Fertility and pregnancy

First time births at home more risky

First time home birth Hospital and home as safe for second birth

Babies born at home to first-time mothers are nearly three times more likely to have serious medical problems than those born in a hospital, a report has found.

However, overall, the risk to the baby is still low, and for women with low-risk pregnancies who already have a child, a home-birth is as safe as having a baby at hospital, the study by Oxford University found.

The safety of having a home birth compared with giving birth in a hospital setting has been much debated in recent years.

In the largest study of its kind, researchers in the Birthplace in England Collaborative Group compared the outcomes of more than 64,500 planned births in England which took place in a variety of settings including at home, in a midwifery unit, midwife-led units based in hospitals and in obstetric units.

For women with low risk pregnancies, the overall rate of an adverse outcome for the baby was low - at 4.3 per 1,000 births - regardless of where the women gave birth.

Adverse outcomes included stillbirth, death within a week of delivery, brain injury, faeces in the lungs and injuries to the baby's upper arms or shoulders.

But for women giving birth for the first at home, the rate of adverse outcomes was higher, at 9.3 per 1,000 births, compared with 3.5 per 1,000 in a hospital setting.

The rate of adverse outcomes was much lower for women who gave birth to a second or third baby at home at 2.3 per 1,000, and the study found "no significant difference" between the different birth settings.

Women who gave birth for the first time at home were more likely to be transferred to a hospital (45%) compared with women who had given birth before (12%), usually because the pregnancy was not progressing or because the woman asked for an epidural.

Births which took place at home or in a birth centre were much less likely to have interventions such as an epidural, forceps delivery or caesarean section.

Professor Peter Brocklehurst, who led the study, but is now based at University College London, stressed that adverse outcomes are rare. He said: "For every 1,000 women, 995 babies would have a completely normal outcome.

"These results should reassure pregnant women planning their birth that they can make informed decisions about where they'd most like the birth to happen, knowing that giving birth in England is generally very safe."

Dr Tony Falconer, President of the Royal College of Obstetricians & Gynaecologists, said: "The RCOG has always supported appropriately selected home birth but this study has shown that first-time mothers wishing to deliver at home have an increased risk of poor outcomes for their babies thus raising questions about the right birth location for this group of women.

"The case is different for mothers with no complications in their subsequent pregnancies delivering at home or in a midwifery unit.

"There is therefore a need to expand these facilities with appropriate midwifery staffing to improve women's choices."

This article was published on Fri 25 November 2011



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