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Last Updated: Tuesday, 3 April 2007, 11:38 GMT 12:38 UK
Q&A: Maternity plans
The government has promised mothers choice by 2009
Ministers are promising women a choice of where they give birth.

They say they want to create a "world class" maternity service, but there is some doubt over whether this can be achieved.

What is the government promising?

By 2009, every woman should have a choice over where she gives birth. This includes at home, in hospital or in a midwife-led unit.

Midwife-led unit, or birthing centres as they are sometimes known, are either located in hospital grounds or in the community.

Campaigners such as the National Childbirth Trust believe that childbirth has become too medicalised and want to see women given the option of more natural births at home or in birthing centres.

The government recognises there is more appetite for home births as in areas where there are more resources the home birth rate is up to five times the national average of 2% of births.

Ministers have also said they want women to have a "known and trusted" midwife to help them through pregnancy.

In practice, this will mean that women are assigned a named midwife from a team when they first contact the health service.

This midwife, or another member of her team if she is unavailable, will act as their first point of call until labour.

What are the risks of home birth?

There has been much debate and mixed evidence over whether home birth are more dangerous.

The Royal College of Obstetricians and Gynaecologists believe women should be entitled to choose, but warned of the possible complications.

About 15% of home births end with the mother or baby needing to be transferred to hospital. The figure doubles for first-time mothers.

Final draft guidance from the National Institute for Health and Clinical Excellence, which advises the NHS, says that women should be reassured that the risk of their baby dying during childbirth is low wherever they are born - 5.1 deaths per 1,000 births.

However, it says the risks are higher if serious complications occur at home, rather than in hospital.

What happens at the moment?

Much of what the government is recommending is already happening in some places. The problem is that there is much variation across the country.

About 2% of the 600,000 births a year take place at home, with a similar amount in midwife-led units and the rest in hospital.

In the best - and most well-resourced - places, women will also see the same midwife throughout pregnancy.

In practice, it seems what this plan will do is strengthen a woman's right to demand these kinds of services.

Are there extra resources?

This is at the crux of the criticisms of the plan. Midwives and doctors agree maternity resources are stretched at the moment.

While more money has been invested in maternity services - about 700m since 1997 - the proportion of the overall NHS budget spent on it has fallen from 3.1% in 1997 to 2.2% in 2005.

The government is not setting aside extra money for maternity services, but the NHS is getting 8bn extra this year and ministers have told primary care trusts, which hold the purse strings locally, that maternity care must be made a higher priority.

The opposition parties have jumped on this, saying money is so tight in the health service that in reality the choice will not be able to be offered.

What do doctors and nurses make of it?

It is fair to say doctors and nurses are pleased the focus is being put on maternity care - traditionally a neglected part of the health service.

But they concerned about how the choice will be provided on the ground.

Both the Royal College of Midwives and Royal College of Obstetricians and Gynaecologists have said extra staff will be needed.

The RCM has set a figure of 3,000 new full-time midwives by 2012, although the government has refused to guarantee that will happen.

Midwives, especially, are quite sceptical of the promises as over recent years they have seen recruitment freezes imposed and services cut.

One trainee in the north of England told the BBC: "Morale among students is really low. We don't know if we will get jobs and we can see those who have are really stressed and overworked."

The Royal College of Midwives responds to the new plans

Maternity cuts 'a risk to care'
08 Jan 07 |  Health
Birthing centres to remain closed
15 Oct 05 |  Hampshire
Pregnant midwives shut baby units
21 Jun 05 |  Hampshire
How safe are home births?
23 Jun 06 |  Have Your Say

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