NHS trust withdraws ‘dangerous’ advice to women on how to achieve a ‘normal birth’

'Shocking' guidance told women to wait as long as possible at home in labour and avoid epidurals or inductions

An NHS trust has been criticised for advising pregnant women to stay at home for as long as possible during labour to increase the chances of a “normal birth”.

University Hospitals Bristol NHS Trust also suggested mothers should avoid having epidurals or inductions and should try to have a home birth.

The advice has been described as “shocking” by experts, who said the guidance was contrary to evidence and could be “dangerous” for mothers and babies.

Others criticised the language used by the trust which suggested women who needed medical help were somehow “abnormal”.

Earlier this month, the Bristol trust paid out £5.8m in compensation to the family of a six-year-old boy after he was left brain damaged at birth following complications during labour.

After being contacted by The Independent, the trust deleted the childbirth advice from its website and accepted it was “outdated”.

The pursuit of a so-called normal birth is a controversial topic in maternity and is linked to scandals at the Morecambe Bay NHS trust and the Shrewsbury and Telford Hospitals Trust, which is facing an investigation of more than 900 cases of alleged poor care.

The Royal College of Midwives abandoned its normal birth campaign in 2017 amid concerns it may have put women at risk.

The Bristol trust’s advice on how to “help yourself to a normal birth” including telling mothers to “stay at home as long as you can”. It said: “You’re less likely to need medical interventions in the form of drugs to speed up your labour, or to help you give birth when you go to hospital.”

The leaflet added mothers should “try to avoid an epidural” and “have a home birth”. It also advised them to “avoid having your labour induced unless there’s a good reason for it”.

Maureen Treadwell, co-founder of the Birth Trauma Association charity, said: “The advice to have a home birth is shocking. It is totally contrary to the guidance which advises mothers should be told the risk and benefits of different places of birth. For first time mothers, this results in higher risk to the baby – a fact completely missing from the leaflet.”

She adding warning women against epidurals was “unwise” as extreme pain had been linked to postnatal depression and PTSD.

In relation to women being told to stay at home, Ms Treadwell said: “First time mothers vary in their knowledge of what constitutes ‘early labour’. A minority of labours are not particularly painful and there is a risk that women could leave it too late.

“My worry with units who produce leaflets of this kind is that if they depart from safe, nationally agreed practice at this level, what else are they doing?”

The Baby Lifeline charity, which campaigns for safer maternity services, said it was “surprised and concerned to see guidance such as this being published on an official NHS website, which should always be a trusted source that provides evidence and supports informed choice for women”.

“Some of the advice contradicts national guidelines, which could potentially be dangerous and lead women to have unrealistic or unachievable expectations of their birth,” it added.

Dr David Bogod, a consultant obstetric anaesthetist, told The Independent: “The thing that upsets me about this advice is the use of the word ‘normal’ which suggests normal is a vaginal birth and therefore anything else can only by abnormal. It is pathologising the usual interventions that are made during childbirth to improve safety.”

Maternity safety campaigner James Titcombe, whose son Joshua died at the Morecambe Bay trust in 2008, added: “It’s time all NHS organisations binned the phase normal birth once and for all. Mums and families need access to unbiased, evidenced based information – not dangerous and divisive ideology.”

Dr Pat O’Brien, consultant obstetrician and vice president of the Royal College of Obstetricians and Gynaecologists, said only four in 10 births in the UK occurred without some form of intervention and childbirth was unpredictable.

“These interventions are sometimes an essential part of care to ensure the safest possible birth, and in some cases can be lifesaving. While we support the promotion of vaginal birth, it is important to stress that no woman should be made to feel her birth experience is ‘abnormal’, if she has a medical intervention to help with the safe birth of her baby.”

A spokesperson for the Royal College of Midwives added: “We do not want women to feel they have failed if normal birth was not appropriate or safe for them.”

In a statement Carolyn Mills, chief nurse at University Hospitals Bristol NHS Trust, acknowledged the information was “outdated with the term ‘normal birth’”.

She added: “We want to apologise to any patients offended or upset by this content and ask they contact us with any concerns. We have since removed this literature so it can be reviewed and updated, and want to reiterate all births are fully supported by our midwives and their aim to make every birth safe and special.”