A recent recommendation from doctors in the United Kingdom raised eyebrows in the United States: The British National Health Service says healthy women with straightforward pregnancies are better off staying out of the hospital to deliver their babies.
That’s heresy, obstetrician Dr. Neel Shah first thought. In the United States, 99 percent of babies are born in hospitals.
“There’s really only one way of having a baby in the U.S.,” says Shah, who works at Harvard Medical School and Beth Israel Deaconess Hospital. Here, he says, delivering at home or at independent birthing centers is still not considered mainstream.
Shah was asked by the New England Journal of Medicine to respond to the British recommendation. He compared birth outcomes here in the U.S. and Britain, especially the cesarean rates, which average 33 percent in the U.S. compared with 26 percent in the U.K. And he started to think the British were on to something.
“We’re taking excellent care of high-risk women,” he says, “and leaving low-risk, normal women behind. We’re the only country on Earth with a rising maternal mortality rate.”
There are lots of reasons for the rise — increased obesity, a lack of consistent prenatal care, older women having babies. Shah also blames hospital infections, and the rise in emergency and elective C-section deliveries.
Rather than rebut the British, Shah argues in his New England Journal editorial that the practice of giving birth outside a hospital with a midwife can be safer.
“Choose the right patients,” he says. “And you need to be able to link those birth centers to hospitals, like mine, that have blood banks and three operating suites and everything else.”
The American College of Obstetricians and Gynecologists has been supportive of midwife-led births. But it draws the line at home birth.
“I don’t recommend home birth, and as an organization ACOG suggests that a hospital or birth center is the safest option,” says Dr. Jeffrey Ecker, an obstetrician at Massachusetts General Hospital and chairman of ACOG’s committee on obstetrics practice.
Women and babies are in real danger, Ecker says, if something goes wrong during a home birth. Compared with births planned for delivery in a hospital or birthing center, planned home births have a significantly higher rate of infant mortality in the U.S., studies show, though the absolute risk of the baby dying is relatively low in both cases.
Also, Ecker says, the British and American health systems are simply too different for the British recommendation to make sense for the United States. To read more from Dianna Douglas, click here.