25 November 2011
Birthplace Study on safety of births in obstetric units, midwifery units and home births
Today sees the long-awaited publication of the Birthplace Study which looked at what happened to over 64,000 “low risk” mothers and babies giving birth in England. This included:
17,000 women having a home birth
28,000 women giving birth in a midwifery unit (also called a birth centre or midwife-led unit)
20,000 women giving birth in a hospital obstetric unit (also called a consultant unit)
The study was based on women’s plans at the start of labour of where they were going to give birth. It only looked at women who were at low risk of complications – healthy and with no complications in the current or a previous pregnancy. They didn’t include women having twins, or who had had a previous caesarean birth. They also excluded women who had a planned induction or caesarean. When looking at the effect of place of birth, the study took into account women’s age, ethnicity and whether it was a first pregnancy.
The most important outcome the researchers looked at how safe the birth was for the baby. In general, a birth was unsafe if the baby died during the labour or shortly afterwards, if it suffered any birth injury or if the baby didn’t get enough oxygen during the birth.
The research also looked at how the birth was for the mother – such as whether she had interventions like a caesarean or instrumental birth, or if she needed a blood transfusion. It also looked at positive measures such as whether she breastfed her baby after the birth, or if she had a “normal birth” without medical intervention.
Results
For women at low risk of complications, the results showed that, overall, wherever a woman has her baby, birth is very safe with about 4.3 “unsafe births” for every 1000 births.
1.Women having a second or subsequent baby
The results showed there was no difference in safety between births planned to be in obstetric units, midwifery units and at home.
About 10% of women planning out-of-hospital births had to be transferred to hospital either in labour or after the baby was born. Just over 6% of second time (plus) mums planning a home birth had to be transferred before their baby was born and 5% after the baby was born. Nearly 9 out of 10 successfully completed their homebirths with no need to go to hospital.
2 Women having a first baby
There was no difference in safety between women planning a birth in an obstetric unit with those planning a birth in a midwifery unit, whether that unit was some distance away from the hospital ("freestanding") or on the same site ("alongside"). For women planning a home birth for a first baby, the number of babies having problems was 9.3 per 1000 births compared to 5.3 per 1000 in an obstetric unit. Midwifery units were as safe as obstetric units for first time mothers.
Women planning a home birth or midwifery unit birth for their first baby were more likely to transfer to an obstetric unit than second time mums. 35% transferred from home before their baby was born, and 9% afterwards. About 55 in 100 women planning a first baby at home were able to successfully complete their home births without going to hospital. There were fewer transfers from midwifery units – about 36-40%.
Benefits of birth away from obstetric units
Low-risk women planning births at home or in midwifery units had significantly fewer interventions than women giving birth in obstetric units. These interventions would have almost all taken place after transfer to hospital.
|
Obstetric unit |
Home |
Midwifery unit (alongside an obstetric unit) |
Midwifery unit (freestanding) |
Caesarean |
11.1% |
2.8% |
4.4% |
3.5% |
Forceps |
6.8% |
2.1% |
4.7% |
2.9% |
Ventouse |
8.1% |
2.0% |
4.8% |
2.7% |
Augmentation (speeding up labour with a drip) |
23.5% |
5.4% |
10.3% |
7.1% |
Epidural |
30.7% |
8.3% |
15.3% |
10.6% |
Episiotomy (cut to help the baby be born) |
19.3% |
5.4% |
13.1% |
8.6% |
|
|
|
|
|
“ Normal birth”* |
57.6% |
87.9% |
76.0% |
83.3% |
*birth without induction, epidural or spinal, general anaesthetic, caesarean, forceps, ventouse or episiotomy.
Low risk women planning an obstetric birth were nearly 4 times more likely to have an emergency caesarean than those planning a home birth, 4 times more likely to have a ventouse birth and 3 times more likely to have a forceps delivery. They were also more than 3 times more likely to have an epidural or episiotomy, and more than 4 times more likely to have labour artificially speeded up.
BirthChoiceUK says:
This study has been well conducted with expert researchers and investigators. It had a large sample size and chose outcomes appropriate to the size of the study. It adjusted where possible for factors other than birth setting which could have affected the results.
This study shows that birth in England is very safe for women at low risk of complications, wherever that takes place. For first time mothers planning a home birth there is a higher chance that they will have to transfer to hospital and a slight increase in risk to their baby over choosing another setting. This needs to be taken into account when choosing a home birth, along with the significantly higher likelihood of having major interventions during labour of choosing an obstetric birth.
For women having a second or subsequent baby, women can significantly reduce their chance of having medical interventions without any change in the safety of the birth by choosing birth in a midwifery unit or at home.
For more information see the NPEU Birthplace website https://www.npeu.ox.ac.uk/birthplace/results, or read the peer-reviewed paper on the BMJ website.