Many of you are no doubt aware of the study released last week by the Birthplace in England Collaborative Group. The purpose of the study was to take a detailed look at the risks associated with different settings where women with low-risk pregnancies plan to give birth: hospital OB units, midwifery-run birth centers within or close to hospitals, freestanding birth centers, and at home.
The study ran from April 2008 to April 2010. The measured outcome was a composite of things that can go wrong for babies at birth: death at or just after birth, and injuries that may occur during birth such as broken bones, traumatic nerve injury, brain injury and a type of respiratory distress called meconium aspiration syndrome .
The findings: overall, birth for low-risk women was equally safe in all four settings. In other words, low-risk births anywhere in England tended to have low rates of bad outcomes.
When the data was carved up a bit more, one difference popped up: women having their first babies at home were 2 to 3 times more likely to have bad outcomes than those giving birth in any of the other settings. The risks were still quite low, but the increase was statistically significant.
The British press jumped all over that statistic. Many were quick to condemn all home birth as dangerous and not all the reporting was accurate. (See the Daily Mail story here, which exaggerates the risk of death or brain damage.)
Cooler heads are still trying to have themselves heard over the tabloid din. Britain’s National Health Service, which directs midwifery care in England, has an excellent review of the study’s findings and the risks of home birth (which includes the definition of a low-risk pregnancy, too). It’s well worth the read.
What seems to have been somewhat overlooked in all hubbub about risks to first-time mothers is what the study found about women having second or later babies. There was no safety difference for these mothers in any of the birth settings – birth at home was as safe as anywhere else. Fortunately, some reporters picked up on that part of the story.
So what’s the Birthplace in England study’s bottom line? That low-risk births generally go well, regardless of where they happen. A first-time mother planning a home birth needs to be aware of the small but significantly increased risk her choice entails, and second-time moms should be fine regardless of birth setting.
Ah, but that’s in England, where home birth is integrated into the larger maternity care system. The U.S. is a whole different story. And there’s more to assessing risk of place of birth than focusing on immediate outcomes. More on that soon.