The NHS could save women from unnecessary damage and cut costs if more women were given a real option of having their baby in a midwife unit or at home. Low risk women planning a hospital birth are three times more likely to have a c-section than those planning a birth in any other setting.
This study shows women categorised as low risk who plan to give birth at home or in a midwife unit are much healthier following birth. Those planning a hospital birth are much more likely to have interventions that lead to more physical problems during the birth, postnatally and for the rest of their reproductive life, especially during subsequent births.
For women having second or subsequent babies and planning a homebirth or birth in a midwife led unit the outcomes are clear: mothers do better and babies do just as well as women who plan hospital births.
For women having their first baby the research is less clear, women who plan to give birth at home or in a midwife unit clearly have fewer problems, with the associated ongoing implications for better health for themselves and future babies, with babies doing just as well when the birth was in a midwife led unit.
The study shows that there is a small increased risk for babies of first time mothers who plan homebirths. So few babies died that it is not possible to know if this is effected by the place of birth, but when this statistic is considered along with other poor outcome statistics such as meconium aspiration or a broken collar bone, it seems there is a small increase from about 0.5% to 1% of problems overall. However it is not clear to what extent some of the problems may be short term and how many of these babies may recover and grow to be healthy children.
Women need to understand that any risk for the baby is very small, but that there are significant potential benefits of birth at home and in midwife units for themselves, which may make caring for their baby and breastfeeding (if they want to) easier, and which also reduces their risks in their next pregnancy and birth.
Further research is needed on how safety for first babies can be improved at home and in hospital, particularly when the decision to transfer from home to hospital is made during labour.
By implementing a community based midwifery service which enables women to choose birth in free-standing midwifery units or at home would save the NHS tens of millions every year, an improve the health of both mothers and babies. Caesarean sections alone more than double the cost of birth. AIMS is concerned that the costs of hospital deliveries are still inadequately calculated.
AIMS also has concerns that the standard of care received by women transferring into hospital due to medical concerns when a home birth has been planned is very poor in some places.
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 doi: 10.1136/bmj.d7400
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