Birthplace in England
The Birthplace cohort study compared the safety of births in England planned in four settings: home, freestanding midwifery units (FMUs), alongside midwifery units (AMUs) and obstetric units (OUs). The main findings relate to healthy women with straightforward pregnancies who meet the NICE intrapartum care guideline criteria for a ‘low risk’ birth.
The Birthplace in England research programme combines the Evaluation of Maternity Units in England study funded in 2006 by the National Institute for Health Research Service Delivery and Organisation (NIHR SDO) programme, and the Birth at Home in England study funded in 2007 by the Department of Health Policy Research Programme (DH PRP).
- Giving birth is generally very safe. For ‘low risk’ women the incidence of adverse perinatal outcomes was low (4.3 events per 1000 births).
- Midwifery units appear to be safe for the baby and offer benefits for the mother:
- For planned births in freestanding midwifery units and alongside midwifery there were no significant differences in adverse perinatal outcomes compared with planned birth in an obstetric unit.
- Women who planned birth in a midwifery unit (AMU or FMU) had significantly fewer interventions, including substantially fewer intrapartum caesarean sections, and more ‘normal births’ than women who planned birth in an obstetric unit. There is a need to address the higher frequency of major interventions and the relatively low proportion of ‘normal births’ in ‘low risk’ women in OUs.
- For women having a first baby, a planned home birth increases the risk for the baby. 9.3 adverse perinatal outcome events per 1000 planned home births compared with 5.3 in obstetric units.
- Some consideration needs to be given to the information and birthplace options offered to ‘high risk’ women.
- Women having a first baby should be informed that there is a fairly high probability (36-45%) of being transferred to an obstetric unit during labour or immediately after the birth. For women having a second or subsequent baby, the transfer rate is around 10%.
- Increased provision of home birth services and midwifery units is potentially cost saving, but evidence from the studies indicates:
- The higher midwife to birth ratio in non-OU settings is likely to require an increase in midwifery numbers.
- There is considerable variation between midwifery units in size, staffing levels, skill mix and throughput. These all affect costs, and may affect safety and other aspects of care.
- Strong midwifery and obstetric leadership and a culture of mutual professional respect appears to be a central feature of trusts where midwifery led and obstetric services function well alongside each other.
Further information
Find out more about the Birthplace in England Research Programme.
Access the NIHR SDO-funded Birthplace in England Research Programme research.
Read this BMJ article on 'Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study', BMJ 2011;343:d7400