Is It Safe To Convert Local Maternity Units To Midwife Led Services?

Editor's Choice
Main Category: Pregnancy / Obstetrics
Also Included In: Nursing / Midwifery;  Women's Health / Gynecology
Article Date: 28 Sep 2007 - 0:00 PST

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In a move the UK government says aims to offer women more choice, local maternity units are being converted to services run by midwives. How safe they are is discussed in the British Medical Journal (BMJ), this week's issue. Two experts debate the topic - one in favor, and one against.

Yes
Lesley Page, visiting professor in midwifery at King's College London

Page writes that moving all births to hospital was one of the largest uncontrolled medical and social experiments of the last century. During the period 1954-1980s, the percentage of mothers who gave birth at home dropped from 35% to 1%. Hospital births were seen as safer and a way of reducing inequalities of care. However, this belief has never been evaluated or proved.

One of the consequences of moving births from homes to hospitals was dehumanization, especially in the large hospitals. It became harder to offer personal care suitable to individual needs.

Page argues that birth centers, apart from providing another alternative for women, also offer clinical environments where the midwife can fully utilize her skills and provide support for normal birth, avoiding unnecessary intervention.

The author says it is neither advisable nor sustainable to have a one-size-fits-all approach. For women to receive the appropriate attention with the appropriate professional, a network of services is needed.

The focus of consultant obstetricians should be on the care of women with complicated pregnancies. Page concludes that safe maternity services are those that acknowledge and respond to the effects of inequalities and ethnicity, understand the risk of unnecessary interventions, and support all professionals to their full part in care.

No
James Drife, professor of obstetrics and gynecology, University of Leeds, UK

Drife is concerned about the hazards of delivering outside hospital. He argues that the NHS, which runs nearly all childbirth in the UK, is promoting midwife units as a way of offering choice. The NHS is advising women that these units are safe for low risk pregnancies. However, according to Drife, this advice is not based on evidence.

He argues that maternal complications have not gone down over the years - they are just as likely to happen today as several decades ago. We know that what does save lives throughout the UK every day is prompt treatment. The UK has low maternal mortality because emergency services are managed effectively.

There is no evidence to show that midwife led units are safe. Drife points to two reviews which indicate that they may lead towards more perinatal death, and although not statistically significant, they should concern people who wish to modify patterns of care. Even in hospitals which have both a consultant unit and midwife led unit in the same building, the evidence is not entirely encouraging.

He finds it disconcerting that midwife led units are being promoted when their safety has not been proven - especially in an era of evidence based medicine. Even though a relaxed environment and non-intervention are attractive, Drife points out that for most women, the safety of their baby is their most important concern.

A year ago the National Perinatal Epidemiology Unit started an assessment of alternative locations for labor and birth. Rather than be driven by political expedience, further changes should only take place after reliable evidence on safety is demonstrated.

Head to Head: Do we have enough evidence to judge whether midwife led maternity units safe?
BMJ Volume 335 pp 642-3
http://www.bmj.com

Written by: Christian Nordqvist
Copyright: Medical News Today
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