The Birthplace in England research programme

This Birthplace follow-on project attempts to to answer a number of questions, such as the care of women with complications or risk factors who give birth in non-Obstetric Unit settings.

Investigators: Professor Jane Sandall, Jennifer Hollowell (University of Oxford)

Funding: Study taking place in a Tommy’s funded centre

Summary: The NHS in England currently provides services for birth in four types of setting – hospital obstetric units (OUs), midwifery units provided alongside an OU (AMU), freestanding midwifery units (FMUs), and at home. Many NHS trusts, however, provide only a limited range of services. The results of the Birthplace cohort study show that, for low-risk women, giving birth is generally very safe. MUs appear to be safe for babies and to offer benefits for women in terms of reduced intervention. For women having a second or subsequent baby, home birth and MU birth appear to be safe for the baby and to offer benefits for the mother. However, for women having a first baby, home birth increases the risk of a poorer outcome for the baby. For women having a first baby there is a fairly high chance of being transferred to an OU during labour or immediately after the birth, though for women having a second or subsequent baby the chances are much lower.

Progress report: This Birthplace follow-on project has been attempting to to answer a number of questions that have not yet been addressed, such as the care of women with complications or risk factors who elect to give birth in non-OU settings. The expansion of non-OU intrapartum care could potentially reduce intervention rates in low-risk women but major changes such as centralisation of services in larger units (OUs and AMUs) or changes to unit admission criteria need to be accompanied by appropriate monitoring and evaluation. The primary Birthplace study together with the findings of this study support a policy of increasing provision of home birth services to support multiparous women who wish to plan birth at home. The information provided by this research will help managers plan how maternity services are organised and give more information to women, and those caring for them, in order to help women make an informed choice about their planned place of birth.

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