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For generations, both British and American mothers have assumed that the safest way to give birth is to spend many hours, if not days, in a hospital bed under the supervision of an obstetrician. Now, new guidelines are challenging these deeply held beliefs.
After completing an evidence-based review, the United Kingdom's National Institute for Health and Care Excellence (NICE) concluded that healthy women with straightforward pregnancies are safer giving birth at home or in a midwife-led unit than in a hospital under the supervision of an obstetrician.1 Across the pond, eyebrows went up. The New York Times editorial board (and others) wondered, “Are midwives safer than doctors?”2 How can homes be safer than hospitals? And what implications will the British guidelines have for the United States?
Currently, 9 out of 10 babies born in the United Kingdom are delivered in physician-led hospital maternity units (in the United States, the rate is closer to 99 out of 100).1,3 NICE does not dictate a clinician type or birth setting and makes it clear that women should have freedom to make choices consistent with their needs and preferences. Yet Britain's National Health Service believes that when the new guidelines are implemented, these preferences may change. Thousands more British women per year are expected to avoid hospitals willingly — at least in part out of concern for their own safety and with the expectation that their babies will be no worse off.
The safety argument against physician-led hospital birth is simple and compelling: obstetricians, who are trained to use scalpels and are surrounded by operating rooms, are much more likely than midwives to pick up those scalpels and use them (see table).4 For women giving birth, the many interventions that have become commonplace during childbirth are unpleasant and may lead to complications, including hospital-acquired infections....