Perinatal and maternal outcomes in planned home and obstetric unit births in women at ‘higher risk’ of complications: secondary analysis of the Birthplace national prospective cohort study

Li, Y.; Townend, Jonathan N.; Rowe, Rachel; Brocklehurst, Peter; Knight, Marian; Linsell, Louise; Macfarlane, Alison; McCourt, Christine; Newburn, Mary; Marlow, Neil; Pasupathy, Dharmintra; Redshaw, Maggie; Sandall, Jane; Silverton, Louise; Hollowell, Jennifer

doi:10.1111/1471-0528.13283

Cited by 31 publications

(44 citation statements)

References 14 publications

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“…Further work is required. It is important to note that overall prevalence of intervention was higher in the hospital cohort (augmentation, epidural analgesia, assisted vaginal, and cesarean birth), which supports international literature on lower intervention rates in out‐of‐hospital births 7, 10, 13…”

Section: Discussionsupporting

confidence: 78%

“…International literature supports the safety of an out‐of‐hospital birth in a low‐risk population in systems in which an out‐of‐hospital birth is well integrated in a broader maternal‐child health program 2, 3, 4, 5, 6, 7, 8, 9, 10, 11. The safety of a planned home birth under midwifery care in Ontario has been established 12, 13.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes for the First Year of Ontario's Birth Center Demonstration Project

Ae¹,

Sidney²,

Ek³

et al. 2018

J Midwife Womens Health

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IntroductionIn 2014, Ontario opened 2 stand‐alone midwifery‐led birth centers. Using mixed methods, we evaluated the first year of operations for quality and safety, client experience, and integration into the maternity care community. This article reports on our study of safety and quality of care.MethodsThis descriptive evaluation focused on women admitted to a birth center at the beginning of labor. For context, we matched this cohort (on a 1:4 basis) with similar low‐risk midwifery clients giving birth in a hospital. Data sources included Ontario's Better Outcomes Registry and Network (BORN) Information System, the Canadian Institute for Health Information, Ontario census data, and birth center records.ResultsOf 495 women admitted to a birth center, 87.9% experienced a spontaneous vaginal birth, regardless of the eventual location of birth, and 7.7% had a cesarean birth. The transport rate to a hospital was 26.3%. When compared with midwifery clients with a planned hospital birth, rates of intervention (epidural analgesia, labor augmentation, assisted vaginal birth, and cesarean birth) were significantly lower in the planned birth center group, even when controlled for previous cesarean birth and body mass index. Markers of potential morbidity were identified in about 10% of birth center births; however, there were no short‐term health impacts up to discharge from midwifery care at 6 weeks postpartum. Care was low in intervention and safe (minimal negative outcomes and transport rates comparable to the literature).DiscussionIn the first year of operation, care was consistent with national guidelines, and morbidity and mortality rates and intervention rates were low for women with low‐risk pregnancies seeking a low‐intervention approach for labor and birth. Further evaluation to confirm these findings is required as the number of births grows.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Outcomes for the First Year of Ontario's Birth Center Demonstration Project

Ae¹,

Sidney²,

Ek³

et al. 2018

J Midwife Womens Health

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“…Nevertheless, a small proportion of women in England opt for planned VBAC in midwifery‐led settings, including at home and in freestanding midwifery units (FMUs), i.e. those located on a site separate from an OU, or in alongside midwifery units (AMUs) located in the same building or on the same site as an OU …”

Section: Introductionmentioning

confidence: 99%

Maternal and perinatal outcomes in women planning vaginal birth after caesarean (VBAC) at home in England: secondary analysis of the Birthplace national prospective cohort study

Rowe

Knight

et al. 2015

BJOG

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ObjectiveTo compare vaginal birth rates in women planning vaginal birth after caesarean (VBAC) at home versus in an obstetric unit (OU) and explore transfer rates in women planning home VBAC.DesignProspective cohort study.Setting OUs and planned home births in England.Population1436 women planning VBAC in the Birthplace cohort, including 209 planning home VBAC.MethodsWe used Poisson regression to calculate relative risks adjusted for maternal characteristics.Main outcome measuresMain outcomes: (i) vaginal birth and (ii) transfer from planned home birth to OU during labour or immediately after birth. Secondary outcomes: (i) composite of maternal blood transfusion or admission to higher level care, (ii) stillbirth or Apgar score <7 at 5 minutes, (iii) neonatal unit admission.ResultsPlanned VBAC at home was associated with a statistically significant increase in the chances of having a vaginal birth compared with planned VBAC in an OU (adjusted relative risk 1.15, 95% confidence interval 1.06–1.24). The risk of an adverse maternal outcome was around 2–3% in both settings, with a similar risk of an adverse neonatal outcome. Transfer rates were high (37%) and varied markedly by parity (para 1, 56.7% versus para 2+, 24.6%).ConclusionWomen in the cohort who planned VBAC at home had an increased chance of a vaginal birth compared with those planning VBAC in an OU, but transfer rates were high, particularly for women with only one previous birth, and the risk of an adverse maternal or perinatal outcome was around 2–3%. No change in guidance can be recommended.Tweetable abstractHigher vaginal birth rates in planned VBAC at home versus in OU but 2–3% adverse outcomes and high transfer rate.

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“…For high-risk women, maternal and neonatal outcomes can be improved by monitoring the conditions of both [36]. Childbirth safety is linked to childbirth planning, considering maternal and fetal conditions to ensure the well-being of both after childbirth.…”

Section: Resultsmentioning

confidence: 99%