Pregnant women at low risk of complications can safely be offered a choice of where to give birth

November 25, 2011, British Medical Journal

Women with low risk pregnancies should be able to choose where they give birth, concludes a study published in the British Medical Journal today. Although it shows that first-time mums who opt for a home birth are at a higher risk of adverse outcomes, the overall risk is low in all birth settings.

The researchers say their results "support a policy of offering with low risk pregnancies a choice of birth setting" and will enable women and their partners to have informed discussions with health professionals about planned place of birth.

The benefits and risks of birth in different settings have been widely debated in recent years, but there is a lack of good quality evidence comparing the risk of rare but serious perinatal adverse outcomes in these settings.

Perinatal refers to the period just before, during or shortly after birth.

So a team led by Professor Peter Brocklehurst from the University of Oxford for the Birthplace in England Collaborative Group set out to compare 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 , (encephalopathy), in the lungs (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 , ethnic group, and deprivation score were taken into account.

Overall, the rate of adverse outcomes was low in all birth settings (4.3 per 1,000 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 (nulliparous women), the risk of an adverse outcome was higher (9.3 per 1,000 births) for planned home births compared with obstetric units, but not for either midwifery unit settings. In contrast, for women who had given birth before (multiparous women), there were no significant differences in the rate of adverse outcomes between birth settings.

The results also show 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 nulliparous women than for multiparous women (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."

They add that a cost effectiveness analysis of the different settings is currently being carried out, and they suggest that further research on this issue is needed, particularly into the effect of staffing and service configuration on outcomes, and more detailed analysis of transfers from non-obstetric settings.

Explore further: Women with polycystic ovary syndrome at increased risk of pregnancy complications

Related Stories

Women with polycystic ovary syndrome at increased risk of pregnancy complications

October 13, 2011
Women with polycystic ovary syndrome are more likely to have problems with pregnancy regardless of whether they are undergoing fertility treatment, claims new research published in the British Medical Journal today.

Recommended for you

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...

Teens likely to crave junk food after watching TV ads

January 15, 2018
Teenagers who watch more than three hours of commercial TV a day are more likely to eat hundreds of extra junk food snacks, according to a report by Cancer Research UK.

Can muesli help against arthritis?

January 15, 2018
It is well known that healthy eating increases a general sense of wellbeing. Researchers at Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) have now discovered that a fibre-rich diet can have a positive influence ...

Your dishwasher is not as sterile as you think

January 13, 2018
(HealthDay)—Your dishwasher may get those plates spotless, but it is also probably teeming with bacteria and fungus, a new study suggests.

Study reveals what sleep talkers have to say

January 12, 2018
A team of researchers with members from several institutions in France has conducted a study regarding sleep talking and has found that most sleep talking is not only negative in nature, but involves a large amount of swearing. ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.