Until recently, there has been little UK research on the safety of different places for birth. A team from the National Perinatal Epidemiology Unit (NPEU), Oxford carried out the Birthplace study to remedy this. They looked at outcomes for nearly 65,000 healthy mothers and babies at low risk of complications, who planned to give birth at home, in free standing midwifery units (FMU), in alongside midwifery units (AMU) and at home and in obstetric units (OU).
The main findings for the 20,000 women who planned births in OUs, 17,000 in AMUs, 11,000 in FMUs and 17,000 who planned home births were as follows:
- Adverse outcomes for babies were very low in all groups (250 altogether/4.3 per 1000, with only 32 baby deaths/4.9 in 10,000).
- There was no significant difference in deaths around the time of birth for low risk births in the different settings, overall.
- There was a very small increase in adverse outcomes for first babies born at home.
A concern raised about this aspect of the study is that several adverse outcomes around the time of birth were put together. These ranged from death to broken clavicles, and other conditions that some babies will recover from. The argument given was that the study would not have included a large enough number of babies to report on these rare adverse outcomes if each of the outcomes had been looked at on its own.
Women who started labour in OUs had a higher rate of interventions during labour, than women in AMUs, FMUs and at home.
Normal birth (as defined by NICE Guidelines) was highest at home and lowest in OUs (88% for home, 83% for FMUs, 75% for AMU and 58% for OUs).
Breastfeeding initiation is higher in community settings
Thus the main conclusions were that birth is very safe for healthy women and babies, that birth in midwifery units is safe for babies and good for mothers, and that birth at home is safe for babies and good for women, but that for first time babies, while the absolute risk of an adverse outcome remains low, it is slightly raised.
The transfer rate from midwifery care for women having second or subsequent babies was about 10% in out-of-hospital settings, but was over 40% for women having their first babies.
The study found that costs were lower in AMUs, FMUs and at home, even if women transfer to an OU and need medical help.
The Royal College of Midwives has welcomed the findings. They agreed that it shows birth is safe for healthy women and babies and suggests that these women should have the option to birth in the community. The Royal College of Obstetricians and Gynaecologists have also welcomed it and support healthy women to give birth in the community.
The full report can be seen at http://www.bmj.com/content/343/bmj.d7400
Nadine Edwards