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Do we have enough evidence to judge midwife led maternity units safe? No

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39343.461146.AD (Published 27 September 2007) Cite this as: BMJ 2007;335:643
  1. James Drife, professor of obstetrics and gynaecology,
  1. University of Leeds, Leeds LS2 9NS
  1. j.o.drife{at}leeds.ac.uk

    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

    Major changes are being made in the UK's maternity services for political, economic, and clinical reasons. 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. Maternity hospitals are being merged because of pressure to increase consultant presence in labour wards and reduce junior doctors' hours. Large units seem more efficient and can offer more back-up when complications occur. Closing small hospitals is unpopular, however, and a politically attractive alternative is to convert consultant units to free standing midwife led maternity units. The NHS, which has a near monopoly of childbirth, is promoting midwife units as a way of offering choice1 and is advising women that they are safe for low risk pregnancies. This advice is not based on evidence.

    Problem of defining risk

    Everyone knows that safety can never be absolute. Nevertheless, hospital delivery has become …

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