BMJ  2007;335:642 (29 September), doi:10.1136/bmj.39343.471227.AD

Feature

Head to head

Is there enough evidence to judge midwife led units safe? Yes

Florence Nightingale School of Nursing and Midwifery, King's College London, London SE1 9NH

The UK government claims it is trying to give women more choice by converting local maternity units to midwife led services. Lesley Page believes such units improve the birth experience, but Jim Drife remains worried about the risks of delivering outside hospital

The first 150 words of the full text of this article appear below.

The view that birth outside hospital is less safe than hospital birth prevails despite evidence to the contrary. Discussion about maternity services often becomes polarised around the comparative safety of different places of birth, and argument over a single measure of safety, perinatal mortality. The dominance of the medical view of birth has led to an exponential rise in medical and surgical interventions in childbirth in most of the economically developed world and parts of the developing world. The risk of unnecessary intervention, for mother, baby, and future generations is ignored.

One consequence is the steady and continuing rise in the rate of caesarean sections.¹ In the developed world (including Europe, North America, Japan, Australia, and New Zealand) the proportion of caesarean births is 21.1% (range 6.2% to 36%).² Yet, as Bertran and colleagues concluded: "higher caesarean section rates do not confer additional health gain."² Caesarean section is associated with . . . [Full text of this article]

Reducing interventions

Uncontrolled social experiment

Resolving problems of modern maternity services

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