aternity services in England offer care for mothers and babies that is the envy of many other countries. However, there are concerns that intervention rates are rising. The proportion of births by Caesarean section (c-section) has steadily increased in England over the past twenty years. Therefore nationally there is a real focus on ‘normalising birth’.
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Increasing normal or natural birth and reducing c-section deliveries will result in better quality, safer care for mothers and their babies with an improved experience. It is also associated with shorter hospital stays, fewer adverse outcomes and admissions to neonatal units and better health for mothers. It is also associated with higher rates of successful breastfeeding and a more positive birth experience.
The birth centre concept and a choice of homebirth options have come a long way, encouraging women to have babies naturally in a non-medicalised environment. Women enquiring about a planned birth in midwifery led settings should be informed of the risks and benefits. However, until recently, the evidence regarding safety of homebirth and midwifery led units were difficult to interpret. This was until 2011 when the findings from Birth Place Study were reported and published. This was a large scale prospective cohort study that included almost 65,000 mothers. The study ran between April 2008 and April 2010 in England. The study is significant as it gives support to the parents who would like to have a choice of safe birth settings.
The Birth Place Study compared the safety of births planned in four settings:
• Home • Freestanding midwifery units (FMUs) • Alongside midwifery led units (AMUs) • Obstetric units (OUs)
High quality data was collected from all but a few trusts and midwifery units in England. The researchers measured seven adverse birth outcomes. (For example meconium aspiration syndrome that is when a baby inhales contaminated amniotic fluid and respiratory problems may occur).
Small Steps 2
The key findings of the Study:
• Giving birth in England is in the main very safe in all Birth settings.
• For ‘low risk’ mothers, the incidence of adverse birth outcomes was low at 4.3 events per 1000 births.
• For all low risk mothers with planned births in freestanding midwifery and alongside midwifery units, there were no significant differences in adverse birth outcomes compared with planned birth in an obstetric unit.
• Mothers who planned birth in midwifery led units (AMU or FMU) had significantly fewer interventions in labour, including substantially fewer caesarean sections, and more natural births than mothers who planned birth in an obstetric unit.
• For first time mothers, a planned home birth appears to increase the risk for the baby, although the absolute risk is low.
• For subsequent pregnancies, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother.
The Birth Place Study also produced data on the midwifery led transfer rates to obstetric units. For a first time mother the transfer rate is expected to be, for home birth 45%, AMU 40.2%, and FMU 36.3%. For subsequent births the transfer out rate reduced considerably, home birth 12%, AMU 12.5%, and FMU 9.4%. The most common reason for transferring to an obstetric unit was slow progress in the first stage of labour.
Further details and links to the study, reports and publications can be found on the Birthplace website:
https://www.npeu.ox.ac.uk/birthplace
We would like to acknowledge the help of Sara Kenyon (University of Birmingham) with the expert knowledge around Birth Place.
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