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Birth fears over midwife-led units

Pregnant women are being urged to give birth in midwife units despite there being little evidence that they are safer, an expert has said.

James Drife, professor of obstetrics and gynaecology at the University of Leeds, said studies suggest there is a slightly higher risk of a baby dying in midwifery care than in standard care.

In an article published in the British Medical Journal (BMJ), Prof Drife said changes are being made in maternity services "for political, economic, and clinical reasons".

He added: "Much has already happened. Antenatal care is provided mainly by midwives outside hospital, with general practitioners playing little or no part and obstetricians seeing only high-risk cases."

He said the NHS is promoting midwife-led units as a way of offering choice, amid claims that they are safer for low-risk pregnancies.

But he added: "This advice is not based on evidence."

Prof Drife also said studies indicate there may be higher perinatal mortality in "home-like settings", although the findings are not statistically significant.

"Nevertheless, they should worry those who want to change patterns of care," he added.

His comments come after Professor Sabaratnam Arulkumaran, the new president of the Royal College of Obstetricians and Gynaecologists, accused hospitals of putting babies at risk by not employing enough senior staff on labour wards.

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Related story: New NICE childbirth guidelines issued

Your comments: (Terms and conditions apply)

"The current trend to try and close local district general hospitals and relocate to larger regional centres will cause a grater problem than allowing midwives to carry out the role they have been trained to do. How many women will not manage to get to their regional centre and deliver en route without medical/midwifery attention. Larger units run on a staff shoe string where midwives are expected to "care" for a number of labouring women are not giving good safe care. Prof Drife says the advice is not evidence based but surely that is because the units do not yet exist or are very limited in number. We do know however that women who elect to have home delivery and are considered low risk do very well providing the midwife is experienced and refers into hospital as soon as a problem is detected. I believe that experienced midwifes giving good quality care in well staffed midwifery led units to low risk women will improve birth experiences for a large number of women." - C Smith, RGN RM, Nurse Practitioner