Birth choice urged as study shows "safe" pregnancies
Friday November 25th, 2011
Women with straightforward pregnancies should be allowed to choose where they give birth - but this may not apply to first pregnancies, according to a landmark British study published today.
First-time
mothers who opt for a home birth have a increased risk of medical problems,
according to the research. Even so, the overall risk is low in all birth
settings, at 4.3 serious complications per 1,000 births, the researchers
say.
The University of Oxford study also found there were no significant differences in the odds of an adverse outcome for any of the non-obstetric unit settings compared with obstetric units.
The results should “support a policy of offering women with low risk pregnancies a choice of birth setting” and should enable women and their partners to have informed discussions with health professionals about planned place of birth, say the authors.
The team, led by Professor Peter Brocklehurst for the Birthplace in England Collaborative Group, studied almost 65,000 low risk pregnancies, including nearly 17,000 planned home births and 28,000 planned midwifery unit births, between April 2008 and April 2010.
They compared perinatal outcomes and interventions in labour by planned place of birth – home, freestanding midwifery units, midwife-led units on a hospital site with obstetric services, and obstetric units – across all NHS trusts in England.
For women giving birth for the first time, the risk of an adverse outcome, such as stillbirth after start of care in labour, early neonatal death, brain injury and injuries to the upper arm or shoulder during birth, was 9.3 per 1,000 births for planned home births compared with obstetric units.
But for women who had given birth before, there were no significant differences in the rate of adverse outcomes between birth settings.
Interventions during labour, such as epidural, forceps delivery or caesarean section, were substantially lower in all non-obstetric unit settings.
Transfers to hospital from other birthplaces were frequent, particularly among first-time mothers where between 36 per cent and 45 per cent of mothers are transferred during labour or immediately after the birth.
“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, writing in the British Medical Journal.
Cathy
Warwick, chief executive and general secretary of the Royal College of
Midwives, called for a "seismic shift" in the way birth services
are organised.
She said: “The RCM hopes that its findings will be widely used and will help health professionals support women to make informed choices about their options when considering where to give birth. It should also influence the planning of high-quality maternity services across the UK and internationally.”
But the Royal College of Obstetricians and Gynaecologists warned of the risks faced by first-time mothers - pointing out that more than a third of these women would need transfer from freestanding units to specialist centres.
President Tony Falconer said midwifery units could still be expanded to care for women who have already given birth once without complications.
He said: "This study identified the need for further work on the adverse outcomes of home birth for first-time mothers and to examine why intervention rates are higher in obstetric units."
Tags: Childbirth and Pregnancy | NHS | Nursing & Midwifery | UK News | Women’s Health & Gynaecology
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