We have good evidence that midwifery led care is safe. Moreover it is cost effective and is associated with lower intervention rates. Why then is the default pathway for women in the NHS obstetric led care? There is a critical need to reduce the intervention rate especially caesarean section, and using resources well is crucial. Having healthy women and babies enter midwifery led care with the ability to opt out would bring about change. This would also leave doctors time to attend to women and babies who need medical care. Isn't it time we changed the default?

I hear of places where there are underutilized out of hospital birth centres and alongside birth centres. Sometimes the alongside birth centre even becomes an overflow ward. This is such a waste of a valuable resource.

Essentially making midwifery care the default would mean redirecting the majority of women. Keeping a strong healthy interface between midwifery and medical care would be essential. What would this need? An overnight change? An incremental change? Would midwives need preparation? How should it be evaluated?