Place of birthBMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7185.721 (Published 13 March 1999) Cite this as: BMJ 1999;318:721
- Luke Zander,
- Geoffrey Chamberlain
The management of childbirth is continuously evolving, reflecting changes in clinical, psychological, and social factors. In the past 50 years there have been dramatic falls in perinatal and maternal mortality, a steady increase in the amount of technological intervention in the management of labour, and a change in the roles of members of the maternity care team.
Over the past 60 years the proportion of births at home has fallen markedly from 80% in 1930 to 1% in 1990, but in the past eight years the proportion has begun to rise again. Some studies suggest that 10–14% of women would choose this option if given the opportunity. A similar trend has been seen in all Western countries except the Netherlands, where, in 1995, 32% of births still occurred in the home.
When considering how a birth is to be conducted, attention must be given to both risks and benefits. The debate over the place of birth raises many fundamental questions about the general management of labour, patients‘ satisfaction, and women's rights to choose their form of care. Much professional and lay discussion has taken place on many aspects of pregnancy care, brought into focus by the Department of Health's 1993 report Changing Childbirth, which indicated the way the maternity services may develop. Safety is the foundation of good maternity care but this must take into account the emotional as well as the physical wellbeing of mother and baby.
The home is the place for the practice of midwifery, not obstetrics, and the principal provider of care will be the midwife. The home is therefore appropriate for mothers with …