A large study published in 2011 analysed the perinatal (the period of pregnancy, birth and up to the child’s first birthday) and maternal outcomes based on the planned place of birth of approximately 65,000 women in the UK. The women included in this study were all ‘low-risk’ as defined by the NICE guideline CG55; examples of ‘high-risk’ exclusion criteria included high blood pressure, diabetes, high BMI, preterm birth (before 37 weeks), multiple babies, breech babies or induction of labour.
Of the women enrolled in the study, 26% planned to give birth at home, 17% planned to give birth in a freestanding midwifery-led unit, 26% planned to give birth in a midwifery-unit attached to an obstetric unit, and the remaining (30%) planned to give birth in an obstetric unit.
The main conclusions from the study included:
-Giving birth is generally safe. Adverse perinatal outcomes (including stillbirth, early neonatal death, etc) across all groups was low, at 4.3 events per 1000 births.
-Midwifery units had significantly fewer interventions and more ‘normal births’ than women who planned birth in an obstetric unit. ‘Normal birth’ is defined in this study by lack of: induction of labour, epidural or spinal pain relief, general anaesthesia, forceps or ventouse delivery, caesarean section or episiotomy.
-For women planning home births or midwifery unit births for their second or subsequent baby, adverse perinatal outcomes did not differ significantly from births planned in obstetric units.
-For women planning their first births, adverse perinatal outcomes increased from 5.3/1000 births to 9.3/1000 births when comparing planned obstetric vs planned home births, respectively. Although this increase is statistically significant, the authors state that due to the overall low rate of adverse perinatal events and the statistical method that was required to analyse the data for it to be meaningful, that they could not rule out the possibility that important differences may have been concealed, such as less severe outcomes in a particular setting. However, the authors state that this does not seem to be case, but it can not be ruled out.
-For women planning to have their first baby in non-obstetric units, the transfer rate is high (36% to 45%). Reasons include transferring for pain relief and concerns over the mother’s or baby’s health (which may in fact be a heightened reaction on the part of the midwives which may not always be necessary).
-For women planning to have their second or subsequent baby in non-obstetric units, the transfer rate is lower (9% to 13%).
-Babies were significantly more likely to be breast fed at least once when a non-obstetric birth has been planned.
-The proportion of women with a ‘normal birth’ varied from 58% in planned obstetric birth units to 88% for planned home births, indicating that even when transfer to an obstetric unit was required, it was more likely that the woman would still achieve a ‘normal birth’.
-NHS costs for births in different settings:
£1631 for a planned birth in an obstetric unit
£1461 for a planned birth in an alongside midwifery unit
£1435 for a planned birth in a freestanding midwifery unit
£1067 for a planned home birth
Written by Cathy; mum of 2, researcher, doula & homebirther.