiled guidance stating that healthy women with uncomplicated pregnancies should be encouraged to consider giving birth at home or in a midwife-led unit. Media outrage: on the one hand, columnists saying that giving birth at home was the best thing they ever did, on the other, those claiming that if they had had their baby at home they or the baby would have died.

As the dust settles, it is time to ask: what does the guidance really mean?

Nice deals in hard evidence, so the facts are that healthy women planning a birth outside an obstetric unit is just as safe and has specific benefits. First-time mums are recommended to consider midwife-led units, either in or away from hospital premises, and those who have had a baby before are encouraged to plan a home birth.

‘Choice’ has been a mainstay of maternity policy since Julia Cumberlege’s groundbreaking ‘Changing Childbirth’ document in 1993, while the recommendation of a home setting chimes with much said by the Labour health team, including Andy Burnham’s intriguing pledge to Labour party conference that under such a government there will be a ‘new right to a home birth’.

To many it is counterintuitive that a birth at home is safe. However, in overstretched hospital labour wards the risk that, for example, there is delay in getting medical help to a complicated birth can be just as real as if the woman in labour is at home. In fact, both options are very safe and it is rare that dangerous delays occur.

Looking at overall quality of care, the home setting has a lot to offer. First, the midwife arrives and stays: she will be a professional who the family has got to know, so there is an existing relationship. This can profoundly affect the birth process. Trust is established, communication is easy, the midwife’s constant presence and observation of the labour means any deviation from normal progress is spotted early and timely action can be taken – a calm and organised transfer to hospital if need be.

If all goes to plan, the birthing woman gains many benefits, boosting both the safety and satisfaction of her experience. She does not have to travel in labour or, a few hours later, with a newborn baby; she moves around with freedom and privacy, in any room or in the garden.; if she has hired a birthpool, no one else can jump the queue to use it; she eats or drinks what she pleases; she chooses any available birth companion; and her bedroom, bathroom and toilet are clean. After the birth she will be tucked up in her own bed with partner and baby, and undisturbed by the cries of other babies.

If hospitals could provide all this for healthy women, there might be a good rationale for hospital-based births. But they cannot and, indeed, why should they? It would be better if most of the aspects of care above were available to women at higher risk of complications, who are recommended to be in hospital.

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Elizabeth Duff is senior policy adviser at the National Childbirth Trust

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Photo: Tatiana Vdb