Couples often come to our antenatal classes with the dilemma of where to give birth. Factors such as pain relief options, safety of mother and baby and distance from the hospital all affect their decisions. The recent BirthPlace Study (Oxford University 2011) can provide some facts and figures to help.
The Birthplace study reported on last year compared the safety of 64,500 births planned in four settings:
- Home
- Freestanding midwifery units (FMUs) – not situated in a hospital or site with an obstetric unit or neonatal unit.
- Alongside midwifery units (AMUs)- situated in the same hospital or on the same site as an obstetric unit.
- Obstetric units in hospital.
The main findings relate to healthy women with straightforward pregnancies
Safety of birth outside the hospital
First baby
The study found that for women having a first baby, a planned home birth increases the risk for the baby. For first time mothers there were 9.3 adverse outcome events per 1000 planned home births compared with 5.3 per 1000 births for births planned in obstetric units, and this finding was statistically significant. Adverse outcomes include the death of a child or upper arm injuries.
Second or subsequent baby
The study revealed that for women having their second or subsequent baby giving birth at home or a midwife-led unit (MLU) is as safe as giving birth at an obstetric unit. The study also confirmed that planned births outside hospitals have a far lower rate of medical intervention, fewer caesarean sections and more ‘normal births’.
Transfer rates to Hospital
Birthplace found that possibility of transfer is one of the main worries that stops women from giving birth outside an obstetric unit. It can be distressing travelling in labour in an emergency ‘blue light’ ambulance. The study says: ‘The prospect of intrapartum transfer was a major consideration when women made a decision around place of birth, and women often cited concerns about transfer distance as a reason for planning labour in hospital.’
First baby
For women having a first baby, there is a fairly high probability of transferring to an obstetric unit during labour or immediately after the birth – the transfer rate was 45% for planned home births, 36% for planned FMU births and 40% for planned AMU births
Second or subsequent baby
For women having a second or subsequent baby, the proportion of women transferred to an obstetric unit during labour or immediately after the birth was 12% for planned home births, 9% for planned FMU births and 13% for planned AMU births.
The research confirms that midwife-led care is much more likely to lead to a normal birth – without any interventions, including forceps or ventouse. That was true whether the baby was born at home or in a midwife-led unit. The emergency Caesarean rate for the low-risk women in the study was 11% in obstetric units compared with only 2.8% at home, and 4.4% in a midwife led unit on a hospital site.
There is more research which will come from this study and you can read the full report on the BirthPlace website https://www.npeu.ox.ac.uk/birthplace




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