First time mothers warned over home birth risks
Published 25/11/2011 | 10:24
First-time mothers who opt for a home birth are almost three times more likely to suffer complications than if they go to hospital, a landmark study has found.
The study, the largest and most comprehensive ever conducted, also found that up to half of first time mothers were transferred to hospital while in labour from home and third from a midwifery unit.
Doctors warned that for women having their first babies, these factors should be taken into account when choosing where to give birth.
However the research found that women having their second or third babies, who were classed as low risk, were just as safe at home or in a midwife-only unit as they were in a hospital unit with specialist obstetricians.
Home births were cheaper for the NHS to provide and doctors said they should be encouraged for women having their second or third babies who had straightforward first births and healthy pregnancies.
Midwifery leaders said the landmark study would strengthen calls for changes to be made to NHS services to allow more women to give birth in midwife-only units or at home.
The research was conducted by Oxford University involving more than 65,500 births classified as low risk.
It found that rates of complications affecting the baby including stillbirth after the start of labour, the baby dying within the first week of birth, brain injury, fractures to the upper arm or shoulder during birth, and faeces in the lungs, were higher for first time mothers.
There were 9.5 such complications per 1,000 births for first time mothers having their baby at home, compared with 3.5 per 1,000 births to first time mothers in hospital.
There was no increased risk for babies whose birth was planned at units led by midwives, either ones that stand alone in the community or which are attached to a hospital, according to the report, published in the British Medical Journal.
The researchers stressed that giving birth is generally very safe as 250 babies suffered complications from the 64,538 births in the study.
Only 58 per cent of women in hospital had a natural birth without any intervention, compared to 88 per cent of women who opted for a birth at home and 76 per cent to 83 per cent of women who chose a midwife-led unit.
Professor Peter Brocklehurst, who led the study at Oxford, but has since moved to University College London (UCL), said adverse events are very uncommon.
"For every 1,000 women, 995 babies would have a completely normal outcome," he said.
Prof Brocklehurst added: "These results should reassure pregnant women planning their birth that they can make informed decisions about where they'd most like the birth to happen, knowing that giving birth in England is generally very safe.
"There is an increase in risk for first-time mums planning home births, but poor outcomes for the baby are still uncommon."
He said the reason why babies born to first time mothers at home suffered more complications is not known.
Maureen Treadwell, of the Birth Trauma Association, said: "These findings are useful but are based on a study of only 5,000 women in each type of midwifery unit and do not tell us how many babies died or were brain damaged in each group."
She feared that the government will use the findings as 'an excuse' to restrict women's choices to midwife-led units or home if they were classed as low risk, in order to save money.
The study showed that a home birth cost £310 less than one in an obstetric unit in hospital, while a birth in a midwife-led unit was £130 cheaper.
Cathy Warwick, chief executive and general secretary of the RCM added: "Where a woman having her first baby is considering birth at home, she needs to be aware that whilst the vast majority of babies will be well, there is a chance that wherever she gives birth, the baby may have a poor outcome and at home this chance is slightly increased.
"However, the need for medical interventions in labour, such as the need for pain relief, remains less than in a consultant-led unit."
Dr Tony Falconer, President of the Royal College of Obstetricians & Gynaecologists (RCOG) said: “The RCOG has always supported appropriately selected home birth but this study has shown that first-time mothers wishing to deliver at home have an increased risk of poor outcomes for their babies thus raising questions about the right birth location for this group of women.
"In addition, the high transfer rates from free-standing midwifery units and midwifery units alongside obstetric units, for first-time mothers pose serious logistical problems.
“The case is different for mothers with no complications in their subsequent pregnancies delivering at home or in a midwifery unit. There is therefore a need to expand these facilities with appropriate midwifery staffing to improve women’s choices.
"This study supports the concept of configuring maternity services differently and the expansion of midwifery units should occur."
Public Health Minister Anne Milton said: “Every woman should receive the highest quality maternity care. This study will help NHS organisations around the country design excellent maternity services, based on what women want and need.
"This report gives valuable evidence on which to base decisions about the design of services, including the opportunities for women to choose midwife-led care in both free-standing and alongside midwife-led units.
“It will also help midwives advise women so that they can make the most informed choice about their birth setting.”