Written by Christian Nordqvist
Women who are pregnant for the first time and decide to have a home birth should be aware that there is a significantly higher risk of complications, compared to first time mothers who have the baby in an an obstetric or midwifery unit, researchers from Oxford University reported in the BMJ (British Medical Journal). However, for second and subsequent births, women with low risk pregnancies do not have a statistically significantly higher risk, the authors added.
Professor Peter Brocklehurst and team explained that in general, women with low risk pregnancies should be able to freely select where they wish to give birth. They say their findings “support a policy of offering women with low risk pregnancies a choice of birth setting.”. Mothers-to-be and their partners should have informed discussions with their medical team about where they plan to have the baby.
The authors explained, as background information to the article, that birth settings have been extensively debated over the last decade. However, there are very few quality studies which focus on the benefits and risks of home births, obstetric units, and midwifery units.
Brocklehurst and team set out to determine what the perinatal outcomes and interventions might be at four birthplace settings across all NHS trusts in England.
Planned places of birth included:
- The mother’s home
- Freestanding midwifery units
- Midwife-led units at a hospital which also had an obstetric unit
- Obstetric units
They collected data on the following adverse outcomes:
- Upper arm or shoulder injuries during birth
- Meconium aspiration syndrome – feces in the lungs of the baby
- Early neonatal death
- Encephalopathy (brain injury)
- Stillbirth after start of care in labo
The study included 64,538 full term infants whose mothers had low-risk single pregnancies (no multiple births). The researchers took several factors into account, such as BMI (body mass index), ethnic group, and maternal age. In all birth settings, the overall rate for adverse outcomes was 4.3 per 1,000 births. They found no important differences in the adverse outcome rate between non-obstetric and obstetric unit settings.
They report that for first time mothers – nulliparous women – the risk of a home birth adverse outcome was 9.3 per 1,000 births – more than double the 4.3 per 1,000 overall average. Nulliparous women who gave birth at home were also found to have a significantly higher risk of adverse outcomes compared to similar women who gave birth in a midwifery unit or obstetric unit. For women who had already given birth before – multiparous women – there was no significant difference in risk between having the baby at home or elsewhere (uncomplicated pregnancies).
The intervention rate during labor was considerably lower in all non-obstetric unit settings, compared to obstetric unit ones. 45% of first time mothers were transferred from a non-obstetric unit setting to an obstetric one, compared to just 13% of those giving birth for the second, third, etc. time.
The researchers wrote: “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. For policy makers, the results are important to inform decisions about service provision and commissioning.”
The authors say they are currently investigating the cost-effectiveness of different birth settings.
In an Abstract in the same journal, they concluded: “Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes. For nulliparous women, planned home births also have fewer interventions but have poorer perinatal outcomes.”
Compared to giving birth in an obstetric unit, one that occurs in a midwifery unit is £130 (US$200) cheaper, while a home birth is £310 (US$496) cheaper. The Daily Telegraph quoted Maureen Treadwell, from the Birth Trauma Association, as saying: “These findings are useful but are based on a study of only 5,000 women in each type of midwifery unit and do not tell us how many babies died or were brain damaged in each group.”
Treadwell hopes the UK government does not use this apparent cost-benefit to eventually limit women’s choices to the cheapest option.