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Birthplace under the microscope

22 January, 2014

Birthplace under the microscope

Secondary analysis of Birthplace confirms a lower rate of intervention for low-risk births outside OUs. Posted: 22 January 2014 by Julie Griffiths

A secondary analysis of the Birthplace cohort study has confirmed that, regardless of age, women with low-risk pregnancies who give birth outside an obstetric unit (OU) have a lower rate of intervention.

Pregnant bump for fetal growth story

But the study, published in the BMJ, also found that the incidence of intrapartum intervention and adverse outcomes requiring obstetric care does increase with maternal age.

The effect of maternal age and planned place of birth on intrapartum outcomes in healthy women with straightforward pregnancies: secondary analysis of the Birthplace national prospective cohort studyby Yanmei Li et al was looking at the data from the Birthplace in England national prospective cohort study, which compared perinatal and maternal outcomes and interventions by planned place of birth.

The initial study compared the safety of births planned in four settings: home, freestanding midwifery units, alongside midwifery units and OUs. The findings were based on 79,774 births between 2008 and 2010 in England.
The secondary analysis found that, among nulliparous women, younger women appear to benefit more from the reduction in interventions associated with planned birth in a non-OU setting.

It said that increased intervention rates at older ages may partly reflect women's expectations and preferences as well as the possibility of being labelled ‘higher risk’ by clinicians.

The paper said that first-time mothers who planned birth in a non-OU setting should be told that the risk of an intervention required obstetric care increased with age.

It concluded that further research was needed to evaluate the adverse perinatal outcomes in ‘low-risk’ women aged over 40.

Louise Silverton, RCM director for midwifery, said:’The Birthplace study of 2011 showed that planned out of hospital births were, generally, as safe for the baby as those in hospital for low-risk women having their second or subsequent baby. This major study took into account early indicators of the potential risks of future disabilities to the baby.
‘Continuity of care is key to ensuring good outcomes for both mother and baby, hence our call for more midwives to ensure that this happens.’

To read the secondary analysis, click here.

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