Intended for healthcare professionals

General Practice

Prospective regional study of planned home births

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7068.1302 (Published 23 November 1996) Cite this as: BMJ 1996;313:1302
  1. J Davies, research midwifea,
  2. E Hey, consultant paediatricianb,
  3. W Reid, consultant obstetricianc,
  4. G Young, general practitioner

    for the Home Birth Study Steering Group

    d
  1. a Maternity Survey Office, Newcastle upon Tyne NE2 4AA
  2. b University of Newcastle, Newcastle upon Tyne NE2 4HH
  3. c Cumberland Infirmary, Carlisle CA2 7HY
  4. d Temple Sowerby, Cumbria CA10 1RZ
  1. 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.
  • Accepted 8 October 1996

Abstract

Objective: To collect data from a cohort of women requesting a home birth and examine the experience and outcome of pregnancy, the indications for hospital transfer, and the attitudes of mothers, 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 who expected to deliver in 1993 and whose request for a home birth became known to one of the local supervisors of midwives. Limited cross validating information was also collected retrospectively on 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; perinatal outcome.

Results: Five women miscarried, leaving 251 in the study. Of these, 142 (57%) delivered at home. There were 17 (7%) caesarean sections but no perinatal deaths. General practitioners had reservations about half of the booking requests. Two thirds of the women thought they had not been offered any option about place of birth, 74 (29%) were referred to hospital for delivery before the onset of labour, and 35 (14%) were referred to hospital during labour. Intrapartum transfers were uneventful, and half the mothers commented spontaneously that they valued having spent even part of their labour at home.

Conclusions: Home birth is valued for its family setting. General practitioners' support is sought and influential but uncommon, possibly because of a lack of understanding of the responsibilities of 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

Footnotes

  • Funding Northern Regional Health Authority

  • Conflict of interest None.

  • Accepted 8 October 1996
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