Leading article: A mother's birthright

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The Independent Online

The reason why Patricia Hewitt's attempt to promote home births is controversial is not that she wants to give women a choice. No one should argue that expectant mothers be put under pressure to give birth in hospital. If a mother expecting a normal delivery chooses to have her baby at home, that decision should be supported by the health service.

As we report today, however, the Secretary of State for Health goes further than that. She talks of "a strategic shift towards more home birth", which sounds at first blush to be a good thing. We as a nation have rightly grown sceptical of the healthcare model that concentrates everything - medical excellence, emergency response and recuperative care - in massive general hospitals. We recognise the truth in the old joke that the trouble with hospitals is that they are full of sick people. The evolution of drug-resistant bacteria has underlined this point. The emphasis across the National Health Service is now shifting to primary care and decentralised treatments carried out in small clinics or cottage hospitals.

So when Ms Hewitt talks of trying to "demedicalise" childbirth, the temptation is to nod along in agreement. It is true that childbirth is not an illness, and that for many women, especially those having second and subsequent children, it can be straightforward. It is also the case that painkilling drugs can be counter-productive, interfering with the natural responses of the mother's body or affecting the baby. Equally, there are justified concerns about the increase in the number of elective Caesareans, which in some cases are "medicalising" what could be a largely non-medical experience.

These issues are all separate from the question of where to give birth, however. There is no reason why hospital births could not be less medicalised. And there is a good reason why most women prefer to give birth in places with full emergency medical back-up. Namely, that it is safer for them and for their baby should anything go wrong. This might be the case even with the best possible midwifery service - and the NHS is some distance from that at the moment, because of staff shortages.

Ms Hewitt would be better advised to focus on the problem of the quality and quantity of midwives than on another apparently cost-free "shift of emphasis", which follows her recent, more unequivocally welcome, shift from the medicalisation of mental illness. This is because it is far too sweeping a generalisation to think that high-technology chemical intervention in human health is a bad thing. Recently, The Independent on Sunday has highlighted a number of cases of new treatments, especially for cancer, that are controversial because they are effective but expensive.

Women should have the choice of where to give birth on the basis of the best possible information. On this point, the approach of the Department of Health should prompt concern. Officials talk of commissioning research to challenge the assumption among doctors that hospital births are the best option. That sounds suspiciously as if the department intends to find the evidence to prove what it wants to prove. More evidence, more research and more information are essential, but they must be presented to would-be mothers in a neutral and objective way.

Ms Hewitt has misjudged the issue. To the extent that she is trying to ensure that all mothers have a meaningful choice between home and hospital births, she should be applauded. To go beyond that, however, to seek to encourage more women to have their babies at home, is to take a step too far.