First time mums who opt for a home birth are at a higher risk of complications, but the overall risk is low in all birth settings, concludes a study published on bmj.com today.
The researchers say their results back a policy of offering women with low risk pregnancies a choice of where to give birth and will enable them and their partners to have informed discussions with health professionals about planned place of birth.
Researchers from the Birthplace study, conducted by the National Perinatal Epidemiology Unit at the University of Oxford, compared perinatal outcomes and interventions in labour by planned place of birth across all NHS trusts in England.
Planned place of birth included home, freestanding midwifery units, midwife-led units on a hospital site with obstetric services, and obstetric units.
Serious adverse outcomes included stillbirth after start of care in labour, early neonatal death, brain injury (encephalopathy), meconium aspiration syndrome, and injuries to the upper arm or shoulder during birth.
A total of 64,538 single, full term infants born to women with low risk pregnancies were involved in the study. Factors, such as maternal age, ethnic group, body mass index and deprivation score were taken into account.
Overall, the rate of adverse outcomes was low in all birth settings (4.3 per 1000 births) and there were no significant differences in the odds of an adverse outcome for any of the non-obstetric unit settings compared with obstetric units.
For women giving birth for the first time, the risk of an adverse outcome was higher (9.3 per 1000 births) for planned home births compared with obstetric units, but not for either midwifery unit settings.
And for women who had given birth before, there were no significant differences in the rate of adverse outcomes between birth settings.
The results also showed that interventions during labour, such as epidural, forceps delivery or caesarean section, were substantially lower in all non-obstetric unit settings. Transfers from non-obstetric unit settings were also much higher (up to 45%) for first time mums than for women who had given birth before (up to 13%).
“These results will enable women and their partners to have informed discussions with health professionals in relation to clinical outcomes and planned place of birth,” say the authors. “For policy makers, the results are important to inform decisions about service provision and commissioning.”
But the research found wide differences across the country in the availability of midwifery units and in the way maternity services are organised and staffed, with 50% of trusts having no midwifery units in 2010.
The authors suggest that further research is needed, particularly into the effect of staffing and service configuration on outcomes, as well as a more detailed analysis of transfers from non-obstetric settings.
Dr Tony Falconer, President of the Royal College of Obstetricians and Gynaecologists commented: “We now have good evidence on the risks and benefits of each birth setting, information that is important to help women and healthcare professionals make informed choices on the place of birth.”
The College had always supported appropriately selected home birth, he said, but sounded a note of caution on first time mums wanting to give birth at home.
“The case is different for mothers with no complications in their subsequent pregnancies delivering at home or in a midwifery unit. There is therefore a need to expand these facilities with appropriate midwifery staffing to improve women’s choices,” he said.