UK urges women with low-risk pregnancy to have their babies at home
NBC News - When it was time for Jennifer Kennedy to give birth, she didn't rush off to the hospital. Instead, she had her baby Dash, now 8-weeks-old, at a birthing center.
“I just wanted less intervention," Kennedy told NBC's Kelly Cobiella on TODAY. “I really was going for the more natural type of labor.”
Currently nine out of 10 babies in England and Wales are born in the hospital with a doctor attending. But that may change soon.
On Wednesday, Britain's National Institute for Health Care and Excellence issued new guidelines advising women with uncomplicated pregnancies to have their babies at home or in a birth center rather than in a hospital.
The health service says that almost half—45 percent—of babies could be born with midwives at home or in a birthing center. The rationale: the moms and babies will be safer.
“The advantage for the mother is that the further they are from an obstetric unit, the less likely they are to be operated on, to have an assisted birth, to receive drugs that they don't want or don't need,” said Mark Baker, clinical practice director of the U.K.'s National Institute for Health Care and Excellence.
Although there is a growing number of women in the U.S. who are choosing to have their babies at home or at a birth center—1.36 percent in 2012 according to the Centers for Disease Control and Prevention—the vast majority are still choosing to have their babies in a hospital.
And America's obstetricians believe that's the way it should be. The American College of Obstetricians and Gynecologists said in a 2011 statement that it still views the hospital as the safest place to deliver, but it “respects the right of a woman to make a medically informed decision about delivery.”
“We're a hospital/birthing center culture,” said NBC chief medical editor, Dr. Nancy Snyderman. “We've been taught you go to a place to have a baby. You don't have someone come in to have a baby. Will that change? Yes. But slowly.”
One major obstacle to such a change is the state of midwifery in the United States.
There's a big difference between how midwives are trained and regulated in the U.S. and Britain, said Jennie Joseph, a registered midwife in the U.K., and a certified professional midwife in the U.S.
“In Britain training is university based,” said Joseph, executive director of Commonsense Childbirth, Inc., a non-profit organization that runs a prenatal care clinic and a midwifery school. “It's a three-year degree program with clinical rotations.”
In the U.S., midwife training varies wildly. At one end of the spectrum, there are nurse midwives who are educated in colleges and universities and do clinical rotations. At the other end, there are midwives who may have only a high-school degree and little formal training.
Part of the reason for the variability in the U.S. is the differences in the way different states regulate midwives.
“In the U.K., as in most other countries, there is one nation-wide licensing system,” said Ida Darragh of the North American Registry of Midwives “In the U.S., licensure is done separately by each state so there are many variations in both the scope of practice under licensure and the actual requirements for obtaining a license.”
In fact, some U.S. states have no requirements at all.
“In some states, you can have the services of a midwife who isn't licensed and who may not even have passed a test,” Joseph said. “She can just hang her shingle and off she goes. The biggest issue of concern across this country is how to have a standard that provides for the safety of the public and for the profession.”
The training that British midwives receive is the same across the country and it matches up with the standards set by the International Confederation of Midwives. That's why a British midwife can practice in France, Joseph said.
Even in Britain, less than 3 percent of babies are born at home and some wonder whether the new guidelines are more about saving money than the health of moms and babies. But the savings aren't huge. A hospital birth in the UK costs $2,500, while a home birth, with two midwives provided by the health service costs $1,500, according to a report in the New York Times.
In contrast, reports show that giving birth is more expensive in the U.S. A study published in BMJ Open in January, University of California, San Francisco found that California women giving birth were charged from $3,296 to $37,227 for an uncomplicated vaginal delivery, depending on the hospital. For a C-section, women were billed between $8,312 and nearly $71,000.
Some experts worry about what will happen in cases where something goes wrong during the birth.
“It can be a very traumatic thing and it's something a lot of women would prefer to avoid,” said Lucy Jolin of the Birth Trauma Association, located in England.
Saturday, January 20 2018 7:36 AM EST2018-01-20 12:36:57 GMT
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