A paper published today in the BMJ, by Dutch researchers, assesses whether low-risk women at the onset of labour with planned home birth have a higher rate of rare but severe maternal outcomes than those with planned hospital births.
Severe maternal outcomes were defined as admission to an intensive care unit, uterine rupture, eclampsia or major obstetric haemorrhage (requiring a large blood transfusion). Other adverse complications included postpartum haemorrhage (severe loss of blood after delivery) and manual removal of the placenta.
The study included 146,752 women, 92,333 (63%) had a planned home birth and 54,419 (37%) had a planned hospital birth.
The results showed that for women who had previously given birth, adverse outcomes were less common among planned home births (1 per 1000) than among planned hospital births (2.3 per 1000). The rate of postpartum haemorrhage was 19.6 per 1000 for a planned home birth compared with 37.6 per 1000 for a planned hospital birth.
For women having their first baby the rate of severe outcomes for a planned home birth was 2.3 per 1000 compared with 3.1 per 1000 for a planned hospital birth. The rate of postpartum haemorrhage was 43.1 per 1000 for a planned home compared with 43.3 per 1000 for a planned hospital birth.
Dr Tony Falconer, President of the RCOG, said:
“The RCOG supports the choice of a home birth for low-risk women expecting a second or third baby. This large study reiterates the findings from the Birthplace study (https://www.npeu.ox.ac.uk/birthplace) which showed good outcomes for some low-risk women and their babies who delivered in either midwife-led units or at home. However, transfer rates to consultant-led units were high, particularly for first time mothers.
“This study, which focused on maternal outcomes only, makes the case for an expansion of midwife-led units with appropriate midwifery staffing, alongside consultant obstetric units. This would improve women’s choices, in particular for women with a previous history of normal labour and good outcome.
“The rate of home birth in the UK (2%) is low in comparison to the Netherlands where the proximity to specialist services with short transfer times is the norm. The same advantages are not always available across the UK, so the safety of home birth has to be considered in the context of the availability of local services.
“Our High Quality Women’s Health Care report emphasised the need for a reorganisation of women’s health services around clinical networks. There is a greater need for more services to be provided in the community for low-risk women. For more complex cases, women need access to units providing 24 hour consultant cover.”
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Read the full BMJ study here