Where is it best to give birth?

The challenge

For expectant parents, the decision of where they choose to give birth can be a difficult one. There are a variety of conflicting and strongly held opinions about the relative benefits and risks associated with giving birth at home, in a midwife-led unit or in an obstetric unit.

Without strong, reliable evidence, about the various options, doctors and midwives can’t provide women with the information they need to make an informed choice.

 

Newborn baby

What we did

Researchers funded by the NIHR collected data about the labour, delivery and outcomes of over 64,000 ‘low risks’ births in England. They compared the safety of births planned to take place in four different settings: home, freestanding midwifery units, alongside midwifery units  and obstetric units.

Obstetric units are situated in hospitals where diagnostic and medical treatment services (including obstetric, neonatal and anaesthetic care) are available on site.

‘Alongside’ midwifery units are situated in the same hospital or site as an obstetric unit so, although women may need to be physically moved to the obstetric unit, they have access to the same treatment options on site.

‘Freestanding’ midwifery units are not situated in a hospital or site with an obstetric unit or neonatal unit. This means that if the woman or the baby requires this care, they will need to be transferred to a hospital where these services are provided.

 


 

What we found

The study found that for healthy women with low risk pregnancies, there was generally a low risk of unfavourable outcomes in all settings.

For the women in this group giving birth to a second or subsequent child, there was no differences in unfavourable outcomes between planned births at home or those in a midwifery unit, compared with planned births in an obstetric unit.

Midwifery units appear to be safe for the baby and offer benefits for the mother. Women who planned birth in these units (AMU or FMU) had fewer interventions - including substantially fewer intrapartum caesarean sections. There were more ‘normal births’ in these units compared to planned births in an obstetric units, with no significant differences in adverse outcomes.

For those giving birth to their first child, the risk seems to be higher for planned births at home (although the risk is still generally low). The transfer rate to hospital is higher for these women in all setting, compared to women who had given birth before.

 


 

Impact

The findings could affect how hundreds of thousands of women think about where they wish to give birth. The reassurance the findings give to low-risk women could also save the NHS money - a planned home birth costs the NHS almost 35% less than in an obstetric unit, and a planned birth in a midwife-led unit costs more than 10% less. In 2014, the section on Place of Birth was updated in NICE guidelines to incorporate the findings of the study.