Academic Journal
Main Category: Pregnancy / Obstetrics
Article Date: 25 Nov 2011 - 0:00 PST
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A study published on bmj.com says that women with low risk pregnancies should be able to choose where they give birth, and even though first-time mothers opting for a home birth are at a higher risk of adverse outcomes, the overall risk remains low in all birth settings.
The study's results "support a policy of offering women with low risk pregnancies a choice of birth setting" and encourage parents-to-be to discuss information about planned birth locations with health professionals.
Despite many debates about the benefits and risks of birthing in different settings in recent years, there is a lack of good quality evidence that compares the risk of rare yet serious adverse outcomes just before, during or shortly after birth (perinatal) in these settings.
Research leader, Professor Peter Brocklehurst, from the University of Oxford, on behalf of the Birthplace in England Collaborative Group, and his colleagues decided to conduct a study in which perinatal outcomes and interventions in labor were compared by planned places of birth across all NHS trusts in England. The researchers defined planned birthing places as freestanding midwifery units, home, midwife-led units on hospital sites with obstetric services, and obstetric units.
Serious adverse outcomes included upper arm or shoulder injuries during birth, early neonatal death, stillbirth after the start of care in labor, brain injury (encephalopathy), and feces in the lungs (meconium aspiration syndrome).
Researchers enrolled a total of 64,538 single, full term infants born to women with low risk pregnancies in the study and accounted for factors, such as ethnic group, maternal age, body mass index and deprivation score.
They discovered that the overall rate of adverse outcomes was low, i.e. 4.3 per 1,000 births in all birth settings, with no substantial differences in risk between births that took place in any of the non-obstetric unit settings compared with obstetric units.
The risk of an adverse outcome for first-time mothers giving birth (nulliparous women) was higher, i.e. 9.3 per 1,000 births, for planned home births compared with obstetric units, but not when compared with both midwifery unit settings.
The researchers noted no important differences in adverse outcome rates between birth settings for those mothers who had given birth before (multiparous women) and found that interventions during labor, such as forceps delivery, epidural or cesarean section, were significantly lower in all non-obstetric unit settings.
They also observed that transfers from non-obstetric unit settings were 45% higher for nulliparous women compared with only 13% for multiparous women.
The researchers conclude:
"These results will enable women and their partners to have informed discussions with health professionals in relation to clinical outcomes and planned place of birth. For policy makers, the results are important to inform decisions about service provision and commissioning."??
A cost effectiveness evaluation of the different birth settings is being conducted at present, the authors explained, and indicate the necessity for further research, in particular with regard to the impact of staffing and service configuration on outcomes, as well as more detailed analysis of transfers from non-obstetric settings. ??
Written by Petra Rattue
Copyright: Medical News Today
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MLA
8 Dec. 2011.
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