Women with Low Risk Pregnancies Can Choose Where to Give Birth
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A new study shows that women with low risk pregnancies should be able to choose where they give birth.
The study concludes that first time moms who opt for a home birth are at a higher risk of adverse outcomes but the overall risk is low in all birth settings.
The researchers say their results "support a policy of offering women with low risk pregnancies a choice of birth setting."
The controversy between the benefits and risks of birthing settings has been widely debated, but the authors said that “there is a lack of good quality evidence comparing the risk of rare but serious perinatal adverse outcomes in these settings.”
Researchers were led by Professor Peter Brocklehurst from the University of Oxford for the Birthplace in England Collaborative Group.
To determine the severity of benefits and risk factors, the team took on a study comparing perinatal outcomes and interventions in labor by planned place of birth across all NHS trusts in England including, home, freestanding midwifery units, midwife-led units on a hospital site with obstetric services, and obstetric units.
The study involved a total of 64,538 single, full term infants born to women with low risk pregnancies.
The authors said that factors, such as maternal age, ethnic group, body mass index, and deprivation scores were taken into account.
The researchers said that serious adverse outcomes included stillbirth after start of care in labor, early neonatal death, brain injury, faeces in the lungs, and injuries to the upper arm or shoulder during birth.
Low Risk
But overall the rate of adverse outcomes was low in all birth settings, at 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, the authors explained.
The risk of an adverse outcome was higher for women giving birth for the first time, at 9.3 per 1,000 births for planned home births compared with obstetric units, but not for either midwifery unit settings, while women who had given birth before had no significant differences in the rate of adverse outcomes between birth settings.
The study also showed that in all non-obstetric unit settings had substantially lower interventions during labor, such as epidural, forceps delivery or caesarean section.
"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."
The authors added that “a cost effectiveness analysis of the different birth 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.”
The full study was published Friday on bmj.com.