Home deliveries in Nottingham 1980–81

doi:10.1016/S0033-3506(85)80066-4

Public Health

Volume 99, Issue 5, September 1985, Pages 307-313

https://doi.org/10.1016/S0033-3506(85)80066-4 Get rights and content

Abstract

All 192 women resident in Nottingham Health district who delivered a child successfully at home during 1980 and 1981, together with a control group of 365 women drawn as a random sample of Nottingham residents delivering successfully in hospital, were sent a postal questionnaire seeking their views on why they chose their place of delivery. They were also asked a series of questions about the quality and organization of obstetric services.

Most women were very satisfied both with the general standard of obstetric care andwith their place of delivery at booking, and wanted subsequent children to be born in the same place. The percentages of women who had hospital-deliveries wanting a home-confinement next time, and those who had a home-delivery who wanted a hospital-delivery next time were almost identical (12% as opposed to 10%). Viewed in percentage terms, these figures do not suggest that there is a large suppressed demand for home-confinements among women in Nottingham. However, in absolute terms they imply that around 2300 women who had a hospital-delivery in 1980 and 1981 would like a home-delivery next time-a sizeable figure.

Concern was expressed about certain matters such as the organization and atmosphereof hospital ante-natal clinics, the too-early use of analgesics and the tendency for too much medical intervention. Attention to these problems could, of course, increase the numbers expressing satisfaction with hospital-deliveries. However, it seems clear that there will always be a small group of women who, for a variety of reasons, prefer a home-delivery. This necessitates the maintenance of as high a level of obstetric skill in the community as possible, together with the existence of a well-trained and equipped obstetric flying squad.

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This study describes the outcomes of 11,788 planned home births attended by certified nurse-midwives (CNMs) from 1987 to 1991: A retrospective survey was used to obtain information about the outcomes of intended home birth, including hospital transfers, as well as practice protocols, risk screening, and emergency preparedness. Ninety nurse-midwifery home birth practices provided data for this report (66.2% of identified nurse-midwifery) home birth practices). It is estimated that 60–70% of all CNM-attended home births reported in national statistics data during this period were represented in this survey. The overall perinatal mortality was 4.2 per 1,000, including known third-trimester fetal demises. There were no maternal deaths. The intrapartum and neonatal mortality for those intending home birth at the onset of labor was 2 per 1,000; the overall neonatal mortality rate for this group was 1.3 per 1,000. When deaths associated with congenital anomalies were excluded, the intrapartum and neonatal mortality rate was 0.9 per 1,000; the neonatal mortality was 0.2 per 1,000. The overall transfer rate, including antepartum referrals, was 15.9%. The intrapartium transfer rate for those intending home birth at the onset of labor was 8%. Most responding nurse-midwives used standard risk-assessment criteria, only delivered low-risk women at home, and were prepared with emergency equipment necessary for immediate neonatal resuscitation or maternal emergencies. This study supports previous research indicating that planned home birth with qualified care providers can be a safe alternative for healthy lower risk women.
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Although consumer demands may dictate a review of the highly mechanized and sophisticated technology of obstetric care provided in some parts of the western world, problems in Saudi Arabia revolve around under-utilization of health care facilities for maternity care and the consequences of this circumstance. A multifactorial analysis was performed to study the association of certain social correlates with options for birth settings in a rural region of the Kingdom. Age and educational level of the mother were found to be highly significant (P < 0.005) variables influencing the choice for place of delivery, whereas economic status (P > 0.1) and housing conditions (NS) tailed to make an equally impressive contribution. Within the constraints of available health care manpower at the local level, suggestions are made for the best strategy to successfully educate mothers for safer options in birth.
Birthing autonomy: Women's experiences of planning home births
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Meta-analysis of the Safety of Home Birth
1997, Birth
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1996, British Medical Journal
Sheila Kitzinger's Letter from England: Home Birth—A Call for Action
1994, Birth

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Home deliveries in Nottingham 1980–81

Abstract

Obstetrics versus midwifery—the verdict of the statistics

Maternal and Child Health

Where to be born?

New Society

The safest place of birth; further evidence

Lancet

Home or hospital births?

JAMA