Women's Decision-Making And Factors Affecting Their Choice Of ...

hospital delivery following a review of maternity services (Department of Health
and Social Security 1970).
On the other hand, statistical evidence did not lend support to the premise
that hospital birth was safer than home birth (Campbell and Macfarlane 1994;
Russell 1982; Tew 1977; Tew 1978; Tew 1981; Tew 1985; Tew 1990). The
scientific justification for the trend towards hospital deliveries was questioned,
and consumer organisations such as the National Childbirth Trust (NCT) and the
Association for Improvements in Maternity Services (ALMS) became actively
involved in informing women about their maternity care rights. The Netherlands
was held up as an example of a country with low perinatal mortality rates despite
a high home birth rate (Lovell 1996).
In the midst of the confusion about home and hospital birth, the Expert
Committee of the Department of Health was set up in 1992 to review policy on
National Health Service (NHS) maternity care, particularly during childbirth, and
to make recommendations (Department of Health 1993b). This was a sequel to
the Government response to the Select Committee's report (House of Commons
Health Committee 1992), which had suggested that the medical model of care that
encouraged all women to deliver in hospital could no longer be justified on the
grounds of safety. The expert committee's efforts culminated in the production of
the policy document Changing Childbirth (Department of Health 1993b), which
advocates maternity care that is appropriate, accessible, and effective. The
document aims to make care during pregnancy and childbirth more woman-
centred by setting targets for implementation and recommendations for good
practice. The report stresses that:
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