About the Discussion

@NEJM Ask the Author & Experts: A NICE Delivery--The Cross-Atlantic Divide over Treatment Intensity in Childbirth

Perspective

A NICE Delivery — The Cross-Atlantic Divide over Treatment Intensity in Childbirth

For generations, both British and American mothers have assumed that the safest way to give birth is to spend many hours, if not days, in a hospital bed under the supervision of an obstetrician. Now, new guidelines are challenging these deeply held beliefs.

After completing an evidence-based review, the United Kingdom's National Institute for Health and Care Excellence (NICE) concluded that healthy women with straightforward pregnancies are safer giving birth at home or in a midwife-led unit than in a hospital under the supervision of an obstetrician.1 Across the pond, eyebrows went up. The New York Times editorial board (and others) wondered, “Are midwives safer than doctors?”2 How can homes be safer than hospitals? And what implications will the British guidelines have for the United States?

As a U.S.-trained obstetrician, I have little doubt that the United States offers outstanding care for medically complicated pregnancies. But there are lessons to be learned from the British system. The majority of women with straightforward pregnancies may truly be better off in the United Kingdom.