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Behind the headlines; what the Birthplace in England Research Programme and revised NICE guidelines

No-one will be surprised to find me blogging about this today - nor will they be surprised it's so late by the time I get fingers to keyboard! (The benefit of blogging at this time of night is that I've had plenty of time to ruminate on and discuss today's 'hot news'!)

There's been quite a kerfuffle today, at the news that NICE have updated their guidance to reflect that birthing supported by midwives alone, is as safe (for 2nd time and low-risk births) as birthing in a 'traditional' consultant-led labour ward . Or, as the BBC put it 'LABOUR WARDS NOT FOR STRAIGHTFORWARD BIRTHS'.

The social networks are awash with shared links to the story; Radio 4's You & Yours devoted the majority of the programme to the topic (it's worth listening to, here); my fellow Wise Hippo's were asked to give their views - personal and professional - to local media outlets. For those of us who work with women to optimise their chances of having a 'Good Birth' this IS exciting news. At last! 'The Establishment' recognising what we've been saying for a while; birth is a normal event; women can birth their babies.

All gratifying stuff - and a great step on the journey to de-mystifying, normalising and even celebrating birth - but what does it mean to you, if you're currently pregnant and wondering where the best place to give birth is? Here are my Top Three Things To Take from today's news;

One size doesn't fit all

We teach this as part of The Wise Hippo Birthing Programme, but it bears stating again and again and again. You are a unique individual in birth, as in all other things. Your pregnancy will not be the same as any other woman's pregnancy. Your baby won't be the same. The things that are important to you about where and how you birth will be unique to you. Home birth is right for some women, because it's where they feel most comfortable. Others prefer the idea of 'Alongside Midwifery Units' (AMU's). And there will always be some women who prefer to birth under the supervision of a consultant-led unit. That's fine. As Cathy Warwick (Director of the Royal College of Midwives) said during today's You & Yours "How the woman feels about her birth & letting her make her own informed choice is very important."

Be prepared - it matters

How many times have you heard this old chestnut; 'there's no point in doing birth preparation - it all goes out of the window the second you go into labour anyway'? I've heard it many times, but it just isn't true. Preparing for birth gives mothers-to-be and birth partners the information & time they need to really consider what their birth preferences are. It also flags up all sorts of things - practical & emotional - that simply don't crop up in every day conversation. Being well-prepared for birth is one of the consistent associating factors of women reporting a 'Good Birth' experience (see Anne Lyerly Drapkin's Good Birth Project) - and as Cathy Warwick said in today's You & Yours "Safety in childbirth is very closely associated with good planning, working our what women really need & particularly good communication between midwives and obstetricians"

Understand the real implications of birth environment

It really isn't as simple as 'my baby is precious and I want to be near medical equipment in case there's a problem'. Births in consultant-led units are statistically more likely to be subject to intervention (more on which later). Andrew Whitelaw, Professor of Neo-Natal Medicine at the University of Bristol, urges 1st time mothers to be cautious of homebirth, but even he (with over 40 yrs experience working with the poorliest of baby's) notes that births requiring resuscitation are rare, and that 'there's a lot of evidence that some of the interventions in obstetrics have caused more problems than they've solved'. Cathy Warwick highlighted a salient point too - the point of the research is to say that you can run into as many problems in hospital as you can at home.

So there you have it. There isn't a definitive answer. It's all about your personal choices, made with a good understanding of yourself, your birth partner, the nature and process of birth, the availability and quality of the services around you, and your own particular requirements. Simples!

If you want to see the information straight from the horses mouth, here's what you need to know;

NICE amended their guidelines based on findings from the 'Birthplace in England Research Programme'. The programme is affiliated with the National Perinatal Epidemiology Unit, part of the University of Oxford


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