The Birthplace in England Research Programme was a multi-disciplinary research progamme, jointly funded by the National Institute for Health Research (NIHR) Service Delivery and Organisation programme and the Department of Health Policy Research Programme. Further analyses of data from the Birthplace cohort study were funded by the NIHR Health Services and Delivery Research Programme.
The Birthplace cohort study
The Birthplace national cohort study was designed to answer questions about the risks and benefits of giving birth in different settings, focusing in particular on birth outcomes in healthy women with straightforward pregnancies who are at ‘low risk’ of complications.
The study collected data on care in labour, delivery and birth outcomes for the mother and baby for over 64,000 ‘low risk’ births in England including nearly 17,000 planned ‘low risk’ home births, 28,000 planned ‘low risk’ midwifery unit births (AMUs and FMUs) and nearly 20,000 planned ‘low risk’ obstetric unit births.
The cohort study: key findings
The Birthplace cohort study compared the safety of births planned in four settings: home, freestanding midwifery units (FMUs), alongside midwifery units (AMUs) and obstetric units (OUs). The main findings relate to healthy women with straightforward pregnancies who meet the NICE intrapartum care guideline criteria for a ‘low risk’ birth.
Giving birth is generally very safe
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).
Midwifery units appear to be safe for the baby and offer benefits for the mother
For planned births in freestanding midwifery units and alongside midwifery there were no significant differences in adverse perinatal outcomes compared with planned birth in an obstetric unit.
Women who planned birth in a midwifery unit (AMU or FMU) had significantly fewer interventions, including substantially fewer intrapartum caesarean sections, and more ‘normal births’ than women who planned birth in an obstetric unit.
For women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother
For multiparous women, there were no significant differences in adverse perinatal outcomes between planned home births or midwifery unit births and planned births in obstetric units.
For multiparous women, birth in a non?obstetric unit setting significantly and substantially reduced the odds of having an intrapartum caesarean section, instrumental delivery or episiotomy.
For women having a first baby, a planned home birth increases the risk for the baby
For nulliparous women, there were 9.3 adverse perinatal outcome events per 1000 planned home births compared with 5.3 per 1000 births for births planned in obstetric units, and this finding was statistically significant.
For women having a first baby, there is a fairly high probability of transferring to an obstetric unit during labour or immediately after the birth
For nulliparous women, the peri?partum transfer rate was 45% for planned home births, 36% for planned FMU births and 40% for planned AMU births
For women having a second or subsequent baby, the transfer rate is around 10%
For women having a second or subsequent baby, the proportion of women transferred to an obstetric unit during labour or immediately after the birth was 12% for planned home births, 9% for planned FMU births and 13% for planned AMU births.
Birthplace Q&A guide to the key findings of the Birthplace cohort study and other studies conducted as part of the Birthplace in England research programme.
The Birthplace research programme was coordinated from the National Perinatal Epidemiology Unit, University of Oxford. Jennifer Hollowell, Associate Professor, is the principal point of contact for Birthplace.
National Perinatal Epidemiology Unit (NPEU) RDB, University of Oxford
Old Road Campus Oxford OX3 7LF
Birthplace was designed by the multi-disciplinary collaborative group of maternity care researchers, health professionals and service users listed below. This group was responsible for the design and governance of the Birthplace programme.
Professor Peter Brocklehurst, Professor of Perinatal Epidemiology, NPEU, University of Oxford
Professor Alison Macfarlane, Professor of Perinatal Health, City University London
Professor Neil Marlow, Professor of Neonatal Medicine, University College London
Professor Rona McCandlish, Midwifery Professional Advisor, Chief Nursing Officer's Professional Leadership Team, Department of Health (on secondment from NPEU from February 2009)
Professor Christine McCourt, Professor of Maternal and Child Health, City University London
Alison Miller, Programme Director and Midwifery Lead, CMACE
Mary Newburn, Head of Research and Information, NCT
Professor Stavros Petrou, Professor of Health Economics, University of Warwick
Dr Maggie Redshaw, Social Scientist, NPEU, University of Oxford
Professor Jane Sandall, Professor of Women's Health and Programme Director (Innovations), NIHR King's Patient Safety and Service Quality Research Centre, King's College, London
Louise Silverton, Deputy General Secretary, Royal College of Midwives