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What are the main results of the study?
Giving birth is generally very safe for healthy women with a
straightforward (‘low-risk’) pregnancy. ‘Adverse outcomes’ for
babies are rare regardless of where mothers plan to give birth,
occurring overall, in just 4 or 5 births in every 1000. These, adverse
outcomes (see below) are serious, or potentially serious events, but
thankfully they are rare.
All the results from the Birthplace study discussed below are for
healthy women with a straightforward pregnancy and they refer
to outcomes for births in different settings analysed according to where
the birth was planned at the start of labour care.
Planning to give birth in a midwifery unit results in no differences in adverse
outcomes for their babies (deaths and serious, or potentially serious, health
complications), compared with planning to give birth in an obstetric unit.
This applied to the babies for women who had given birth previously and to
Midwifery units also offer benefits for the mother. Mothers were significantly
less likely to have an assisted delivery, caesarean section or other common
interventions. There are also many more ‘normal births’ without major
interventions at any stage. ‘Normal birth’ is defined as occurring when
labour starts spontaneously, there is no use of epidural, spinal or general
anaesthesia and the baby is born without the assistance of episiotomy,
ventouse, forceps or caesarean.1,2
Women planning a home birth were more likely than women planning for
birth in other settings to have a normal birth: 88% of planned home births are
‘normal births’ compared to just under 60% of planned obstetric unit births.
For women having a second or subsequent baby, home births are safe for the
baby and offer benefits for the mother.
For women having a first baby, a planned home birth increases the risk for the
baby somewhat. In all groups of women there were at least 990/1000 births
without adverse outcomes. There were 9.3 adverse outcomes for babies
per 1000 planned home births compared with 5.3 per 1000 for births planned
in obstetric units, and this finding was statistically significant. So there may be
around 4 extra adverse outcomes in every 1000 planned home births
compared with births planned in obstetric units.
Transfers to hospital from planned home births and midwifery units are
relatively frequent, particularly among first-time mothers. Transfers are one
of the reasons why planned home and midwifery unit births are as safe
as they are, enabling additional care to be provided when it is needed.
Birthplace findings generally support women with healthy,
straightforward pregnancies having free choice of place of birth,
based on where they would feel most comfortable giving birth.
1. Werkmeister G, Jokinen M, Mahmood T, et al. Making normal labour and birth
a reality - developing a multi-disciplinary consensus. Midwifery 2008;24(3):256-9.
2. Maternity Care Working Party. Making normal birth a reality. Consensus
statement from the Maternity Care Working Party: our shared views about the
need to recognise, facilitate and audit normal birth. National Childbirth Trust;
Royal College of Midwives; Royal College of Obstetricians and Gynaecologists;
2007. Available from: http://www.nct.org.uk/professional/research/