Homebirth for first-time Mums: what does the research say?

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...Homebirth carries a higher risk for the babies of first-time mothers, according to a landmark study published in the British Medical Journal.

However, the chance of harm to the baby is still under 1% ...

For a second birth there was no difference in the risk to babies between home, a midwife-led unit or a doctor-led hospital unit.

Midwife-led care was in general much more likely to lead to a natural birth.

The Birthplace study is the largest carried out into the safety of different maternity settings - comparing births at home, in midwife-led units attached to hospitals, those that are stand-alone and doctor-led hospital units.

All the women followed had healthy pregnancies and began labour with no known risk factors.

It found that, overall, birth is very safe wherever it happens.

The rates of complications, including stillbirth or other problems affecting the baby, was 5.3 per 1,000 births in hospital compared with 9.3 per 1,000 home births (for women having their first baby).

Rate of complications for first-borns per 1,000

Stand-alone midwife unit - 4.5 Hospital midwife unit - 4.7 Hospital - 5.3 Home - 9.3

... About 45% of women planning to have their first baby at home were transferred during labour, although this was mainly because of delays in giving birth and the need for an epidural pain-relief injection, rather than because the baby was in distress.

Rates of normal birth

60% hospital obstetric unit 76% hospital midwife unit 83% freestanding midwife unit 90% home

The transfer itself was not thought to be responsible for the difference because there was no raised risk for women moved from stand-alone midwife units to hospital during labour.

There was no difference in risk when women were having their second baby, whether that was at home, in a midwife unit or a traditional hospital setting.

The rate of transfer from home to hospital was much lower too, at just 12% (for women having their second and subsequent babies).

... [This study] reveals an unexplained difference in the rate of normal birth between units run by midwives and those run by doctors. The disparity on emergency Caesarean sections is particularly striking. It suggests a different culture in the way midwives and doctors see birth, with doctors concerned about risks and midwives focused on normality.

... this research should drive an an expansion in midwife-led care, either at birth centres or at home for the half of women expected to have a low-risk birth.

... The research also confirms that midwife-led care is much more likely to lead to a normal birth - without any interventions, including forceps or ventouse.

That was true whether the baby was born at home or in a midwife-led unit.

The emergency Caesarean rate for the low-risk women in the study was 11% in doctor-led units compared with only 2.8% at home, and 4.4% in a midwife led unit on a hospital site.

... "Where a woman needs an emergency Caesarean section for their first birth, they will not be regarded as low risk for the next birth, and won't have the choice of going outside a medically-led unit."

The Key Findings of the study:

Giving birth is generally very safe

For 'low risk' women, the incidence of adverse perinatal outcomes (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, and specified birth related injuries including brachial plexus injury) was low (4.3 events per 1000 births).

Midwifery units appear to be safe for the baby and offer benefits for the mother

... there were no significant difference in adverse perinatal outcomes compared with planned birth in an obstetric unit.

Women who planned birth in a midwifery unit ... had significantly fewer interventions, including substantially fewer intrapartum caesarean sections, and more 'normal births' than women who planned birth in an obstetric unit.

For women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother

For multiparous women, there were no significant differences in adverse perinatal outcomes between planned home births or midwifery unit births and planned births in obstetric units.

For multiparous women, birth in a non-obstetric unit setting significantly and substantially reduced the odds of having an intrapartum caesarean section, instrumental delivery or episiotomy.

For women having a first baby, a planned home birth increases the risk for the baby

For nulliparous women, there were 9.3 adverse perinatal outcome events per 1000 planned home births compared with 5.3 per 1000 births for births planned in obstetric units, and this finding was statistically significant.

For women having a first baby, there is a fairly high probability of transferring to an obstetric unit during labour or immediately after the birth

For nulliparous women, the peri-partum transfer rate was 45% for planned home births, 36% for planned FMU births and 40% for planned AMU births

For women having a second or subsequent baby, the transfer rate is around 10%

For women having a second or subsequent baby, the proportion of women transferred to an obstetric unit during labour or immediately after the birth was 12% for planned home births, 9% for planned FMU births and 13% for planned AMU births.

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