In a recent draft guideline, health care professionals are recommended to explain to women “who are at low risk of complications that giving birth is generally very safe for both the woman and her baby”, and that “she may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support her in her choice of setting wherever she chooses to give birth” (NICE, 2014, pp. 169–170). This NICE guideline for Normal Birth draws on evidence from high quality evidence, like the one provided by the Birthplace in England Research Program and by several studies from other countries. According to this evidence, home birth carries little risk for healthy women at term with uncomplicated pregnancies, especially if they have access to the services of properly trained midwives who work in collaboration with the health care system.
Nevertheless, in countries where there are barriers to less medicalised birth options, women still search for alternatives. In Sweden, 20% of home births occur without a midwife present (Lindgren, Rådestad, Christensson, & Hildingsson, 2008). In Slovakia, women travel to Austria to escape hospitals with high episiotomy rates (cut in the perineum) and the Kristeller maneuver (pushing, sometimes forcefully, on the belly before the baby is born) a potentially risky procedure with no documented positive effects. Whereas in Portugal, some women try to plan a hospital birth without unnecessary interventions, but due to institutional resistance decide to choose a midwife to assist their birth at home(Santos, 2012). Sometimes, midwifes can be at a travel distance of two hours, leading some births to happen with no professional assistance. There are plenty of other examples across Europe.
In fact, Portugal has high intervention rates and, at the same time, the National Health System does not provide its citizens with home birth services. Birth in Denmark is also being increasingly medicalised; the rice in labour induction went from 9% in 1997 to 25% in 2014 (Sundhedsstyrelsen, 2014). Women can opt for home birth, as Denmark has integrated home birth into its publicly financed health care system. However, these services are only used by 1-2% of Danish pregnant women as the majority of them give birth in highly specialised