Forget the epidural, NHS pushes for water births

The new NHS rules are aimed at reducing the number of epidurals and caesarean sections.

The guidelines say women should be advised to use birthing pools instead of taking drugs for pain relief.

They must also be warned of the dangers of pain-relieving epidurals, according to rules drawn up by the National Institute for Health and Clinical Excellence (Nice), in the biggest shift yet towards natural childbirth.

The rules say midwives and obstetricians should only intervene if there are problems with the birth, and all women should be offered the choice of having their baby at home.

Once a woman is in established labour, she should receive "one-to-one care".

The guidelines also advise staff to smile at pregnant women and treat them with respect.

Women should be told that first labour lasts on average eight hours, and second labour lasts on average five hours.

Even if dilation is less than a centimetre an hour, this will not be viewed as problematic unless the woman is in great pain and feels the process needs to be speeded up.

The guidelines are expected to mean longer labour for some women. However, those who drew them up insist it could also mean fewer medical interventions, which can result in more complicated, painful and longer labours for others. More than 126,000 women gave birth in London last year and up to one in four had a caesarean section.

Dr Julia Sanders, a consultant midwife, and a member of the group which drew up the guidance said: "There is a perception that water is just nice. But it is the most effective form of pain relief barring an epidural in labour. I would like to see more women using water."

The Royal College of Obstetricians and Gynaecologists said it supported natural birth. But it added that "complications during childbirth are unpredictable and can occur even in low-risk births".

It said: "When emergencies do occur when delivering at home or in a stand-alone midwifery unit, the transfer time to hospital is crucial to minimising risks and enhancing safety."

"More transfers using ambulances at a time when ambulance services are already finding it difficult to cope with demand, adds pressure to the system."

Under a shake-up of London health services more stand-alone midwifery units are planned.

The advice comes amid claims that the NHS is short of 5,000 midwives. The Government wants every woman to have a choice of home birth by the end of 2009 but the Royal College of Midwives says it is unachievable unless thousands more staff are recruited.

Health Secretary Alan Johnson has announced plans for 1,000 more midwives within three years.