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Understanding the Shifts in Maternity Care Over the Past Century
Childbirth has undergone a monumental shift over the last hundred years, fundamentally reshaping where and how women give birth. To make informed decisions about birth settings today, it helps to understand the historical journey and societal beliefs that led us to our current maternity care system.
In this journal article, we’ll take a closer look at the milestones that transformed maternity services in the UK, from the widespread practice of home births to the predominant hospital-based model we see today.
As we approach the release of our newest developments to support decision making, we are visiting some of the key choice’s women, people and families make. The Real Birth Company is dedicated to empowering expectant women or people by providing them with comprehensive, evidence-based information about childbirth. Our newest and soon to launch RealBirth v4, takes this commitment even further by offering personalised sessions tailored to each individual’s unique needs, health conditions, and preferences. This customised approach ensures that everyone can understand their options and make informed choices that align with their circumstances, building confidence and autonomy throughout their pregnancy and birth.
Early 20th Century: The Dominance of Home Births
Before 1920
In the early 1900s, most births took place at home, with midwives attending about 75% of them. There was no official structured antenatal care; women called their midwife or GP only once they were in labour. Unfortunately, poor pre-existing health and hygiene practices and limited healthcare contributed to high maternal and infant mortality rates. This was also due to the lack of understanding about hygiene and hand washing. For example, a lack of understanding that you can’t remove someone’s infected liver, not wash your hands and attend to a birthing woman, by performing a VE. Anyone else with a scrunched up nose and shaking their head?!
1930s: The Medicalisation of Birth
By the 1930s, childbirth started moving from home to hospital settings, driven by emerging obstetric practices, the meaning of the word obstetric is, the management of midwives and childbirth (in case you weren’t sure!). Forceps, ventouse, and caesarean procedures began to be used by doctors, and birth became viewed as a medical event rather than a natural process. This was because there was a belief that having a doctor paid to be at your birth, would provide a healthier mother and baby. Throughout the 1930’s antibiotics and blood transfusions were used more in general health, and these improvements in pre-pregnancy health was contributing factor, so the number of women who died in birth reduced.
1948: The Birth of the NHS
In 1948 the National Health Service (NHS) began offering free health care for all, promising care by doctors who promoted safety in maternity care. The increasing number of doctors, medical training, and new NHS hospitals in the late 40s/early 50s, began to change how people felt about midwives, as people saw birth in the hospital with its modern advances, preferable to birthing at home. During this time there was no standard way maternity care was run, and care was spread between GPs, hospitals, local authority services and maternity clinics.
1959: The Cranbrook Report
In 1959 The Cranbrook Report stated that 70% of all births should take place in the hospital, and that the remaining 30% should be ‘safe enough’ to take place at home. Where each person would give birth would be decided by the woman’s doctor. However, this decision was not popular amongst the doctors, as they believed more people should give birth in the hospital and not with midwives at home. The Earl of Cranbrook, who Chaired the committee who published the report - had no background in birth at all!
The Peel Report of 1967 went a step further, recommending that all births take place in hospitals for safety—a claim that, even today, lacks concrete evidence. Even though there was no evidence to support the Peel Report, big changes began to happen within maternity care services - changes which are still apparent today. Actions were taken to make sure that there were enough hospital beds for every birthing woman, and birth within the hospital quickly became the norm. Between 1940-1970 birth had completely switched. This switch from home to hospital changed the face of birth and maternity care in this country, and took place with very little research behind it.
1970s–1980s: The Rise of Advocacy and Evidence
Between the 1970’s and 1990’s campaigning continued in support of physiological birth.
In the 1970s, movements championed by organisations like the National Childbirth Trust (NCT) and the Association for Improvements in the Maternity Services (AIMS) opposed routine practices that caused harm, such as automatic episiotomies, enemas and pubic shaving.
Research by Professor Majorie Tew challenging medicalisation and promoting the safety of planned home births in low-risk pregnancies. Professor Majorie Tew realised whilst teaching medical students, that the conclusions the Government had come to, were not based on evidence. She showed that hospital was only of benefit to those who had a higher chance of complications. Her research showed that the rate of poor outcomes were lower where babies were born at home compared to those born in hospital. British medical journals refused to publish her research until the Journal of the Royal College of General Practitioners finally did so in 1985.
1993: Changing Childbirth and the Shift in Attitudes
The Changing Childbirth Report published in 1993 was revolutionary. It was the first government review that incorporated the voices of both women and midwives, acknowledging that increased medical interventions could inhibit physiological birth. The report encouraged women’s autonomy in choosing their birth setting. Although this shift in mindset was substantial, it didn’t lead to a significant rise in home births, as hospital birth had by then become deeply ingrained in the UK’s birthing culture.
2010–2011: A Legal Landmark for Birth Rights
In 2010 a landmark case was brought to the European court of Human Rights by soon-to-be mother, Anna Ternovsky. She claimed that in her home country of Hungary, she was being denied her legal right to birth at home. At the time, home birth was banned, and any health professional found to be helping at a home birth could face criminal action. Anna Ternovsky won her case, and in 2011, Hungary passed a new law allowing soon-to-be mothers whose pregnancies are free of medical complications to choose to give birth at home. This had a ripple effect as home birth now became a legal right for birthing people across the European Union and beyond.
2011: The Birthplace Study – Evidence for Home Birth
The 2011 Birthplace study compared outcomes for births in different settings, including home birth, birth centres and hospital units. It has been welcomed by supporters of physiological birth as it showed that the impact of planned home birth can reduce interventions such as caesarean, ventouse and forceps birth, and haemorrhage. It also showed that these rates were still lowered, even if transfer to hospital occurred. For the first time in modern midwifery, midwives and home birth teams across the country were able to share these findings and use these figures in their discussions regarding home birth. But still despite this new evidence, in 2019 only 2.1% of all births took place at home.
2020–2021: The Impact of COVID-19
The COVID-19 pandemic sparked renewed interest in home birth, with families seeking alternatives to hospital settings due to safety concerns, visitor restrictions, and the risk of infection. While home birth rates saw a slight rise to 2.4% in 2020, many NHS Trusts suspended home birth services due to staff shortages and increased hospital demand. Areas with strong midwifery teams, like Powys in Wales (8%) and Sussex (9%), saw higher rates of home birth.
Reflection
Reflecting on these milestones, it’s clear that policies like the Peel Report still shape birth settings today, creating a deeply ingrained preference for hospital birth that overshadows research supporting home birth for low-risk pregnancies. The journey from home birth to hospital-centred care has been shaped by evolving practices, public perceptions, and advocacy, yet the safety and autonomy offered by planned home birth remain relevant. For midwives, understanding this journey and the evidence that supports home birth can be essential in guiding families towards informed, empowered birthing choices.
As maternity services continue to face challenges, particularly post-pandemic, the conversation around birth choice, safety, and midwifery-led care continues. The commitment to balanced, evidence-based birth options remain essential as midwives support each family’s unique journey.
By focusing on personalised care, the RealBirth workshop is paving the way for a new standard in maternity education. We recognise that every birth journey is different, so our workshops are designed to address the specific concerns and priorities of each individual. This flexibility enables us to adapt to varying health conditions and birthing preferences, making truly informed choice possible. Through this approach, we are not only enhancing birth education but also supporting families in feeling empowered, respected, and prepared for their unique journey ahead.
