Should More Women Give Birth Outside The Hospital? : Shots - Health News The British medical system says healthy women with normal pregnancies should give birth at home or in a midwife-led facility. But 99 percent of babies in the U.S. are born in hospitals.
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Should More Women Give Birth Outside The Hospital?

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Should More Women Give Birth Outside The Hospital?

Should More Women Give Birth Outside The Hospital?

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A recent recommendation from doctors in the United Kingdom raised some eyebrows here in the United States. The British National Health Service says healthy women with straightforward pregnancies are better off out of the hospital. NPR's Dianna Douglas reports.

DIANNA DOUGLAS, BYLINE: The idea of birth being better at home was practically heretical to Neel Shah, an obstetrician at Harvard Medical School. In the U.S., 99 percent of babies are born in hospitals.

NEEL SHAH: There's really only one way of having a baby in the U.S., which is effectively in, like, an intensive care unit surrounded by surgeons.

DOUGLAS: Shah was asked by the New England Journal of Medicine to respond to the British recommendation. You'd think a leading U.S. obstetrician would say the British had gone batty. But he started to think the U.K. was on to something after comparing outcomes there and here.

SHAH: We're taking excellent care of high-risk women, but we're leaving low-risk and normal women behind. We're on the only continent on Earth with a rising maternal mortality rate.

DOUGLAS: There could many reasons for the rise - increased obesity, lack of prenatal care. Shah also blames hospital infections and the rise in cesarean deliveries. So rather than rebut the British, Shah argued that the practice of giving birth outside a hospital with a midwife can be safer and much cheaper.

SHAH: Choose the right patients who are appropriate for that, and then you need to be able to link those birth centers to hospitals like mine that have the blood banks and the three operating suites on the labor floor and everything else.

DOUGLAS: But Jeffrey Ecker, an obstetrician and chair of the American College of Obstetricians and Gynecologists, says women and babies are in real danger if something goes wrong at home.

JEFFREY ECKER: I don't recommend home birth. And as an organization, ACOG suggests that hospital or birth center delivery are the safest options.

DOUGLAS: Ecker says the British and American health systems are simply too different.

ECKER: The system that supports home birth in the United Kingdom is much different than the system that currently exists in the United States. In fact, I'd argue that there really isn't a system in the United States.

DOUGLAS: In the U.K., there's universal health care, and British women are generally referred to a midwife as soon as they're pregnant. In the U.S., a growing minority are choosing a midwife-led birth. But it's still only around 9 percent.

YINKA SOKUNBI: There a lot of people who actually do not know what midwives do. They have this vision of old lady using potions and herbs.

DOUGLAS: That's Yinka Sokunbi, who worked as a midwife in London until her husband's work transferred her to Dallas last year. Sokunbi can handle a host of common childbirth scenarios.

SOKUNBI: I am suitably trained to recognize when things aren't going as they should be going and what to do about it, how to intervene, what my backup is.

DOUGLAS: The bag she takes to a home birth has no potions but does have a Doppler for monitoring the baby's heartbeat, Pitocin and Cytotec for hemorrhaging, oxygen for reviving a blue baby. In bad cases, she sends her patient to the nearest hospital. That handoff is another major difference between the U.S. and the U.K. In the U.K., doctors and midwives have a close partnership.

SOKUNBI: In the states, the way I see it so far, it seems like the midwives on one side and obstetricians on the other side, and there's this sort of opposition.

DOUGLAS: If these two camps can work together to figure out which women are better off outside a hospital, it could lead many women to a cheaper, safer and more pleasant childbirth. For NPR News, I'm Dianna Douglas.

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