Homebirth Evidence by AMELIA JANE BROWN

2018-03-23 14:07:08 UTC

Home is a familiar environment where a woman can receive all required standard care during labour and after the birth (NICE 2014)

Are First‐Time Mothers Who Plan Home Birth More Likely to Receive Evidence‐Based Care? A Comparative Study of Home and Hospital Care Provided by the Same Midwives

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This study revealed that women in the planned hospital birth group used more pharmacological pain management, experienced more obstetric interventions, had a greater rate of postpartum hemorrhage, and achieved spontaneous vaginal birth less often than those in the planned home birth group. All results were significant (p < 0.05).

Miller, S., & Skinner, J. (2012). Are First-Time Mothers Who Plan Home Birth More Likely to Receive Evidence-Based Care? A Comparative Study of Home and Hospital Care Provided by the Same Midwives. Birth-Issues In Perinatal Care, 39(2), 135-144.

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One to one midwife care- At home, the same midwife will usually stay with a woman in established labour until the baby is born, and a second midwife will also be present for the birth. This makes the experience much more personal and reassuring for the woman and also means the midwife is more likely to notice any potential problems before they become an emergency. (Johnson and Taylor, 2016)

Planned home birth versus planned hospital birth. Olsen (2012). Cochrane library

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Planned hospital birth is as safe as planned home birth

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Home births for women with low-risk pregnancies carry no increased risk of harm to the baby compared with a planned hospital birth, new research has found (RCM 2015)

2018-03-23 14:15:07 UTC

Home birth experiences also tend to demonstrate high levels of satisfaction (Borquez and Weigers, 2006) with an enhanced feeling of control and empowerment (Lindgren and Erlandsson, 2010).

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The Birthplace study- lowest rates for CS, assisted vaginal birth, episiotomy and drug use in labour. Home birth also resulted in the highest normal birth rate, with high levels of water immersion and physiological third stage. There were low transfer rates too (Brocklehurst et al, 2011).

Giving birth is generally safe for low risk women

2018-03-23 14:15:48 UTC

For ‘low risk’ women the incidence of adverse perinatal outcomes (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, and specified birth related injuries including brachial plexus injury) was low (4.3 events per 1000 births) NPEU (2011)

2018-03-23 14:16:10 UTC

Home Environment-

Not only do most women feel more comfortable in their own home, but at home women have everything they might need to drink, eat, wear, or to distract yourself between contractions - and there are no strangers to break concentration.

Lavender T, Chapple J. (2005) How women choose to give birth. The Practising Midwife

2018-03-23 14:18:08 UTC

Studies which look at women's experience of pain generally demonstrate that women at home are more likely to feel relaxed and in control, experience less intervention and use less pharmacological analgesia. Inevitably these factors play into each other and affect the way women perceive pain (Yerby, 2000).

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Fewer interventions

In hospital women are often given “just in case” interventions, or time limit interventions to speed up the process. One intervention unfortunately often leads to another. Research has shown that women who have home births are less likely to have medical interventions, and one study showed that planning a home birth halved the incidence of both assisted delivery and Caesarean birth.

Being in control

Many women describe feeling out of control during a hospital birth, with things being done to them, drugs administered, and not really understanding or being able to influence what happens. In their own home, women naturally feel much more in control of the whole situation and tend to report a much more positive birth experience. (Wesson, 2006)

Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort studyBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7400 (Published 25 November 2011)

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Objective To compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies.
Participants 64 538 eligible women with a singleton, term (≥37 weeks gestation), and “booked” pregnancy who gave birth between April 2008 and April 2010.
Conclusions The results support a policy of offering healthy women with low risk pregnancies a choice of birth setting. Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes. For nulliparous women, planned home births also have fewer interventions but have poorer perinatal outcomes.

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Advise low-risk multiparous women that planning to give birth at home or in a midwifery-led unit is particularly suitable for them, because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit (NICE, 2014)

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https://m.youtube.com/watch?v=r2a4c3HOk7ghttps://m.youtube.com/watch?v=r2a4c3HOk7g

2018-03-23 14:43:03 UTC

Women aged 35 to 39 were most likely to give birth at home; 3.0% of all women in this age group gave birth at home in 2015. Women aged under 20 were least likely, with only 0.9% of under twenties giving birth at home. In 2015, the percentage of women giving birth at home is lower for women aged 25 and over and higher for the under 25’s when compared with 2005.

Birth characteristics in England and Wales (2015)