I wrote this a while ago and a version of it will be in the book.
Where Should I Have My Baby? Or Is Home Birth Safe?
When I was born home birth was normal and hospital birth was considered unusual; it was reserved for that small amount of complicated pregnancies, but ever since a government paper called the Peel Report (1971) was published most births have taken place in hospital; recent research however, published in 2014 has looked at this subject again and come to very different conclusions (the Birthplace Study 2011).
The National Perinatal Epidemiology Unit in Oxford (NPEU) completed the Birthplace Study 2011 and here is the summary of the scientists’ findings:
The Birthplace cohort study compared the safety of births planned in four settings: home, freestanding midwifery units (FMUs), alongside midwifery units (AMUs) and obstetric units (OUs).
The main findings relate to healthy women with straightforward pregnancies that meet the NICE intrapartum (another word for ‘in the birthing process’) care guideline criteria for a ‘low risk’ birth.
Giving birth is generally very safe
- For ‘low risk’ women the incidence of adverse perinatal outcomes (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, and specified birth related injuries including brachial plexus injury) was low (4.3 events per 1000 births).
Midwifery units appear to be safe for the baby and offer benefits for the mother
- For planned births in freestanding midwifery units and alongside midwifery units there were no significant differences in adverse perinatal outcomes compared with planned birth in an obstetric unit.
- Women who planned birth in a midwifery unit had significantly fewer interventions, including substantially fewer intrapartum caesarean sections, and more ‘normal births’ than women who planned birth in an obstetric unit.
For women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother
- For multiparous (women having second babies) women, there were no significant differences in adverse perinatal outcomes between planned home births or midwifery unit births and planned births in obstetric units.
- For multiparous women, birth in a non‐obstetric unit setting significantly and substantially reduced the odds of having an intrapartum caesarean section, instrumental delivery or episiotomy (a cut between the anus and perineum).
For women having a first baby, a planned home birth increases the risk for the baby
- For nulliparous (woman having first baby) women, there were 9.3 adverse perinatal (occurring during the time of birth) outcome events per 1000 planned home births compared with 5.3 per 1000 births for births planned in obstetric units, and this finding was statistically significant.
For women having a first baby, there is a fairly high probability of transferring to an obstetric unit during labour or immediately after the birth
- For nulliparous women, the peri‐partum (while a woman is in the birthing process (transfer rate was 45% for planned home births, 36% for planned FMU births and 40% for planned AMU births
For women having a second or subsequent baby, the transfer rate is around 10%
- For women having a second or subsequent baby, the proportion of women transferred to an obstetric unit during labour or immediately after the birth was 12% for planned home births, 9% for planned FMU births and 13% for planned AMU births.
What does all that mean?
- Giving birth is generally safe; there are only 4.3 negative birth events per 1000 births.
- If you are having your first baby together, choosing to give birth in a midwifery led unit is as safe as giving birth in a doctor-managed hospital.
- Giving birth in a doctor-managed hospital leads more chance of your partner having a caesarean section (operation) and other unnecessary medical interventions while in the birthing process.
- Your partner has more chance of having a ‘normal birth’ in a midwifery led unit.
- If you are planning your first baby at home there is a 9.3:1000 chance of a negative birth event happening in the birthing process as compared to a 5.3:1000 rate in a doctor-managed hospital.
- If this is your partners first pregnancy and you are considering a home birth she has an increase chance of 4 negative birth events in 1000 births more than if she was giving birth in a doctor-managed hospital. She does however have a 45% chance of needing to transfer to hospital in the midst of the birthing process.
As we have discussed already given the impact that a quiet place as on birth unfolding well thinking and planning for a birth in a midwifery unit might seem the best option.
You may not want to rule out a home birth given the study’s finding, the 45% transfer rate refers to moving into hospital and not to actual negative birth events per say; the reasons for making a move could be many.
The study above is of women who have ‘uncomplicated pregnancies’, if your partner has any medical ‘problems’ that are effecting her pregnancy getting specialist advice is the place to start as you seek to settle your mind about choice of place to give birth