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November 28, 2011
Women Should Be Able To Choose Where They Give Birth


For decades, restrictive medical systems worldwide have been under the assumption that they know best when it comes to delivery and labour practices for pregnant women. However, all women with low risk pregnancies should be able to choose where they give birth anywhere in the world and it should be their right as new mothers to be. Non-obstetric unit settings such as home births are not only safe, but offer no significant differences in the odds of adverse events when compared to hospital settings.

First-time mothers who opt for home births are at no more higher risk of adverse outcomes and the overall risk has been proven to be quite low in most home birth settings.

Researchers who recently published a study on bmj.com say their results "support a policy of offering women with low risk pregnancies a choice of birth setting" and will enable women and their partners to have informed discussions with health professionals about planned place of birth.

"This not only empowers women and their partners, but it also gives the freedom to express their needs and the needs of newborns more effectively than hospital settings," said Doris Hatleva, Doula and practicing Midwife.

Many parents are opting out of hospital births due to often unnecessary procedures such as caesarean section and epidural, or invasive and mandatory protocols for newborns such forceps delivery, antibiotics for the eyes, vitamin K, and toxic environments which many claim pose greater risks to newborns non-obstetric settings.

The benefits and risks of birth in different settings have been widely debated in recent years, but there is a lack of good quality evidence comparing the risk of rare but serious perinatal adverse outcomes in these settings.

Perinatal refers to the period just before, during or shortly after birth.

So a team led by Professor Peter Brocklehurst from the University of Oxford for the Birthplace in England Collaborative Group set out to compare perinatal outcomes and interventions in labour by planned place of birth.

Planned place of birth included home, freestanding midwifery units, midwife-led units on a hospital site with obstetric services, and obstetric units.

A total of 64,538 single, full term infants born to women with low risk pregnancies were involved in the study. Factors, such as maternal age, ethnic group, body mass index and deprivation score were taken into account.

Overall, the rate of adverse outcomes was low in all birth settings (4.3 per 1,000 births) and there were no significant differences in the odds of an adverse outcome for any of the non-obstetric unit settings compared with obstetric units.

For women giving birth for the first time the risk of an adverse outcomes was no higher midwifery unit settings than hospitals. For women who had given birth before (multiparous women), there were no significant differences in the rate of adverse outcomes between any birth settings.

The results also show that interventions during labour, such as epidural, forceps delivery or caesarean section, were substantially lower in all non-obstetric unit settings.

"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," say the authors. "For policy makers, the results are important to inform decisions about service provision and commissioning."

They add that a cost effectiveness analysis of the different birth settings is currently being carried out, and they suggest that further research on this issue is needed, particularly into the effect of staffing and service configuration on outcomes, and more detailed analysis of transfers from non-obstetric settings.


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