When did UK working class women shift away from home birth?

The big transition from home-births to hospital-births began in the mid-1960s and was largely complete by the mid-1970s. This is illustrated by the graph below:

(Click to enlarge)

• Source: Percentage of maternities taking place at home, England and Wales, 1955–2006, from Andrea Nove, Ann Berrington and Zoë Matthews: Home births in the UK, 1955 to 2006

Before 1945, the majority of births for working-class women in the UK took place in the home. With the creation of the National Health Service (NHS) in 1948, expectant mothers were increasingly directed towards hospitals and maternity clinics, and the proportion of home-births gradually began to decline.

From the creation of the NHS in 1948 until 1974, responsibility for maternal care was been divided between hospitals, General Practitioners (GPs), and local authority health services (the so-called 'tripartite system'). This division of responsibility had led to some confusion as to who exactly was responsible for what in regard to maternity care, and to a considerable duplication of effort and resources. The 1956 Guillebaud Report into the cost of the NHS identified this as a problem.

Noting the division of responsibility for maternity services, the result of history rather than logic, an early review was recommended, which was chaired by the Earl of Cranbrook.

• Rivett, Geoffrey, NHS History, Chapter 1

The Cranbrook Report was published in 1959, and recommended that the NHS should aim for 70% of births to take place in a hospital. However, the 70% figure was:

"... a figure without scientific justification, derived from a report by the Royal College of Obstetricians and Gynaecologists (RCOG) in 1944"

• Rivett, Geoffrey, NHS History, Chapter 2

Notwithstanding the recommendations of the Cranbrook Report, the debate within the medical community regarding the relative merits of hospital-births relative to home-births continued alongside the development of improved obstetric knowledge, techniques, and equipment.

In 1967 the Maternity and Midwifery Advisory Committee commissioned a report on the future of maternity services in the UK. The committee was chaired by John Peel (a consultant obstetrician), and their report is known as the Peel Report. Among their recommendations, the committee stated:

We consider that the resources of modern medicine should be available to all mothers and babies, and we think that sufficient facilities should be provided to allow for 100% hospital delivery. The greater safety of hospital confinement for mother and child justifies this objective.

and

The district general hospital will be the obvious focus for all maternity services, both hospital and domiciliary, in the area served by it. District general hospitals should have close links with health centres.

and also that:

Medical and midwifery care should be provided by consultants, general practitioners and midwives working as teams.

• Peel Report, p60

Although there has been a lot of criticism of the recommendations of the Peel Committee report, and claims that their conclusions and recommendations weren't really supported by the evidence, they did base their conclusions

... largely on findings from the Reports of the Confidential Enquiry into Maternal Deaths, and this led rapidly to over 95% of women giving birth in a hospital setting.

• NICE Clinical Guidelines, No. 190; Chapter 3 - Place of birth

The message that hospital-birth was "safer" for mother and baby fed an increasing demand for hospital-deliveries from expectant mothers, which increased the rate-of-change from home-birth to hospital-birth, and this is clearly reflected in the graph above.

Sources

• NICE Clinical Guidelines, No. 190. Intrapartum Care: Care of Healthy Women and Their Babies During Childbirth. Chapter 3 - Place of birth

• 'Peel Report' Domiciliary midwifery and maternity bed needs, Maternity and Midwifery Advisory Committee, 1970

• Rivett, Geoffrey: National Health Service History, Chapter 1, 1948 -1957

• Rivett, Geoffrey: National Health Service History, Chapter 2, 1958-1967