Research: What was the impact on home birth rates of a dedicated service?
The Birthplace study provided the catalyst for a dedicated home birth service (HBS) at a large urban teaching hospital.
The aim of the three-year pilot was to increase the home birth rate from 0.3% to 3% of all trust births. MSWs completed a two-year (day release) foundation degree and competency-based training in order to be able to attend low-risk home births as second birth attendants, as well as undertake other skilled tasks such as phlebotomy, newborn blood spot screening and breastfeeding support.
The HBS pilot achieved a 1.4% home birth rate and 1.8% intrapartum care rate in three years. Of the referrals to the HBS (n=886), just under a third (n=278) of women either changed their minds or were recommended to have a hospital birth due to identified risk factors and 223 who had planned to have home births transferred back to hospital during pregnancy, primarily due to development of risk factors. This resulted in just over a third of women (n=302) who had originally requested a referral for home birth actually achieving a home birth.
While home birth was offered as a place of birth choice to low-risk women, 52 women with risk factors chose to have a home birth outside guidance. The most frequent reason was a BMI over 35 (n=11, 21%). Care plans were developed by the named midwife in conjunction with the family, an obstetrician and senior midwife with summary of advice and specific plans for antenatal, intrapartum (which included two midwives to attend the birth) and postnatal care. The peripartum transfer rate from home to hospital was 54% for primigravid and 14% for multiparous women with no adverse outcomes. There were 18 women (33%) who transferred to hospital for delay in labour and 13 (25%) transfers for fetal distress. The most frequent reason (n=12, 29%) for postnatal transfer was suboptimal neonatal observations when babies were transferred to the maternity unit or the neonatal unit for observation.
There has been excellent feedback from the families who planned a home birth including those who had a peripartum transfer. While there has been a five-fold increase in numbers of home births during the three-year pilot, and in spite of extensive promotion of the service, it has not met the target of 3% of all trust births. Increasing the home birth rate requires a longer-term change to the culture surrounding the place of birth.
Fiona Cross-Sudworth was the home birth team leader at Birmingham Women’s Hospital
Cross-Sudworth F, Hindley J, Cheatham C, Clarke P, McAree T. (2018) Creating a dedicated home birth service: results of a three-year pilot. British Journal of Midwifery 26(3): 164-71.