Hospital births have never been safest – Nice is right to reverse this myth

‘Women with low-risk pregnancies are to be encouraged to have high-tech, intervention-heavy deliveries which will lead to a rise in the number of caesarean and forceps births and postnatal complications.”

That sentence has never featured in a British newspaper. It is, however, exactly what took place in this country from the 1960s onwards. In 1970, cementing the trend, the Peel report recommended that all births should take place in hospital.

But there never was any evidence that hospital birth was safer: it was just a massive assumption, driven by white-coated doctors riding on a tide of obstetric advances. What had happened, over the previous decades, was that infant and maternal mortality had declined – in part due to better medical procedures, but just as much the result of better nutrition and the fact that women were having fewer children.

What was much more visible was the rapid expansion in the obstetric investigations and treatments available: foetal monitoring during labour, ultrasound scanning, epidural anaesthetics. And some doctors revelled in their status as the men (and they usually were men) who could preside God-like over mother and baby-saving interventions.

What we collectively forgot, in that heady period of change and drugs and treatments (and I write as a mother whose life, and whose baby’s life, was once saved by them, so I’m certainly not knocking it) was that childbirth is not merely a physical experience, but rather an extremely complex balance of the physical, the psychological and the emotional; an event where the sensitive hormone system, which is at particularly affected by stress, is absolutely crucial.

Treating all women, even the low-risk, as though they were a hair’s breadth from disaster raised stress levels among women in labour exponentially. Suddenly women who had shown no signs of problems were being given drugs to induce their labours, were being hooked up to machines that restricted their movement during labour (and movement is extremely helpful in a normal labour) and were being plied with painkillers which had a knock-on effect on the straightforward progress of the birth. The result, we now know, was that the number of “complicated’’ deliveries – caesareans, forceps, ventouse – rose dramatically, and many mothers who could have had a straightforward births ended up having a dramatic, emergency intervention to get their now-distressed unborn child safely delivered. At the point of birth, it was rarely ‘wrong’ that the baby was born surgically; but if the mother had been encouraged to labour in a lower-stress environment, the chances were that she would have given birth without the need for any of it (and again, as someone who has given birth both by caesarean and with no intervention whatsoever, I cannot believe there are many women out there who would choose the former, if they knew the latter was achievable, and just as safe).

The Nice guidelines published on Wednesday effectively reverse a generation of misconception about birth. They underline the truth, which is that there are risks to any birth, wherever it takes place, but that the risks of needing unnecessary intervention are increased in a highly-medical setting, and that the majority of women do best at home or in a home-from-home environment, where stress levels stay down and the natural process of birth functions best.