Prospective regional study of planned home births

BMJ 1996;313:1302-1306 (23 November)

General practice

Prospective regional study of planned home births

J Davies, research midwife,^a E Hey, consultant paediatrician,^b W Reid, consultant obstetrician,^c G Young, general practitioner,^d for the Home Birth Study Steering Group

^a Maternity Survey Office, Newcastle upon Tyne NE2 4AA, ^b University of Newcastle, Newcastle upon Tyne NE2 4HH, ^c Cumberland Infirmary, Carlisle CA2 7HY, ^d Temple Sowerby, Cumbria CA10 1RZ

Home Birth Study Steering Group Members of the steering group are listed at the end of this report.Correspondence to: Mrs J Davies, Maternity Survey Office, 25 Claremont Place, Newcastle upon Tyne NE2 4AA.

Abstract

Objective: To collect data from a cohort of women requestinga home birth and examine the experience and outcome of pregnancy,the indications for hospital transfer, and the attitudes ofmothers, midwives, and general practitioners.
Design: Follow up study with anonymised postal questionnaires.
Setting: Northern Regional Health Authority area.
Subjects: The 256 women resident in the Northern region whoexpected to deliver in 1993 and whose request for a home birthbecame known to one of the local supervisors of midwives. Limitedcross validating information was also collected retrospectivelyon all other women delivering a baby outside hospital in 1993.
Main outcome measures: Rate of and reason for transferred care;maternal, midwifery, and general practitioner views; perinataloutcome.
Results: Five women miscarried, leaving 251 in the study. Ofthese, 142 (57%) delivered at home. There were 17 (7%) caesareansections but no perinatal deaths. General practitioners hadreservations about half of the booking requests. Two thirdsof the women thought they had not been offered any option aboutplace of birth, 74 (29%) were referred to hospital for deliverybefore the onset of labour, and 35 (14%) were referred to hospitalduring labour. Intrapartum transfers were uneventful, and halfthe mothers commented spontaneously that they valued havingspent even part of their labour at home.
Conclusions: Home birth is valued for its family setting. Generalpractitioners' support is sought and influential but uncommon,possibly because of a lack of understanding of the responsibilitiesof the midwife and general practitioner.

Key messages

Women sought support from their general prac- titioners, which when given was associated with a lower rate of transfer to hospital; most doctors declined to give support, however, because they were concerned about possible complications
A change to hospital care was common before labour (29%), though in half of these cases there was no obstetric reason for transfer
Transfer in labour was also common (14%), but on no occasion was obstetric intervention required in the first hour after transfer; women transferred appreciated having spent part of their labour at home
Midwives found their statutory obligation to help with home births generally rewarding but were sometimes concerned by lack of equipment and professional support

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to Technorati Technorati What's this?

This article has been cited by other articles:

(2006). Planned Home Birth: Safe for Selected Women. JWatch Women's Health 2006: 6-6 [Full text]
Young, G., Hey, E., Macfarlane, A., McCandlish, R., Campbell, R., Chamberlain, G., Drife, J. (2000). Choosing between home and hospital delivery. BMJ 320: 798-798 [Full text]
(1997). Can Home Births Be Safe?. JWatch Women's Health 1997: 14-14 [Full text]
(1996). HOME BIRTH: SAFE UNDER THE RIGHT CIRCUMSTANCES. JWatch General 1996: 4-4 [Full text]
Springer, N. P, Van Weel, C. (1996). Home birth. BMJ 313: 1276-1277 [Full text]
Northern Region Perinatal Mortality Survey Coordin, (1996). Collaborative survey of perinatal loss in planned and unplanned home births. BMJ 313: 1306-1309 [Abstract] [Full text]