Re: Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study
CCBYNCOpen access
Rapid response to:
Research
Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study
Re: Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study
For years, government policy has promoted home birth as a safe option. Now, for first time mums, there are question marks. Birthplace however is reporting that freestanding midwifery units are safe. Are they really?
For low risk nulliparous women without complications at the start of labour the risk of one of the serious ‘primary outcomes’ is:
22 cases out 4785 in a free standing midwifery unit
28 cases out of 8018 in an obstetric unit.
And for stillbirth;
0.4 per 1000 in a freestanding midwifery unit
0.2 per 1000 in an obstetric unit
This is BEFORE adjustment for the increased risk profile of women choosing obstetric unit care and an acknowledgment that there may have been some data loss due to transfer.
These figures do not reach statistical significance but perhaps we should pause for thought, dig a bit deeper and ask a few more questions before reconfiguring the entire country’s maternity services.
A larger study is planned on intrapartum deaths but this still will not tell the whole story – some babies die much later from birth injuries.
As a user group, what we have found inexplicable is that despite the enormous amount of time the NHS devotes to recording data, the reporting of severe maternal and neonatal outcomes is not available at the flick of switch for each unit in the country.
Indeed, despite the hard work of the NPEU, it has actually taken nearly five years and hundreds of thousands of pounds of research funding to get as far as we have.
Rapid Response:
Re: Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study
For years, government policy has promoted home birth as a safe option. Now, for first time mums, there are question marks. Birthplace however is reporting that freestanding midwifery units are safe. Are they really?
For low risk nulliparous women without complications at the start of labour the risk of one of the serious ‘primary outcomes’ is:
22 cases out 4785 in a free standing midwifery unit
28 cases out of 8018 in an obstetric unit.
And for stillbirth;
0.4 per 1000 in a freestanding midwifery unit
0.2 per 1000 in an obstetric unit
This is BEFORE adjustment for the increased risk profile of women choosing obstetric unit care and an acknowledgment that there may have been some data loss due to transfer.
These figures do not reach statistical significance but perhaps we should pause for thought, dig a bit deeper and ask a few more questions before reconfiguring the entire country’s maternity services.
A larger study is planned on intrapartum deaths but this still will not tell the whole story – some babies die much later from birth injuries.
As a user group, what we have found inexplicable is that despite the enormous amount of time the NHS devotes to recording data, the reporting of severe maternal and neonatal outcomes is not available at the flick of switch for each unit in the country.
Indeed, despite the hard work of the NPEU, it has actually taken nearly five years and hundreds of thousands of pounds of research funding to get as far as we have.
Competing interests: No competing interests