Are Booked Home Births Safe? UK

Main Category: Pregnancy / Obstetrics
Also Included In: Nursing / Midwifery
Article Date: 04 Apr 2008 - 3:00 PDT

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A new study to be published in BJOG: An International Journal of Obstetrics and Gynaecology examines the safety of homebirths and provides the best estimate we have of intrapartum perinatal mortality (IPPM) rates for booked home births.

The IPPM rate is defined as deaths of babies from asphyxia, anoxia or trauma during labour or after delivery including stillbirths and deaths in the first week.

Researchers looked at all births in England and Wales between 1994 and 2003. Data was provided by the Confidential Enquiry into Maternal and Child Health (CEMACH). Births analysed in this study were: the completed home births group (births occurring at home on the wishes of the mother), the transferred group (births originally intended to occur at home but transferred to hospital because of arising complications) and the unintended home birth group (births occurring at home, but where intended elsewhere, ie. hospital or midwifery unit).

Over the ten-year period, between 1994 to 2003, a total of 4,991 intraparturm perinatal deaths occurred. Researchers found that the IPPM rate improved over these years.

Researchers found that the completed home birth group had a lower IPPM rate of 0.48 per 1,000 births, while the unintended home birth group had an IPPM rate of 1.42 per 1,000 births. The rate for the transfer group was 6.05 per 1,000 births. The study reveals an increased IPPM rate for the booked home births group over the period of the study. In general, the outcome for women booking a home birth was good. However, for the women requiring a transfer of care, they appeared to have done significantly worse.

Dr Martin Whittle from the National Collaborating Centre for Women's and Children's Health (NCC-WCH), who co-authored the paper, said "Although the findings are interesting the really important issue is the deficiency in the data and the need for much better information in the future, something that should be provided by the Department of Health funded study, Birthplace, being conducted by the NPEU."

Professor Philip Steer, BJOG Editor-in-chief, said "The results of this large scale study show that the IPPM rates for booked home births, especially for women requiring a transfer, did not seem to improve. This does not mean that home births are unsafe but that the series of events during labour are sometimes unpredictable. Recourse to quick action makes a difference.

"More resources are needed to ensure that women booking a home birth are provided with the support they need during this important moment in their lives."

Notes

BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Blackwell Publishing. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide. Please quote 'BJOG' or 'BJOG: An International Journal of Obstetrics and Gynaecology' when referring to the journal

Reference

An estimation of intrapartum-related perinatal mortality rates for booked home births in England and Wales between 1994 and 2003.
Mori R, DoughertyM, Whittle M.
BJOG 2008;115:554-559

Royal College of Obstetricians and Gynaecologists