Does homebirth increase the risk of a negative maternal and fetal outcome in primigravida women than birth in a hospital setting?
Word count: 3,284
Submission date: 5th April 2013
This study intends to examine current evidence and literature on maternal and fetal outcomes in relation to birth setting. The student aims to critically analyse the findings of up to date research studies and make recommendations for change where necessary, whilst concluding whether homebirth is a safe option for primigravide women.
In Britain today all women have the right to choose where to birth their baby. For many the decision will be based on convenience, their lifestyle or medical factors with some feeling that a birth at home is a more natural and relaxed place for their baby to be born. Primigravida women have the same right as primiparous women to choose between a birth at home and a birth in a hospital setting even though evidence has suggested that primigravida’s are at an increased risk of a negative perinatal outcome (Brocklehurst et al, 2011). The student has chosen to discuss the safety of homebirth for primigravida women from her experience of a negative perinatal outcome while in attendance of a planned homebirth. This experience has made the student question how safe a birth is outside of a hospital setting for low risk primigravida women. For this independent study the student intends to research quantitative evidence from UK and European based studies to evaluate if there is a correlation between homebirth and negative maternal and neonatal outcomes for low risk primigravida women in comparison to outcomes for primigravidas birthing in a midwifery or obstetric led unit. The student aims to answer:
• Is homebirth a safe option for low risk primigravida women?
• Does place of birth have an impact on maternal and fetal outcomes?
• Are primigravidas more likely than primiparous women to have a negative outcome regardless of birth setting?
By answering these questions the student hopes to conclude whether the evidence suggests that homebirth should remain an option for all low risk pregnant woman regardless of parity or whether in the interest of patient safety the guidelines on homebirth in the UK need to be reassessed to put in place additional safety measures or an exclusion criteria to make homebirth a safe option for primigravida. The aim of this study is to assess whether the home is a safe place for a primigravide woman to birth her baby with the aim of achieving a positive maternal and neonatal outcome. By drawing a conclusion midwives should be able to offer primigravide women evidence based advice and make recommendations based on the findings of the research in order for women to make an informed decision about their planned place of birth.
At present homebirths account for approximately 3% of births within the UK but they are increasing in popularity amongst women who perceive homebirth to be a convenient option that fits in to a busy lifestyle. The birthplace in England national prospective cohort study (British Medical Journal, 2011) was a large study in to perinatal and maternal outcomes by planned place of birth that encompassed all NHS trusts across England. A total of 64,538 women with low risk pregnancies, as defined by NICE intrapartum care guideline 2007, and included nearly 17,000 planned homebirths were recruited over a 2 year period with the study comparing results from home, midwife led unit and obstetric led unit births with researchers primarily focusing on rates of mortality and morbidity in relation to the birth setting. The study found that overall the rate of a negative maternal outcome occurring which included serious maternal complications and death was 4.3 per 1000 women and that no difference was noted between obstetric led units and non-obstetric led settings...
References: Saving Mothers Lives. CEMACE. 2011. [Available online: www.rcog.org.uk]
The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives
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