New England Journal of Medicine: Ob for Home Birth

The New England Journal of Medicine interviewed American trained obstetrician Neel Shah. He discusses the findings that in the United Kingdom (U.K.) healthy women with low-risk pregnancies were safer giving birth in birth centers or at home under the care of a midwife than in a hospital under the supervision of an obstetrician.1

Obstetricians in hospitals in the U.K., as in the U.S., tend to perform cesarean sections even when not medically necessary. British women also have access to Nurse-Midwives who are part of their health care system. C-sections may result in more complications, including hospital-acquired infections, hemorrhage, and injury to certain organs than in vaginal births.

In the U.S., more midwife-managed birthing centers are needed for low-risk pregnancies.1 When complications arise women need a smooth transfer during labor from their homes or birthing centers to the hospital. Laboring women who have had children before have less chance of needing to be transferred for medical care. Since it is important to avoid that first cesarean and women with their first pregnancy have a higher chance of “unnec-cesareans”, it is Vanita’s professional opinion that it is even more important for these women to consider the option of out of hospital birth.

Shah states that in Britain 50% of first time laboring mothers were brought to the hospital when an out of hospital birth was planned, but the incidence in my private practice was much, much lower. Women with their first labor need to do their best to avoid the “cascade of interventions” that can be a slippery slope into the operating room.


  1. Shah, Neel. NICE delivery – The cross–Atlantic divide over treatment intensity in childbirth. (2015, June 4.) N Engl J Med. 372:2181-2183. Retrieved from



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