Outcomes for births booked under an independent midwife in the UK

Readers of this blog may be interested in a new paper from the BMJ:
Outcomes for births booked under an independent midwife and births in NHS maternity units: matched comparison study

Authors: Andrew Symon, Clare Winter, Melanie Inkster, Peter T Donnan

To access the full paper and citation, click here.

Excerpt
<<Conclusions: Healthcare policy tries to direct patient choice towards clinically appropriate and practicable options; nevertheless, pregnant women are free to make decisions about birth preferences, including place of delivery and staff in attendance. While clinical outcomes across a range of variables were significantly better for women accessing an independent midwife, the significantly higher perinatal mortality rates for high risk cases in this group indicate an urgent need for a review of these cases. The significantly higher prematurity and admission rates to intensive care in the NHS cohort also indicate an urgent need for review.>>


Comment by Joy Johnston:
This paper adds to the significant body of literature supporting homebirth as a safe and reasonable option for well women who are assessed to be at low risk of complications. It also identifies a higher rate of death of babies born at home to mothers in higher risk categories, when compared with births in hospital.

In general the *low risk* woman is in good health; her pregnancy continues without medical complication to Term; she has one fetus who is lying longitudinally and whose presentation is cephalic; she comes into spontaneous labour and progresses to giving birth unassisted to a live healthy baby, without requiring uterine stimulants or pain relieving agents.

Many independent midwives in both UK and Australia would agree to attend a woman who would not meet hospital risk management criteria for low risk. While in the UK the principle of informed choice is a key aspect of government policy for maternity care, Autralian women are increasingly finding that they have little choice. For example, women who have had one or more caesarean births, and who want to plan a vaginal birth, often experience strong pressure to the point of bullying by midwives and doctors who attempt to enforce compliance with the plan of management considered 'best' by the maternity service providers.

Health is not black and white - there's always the possibility of shades of grey.

Independent midwives in Australia, and women who want homebirth, face enormous challenges as the changes to legislation regulating midwifery practice are implemented next year from 1 July. The women in 'grey' zones of risk - women who have had caesareans, or the grand multis - those who have given birth to six or more children, or the older or very young women, or those whose pregnancies are continuing beyond 41 weeks - these are the women for whom the independent midwife provides an invaluable personally refined service, whether they choose to give birth in hospital or at home. These are the women for whom the promotion of normal birth, working in partnership with a trusted and skilled midwife, becomes the key to protecting good outcomes. These are the women who will be most affected by the banning of independent midwives from professional practice.