My mother-in-law is a retired nurse midwife who delivered >600 babies in England & Scotland during her career before moving to the US. I don't know if it's still true, but she tells us that in the UK, midwives have special privileges for things like transportation -- free bus/train/subway, and the ability to hail a cab and get a free ride if it's necessary. This may not be true any longer. She relocated in 1969.
I have zero doubt that had she been born at home she would have died or had severe brain damage before she could get to a facility capable of saving her.
I am a huge opponent of having children away from medical facilities.
As the GP said, it's uncomplicated until it isn't.
for a bit of insight into the US legal situation.
It's a protected term - you can't call yourself a midwife withoutthe qualification and registration.
Most midwives are employed by the NHS.
Obviously they're not doctors - they can't prescribe medication or perform surgery.
I have an aunt that's a neo-natal nurse, and I've never heard her refer to fellow nurses as midwives (but I've never directly asked her before).
When we had our child in May there were two midwifes with us during the process, the doctor joined once it got serious.
We could have had the child at home or at a birthing house, however we wanted to have the security of knowing that there is surgery available if something should go wrong (the hospital had a special icu for babies, I don't know the english phrase for it, but they basically could do every procedure that might have been necessary).
In addition to that, we really enjoyed the "we don't have to do shit" during the next three days (we got a familiy room, so I could stay with my significant ohter and child. Giving birth at home would have added to the stress (cleaning, getting food, trying to keep visitors away until we had slept a little etc), so for us the hospital was perfect.
That beeing said, I have tremendous respect for midwives. They do a hard job with really shitty hours and a lot of responsibility. And they get screwed over with the insurance, especially in Germany (the premiums for insurance skyrocket while the payment doesn't (http://www.huffingtonpost.co.uk/-camalo-gaskin/the-other-upr...)
The best if-you're-pregnant-right-now solution, though, is different, since currently very few hospitals allow birth in their physical location without a hospital physician.
The calculus in that case is probably a tradeoff of unlikely but very bad outcomes (death by homebirth) vs quite likely somewhat-bad outcomes (unnecessary Caesarean, unnecessary rushing, etc., by hospital), I'd think.
So, nurse midwifes do deliver in hospitals. I actually think they are not allowed to do home births or they can lose their license.
(In the US)
Midwives can do their work in a hospital room down the hall from surgical facilities just as easily as they can in your bedroom 20 minutes away from major life-saving surgery.