Women who give birth at home with an independent midwife are nearly three times more likely to have a stillbirth than those who give birth in hospital, a study has found.

Many women at high risk of complications choose to give birth outside hospital because the NHS cannot offer the kind of birth they want.

The researchers urged a review of why more babies were stillborn or dying soon after a birth overseen by an independent midwife, but pointed out that many outcomes were “significantly better” for those who gave birth outside the NHS.

For women at low risk of complications, giving birth at home could be as safe as doing so in hospital, they added.

The findings, published in the British Medical Journal today, come from the largest study to compare outcomes for British women giving birth on the NHS with those who employ an independent midwife for a home birth.

Only 3 per cent of women give birth at home but the Government has pledged to offer women a choice of where and how they give birth by the year’s end.

Campaigners said that the NHS was letting down thousands of women who had to employ an independent midwife because the health service could not offer them a “natural” home birth without painkillers or other medical interventions.

Other women who chose an independent midwife had had a bad experience on the NHS, raising concerns about the quality of childbirth for some women who feel afraid to use the health service again.

Medical leaders say that the health service is unable to provide more home births due to shortages of midwives despite Government promises and the fact that home births could save the NHS money and provide a more natural experience for around 60 per cent of women at low risk of complications.

A report by the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives estimated that if women had “true choice”, between 8-10 per cent of births would be at home. The study, by the University of Dundee, analysed the records of more than 8,600 women who gave birth in Scotland between 2002 and 2005. These included 1,462 who gave birth assisted by a member of the Independent Midwives Association (IMA), and another 7,214 who gave birth on the NHS.

The groups were matched for age, socio-economic status and other factors such as previous obstetric complications. Nearly nine out of ten women in the IMA group, said they wanted to give birth at home, and two thirds did so. But the researchers noted that women who chose a birth with an IMA member were more likely to have had pre-existing conditions, such as blood pressure or diabetes, or previous obstetric complications.

The risk of stillbirth or neonatal death (within 28 days of birth) was 1.7 per cent in the IMA group compared with 0.6 per cent in those giving birth in the NHS. Once high-risk women were excluded from both groups, the difference — 0.5 per cent versus 0.3 per cent — was not statistically significant.

The study also highlighted problems associated with an NHS delivery, including babies being more likely to be born prematurely or admitted to intensive care units soon after birth.

Belinda Phipps, chief executive of the National Childbirth Trust, said that many women who opted to pay for an indpendent midwife did so because they wanted “a home birth, or at least a more homely birth”.

“Women at high-risk of complications are still entitled to choose a home birth and I think we have to ask why they are made to feel that their only option is to turn away from the health service.”

Dr Maggie Blott, spokeswoman for the RCOG, said she was not surprised by the higher mortality rate among the IMA group. “Women with an increased risk of complications should be delivered in hospital where obstetricians can spot those complications,” she added. “Independent midwives should not be agreeing to deliver women who are high-risk at home.”

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