Intended for healthcare professionals

Letters Midwife led delivery

NICE guidance on place of birth falls short of neutrality

BMJ 2014; 349 doi: (Published 31 December 2014) Cite this as: BMJ 2014;349:g7776
  1. Anna Lawin O’Brien, subspecialty trainee in maternal and fetal medicine1,
  2. Manju Chandiramani, subspecialty trainee in maternal and fetal medicine1,
  3. Christoph C Lees, head of department of fetal medicine1
  4. on behalf of Tg Teoh, Tom Bourne, Bryony Jones, Catriona Stalder, Pran Pandya, Shyamaly Sur, Hanine Fourie, Anita Mitra, Maya A-Memar, Tomas Prior, Jasmine Tay, Visha Tailor, Hanine Fourie, Shirin Khanjani, and Srdjan Saso
  1. 1Centre of Fetal Care, Queen Charlotte’s and Chelsea Hospital, Imperial College Health NHS Trust, London W12 0HS, UK
  1. lawinobrien{at}

The title of the news item on the National Institute for Health and Care Excellence (NICE) guidance on intrapartum care—“Midwife led units safest for straightforward births”—and the guideline itself, belie the evidence.1 Birth can be considered straightforward only in retrospect—classification beforehand implies a predictive accuracy that neither obstetricians nor midwives possess.

It is not immediately obvious from the guideline that “the …

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