October 13, 2002

Home birth statistics

Yesterday I was a speaker at a Home Birth Conference in Chichester. The program was titled “Home Birth - Empowering Women” and there were a number of speakers, including Andrya Prescott, independent midwife (“Birth - A Normal Process”), Jill Hutchings, NHS midwife (“A Parents Guide to Homebirth”) Andrea Simons, obstetrician (“Getting Risk into Perspective”) and Jonathan Montgomery, Professor of Health Care Law (“Does the law empower women?”). My presentation was entitled “Empowering Women to Keep Birth Normal”.

There were about 130 people in attendance, a nice mix of parents, midwives, childbirth educators and students. All the presentations were well received and the day was voted a success by everyone.

Several interesting issues arose during the day. Andrew Simons had some intriguing statistics from the hospitals in the counties of Kent, Sussex and Surrey in the south of England that showed considerable variations it the numbers of homebirths within each region. Brighton had a home birth rate of 10%, whereas most hospitals reported around 2%. There were other figures that showed the vacancy rates for midwives in each unit, and there were large variations from 26% down to 1%. When the two tables were matched up it was clear that those hospitals that had the lowest rate of home births were also the ones with the highest vacancy rates for staff and that those units that provided good midwifery services had few vacancies. It was a stark reminder that midwives don’t want to work in units that are medicalised, non midwife and woman friendly and that offer few choices in the way services are provided.

There were also some very good data on the safety of homebirths. Examination of the birth outcomes for mothers and babies for planned homebirths showed that the risk to the baby was extremely low and that women also had a much safer time at home. Of course, this is to be expected, since if the system is working properly (i.e. midwives are well supported in their decisions to transfer) then those women and babies at risk should, on the whole, the identified in time to be transferred to hospital for appropriate care. Unplanned homebirths, however, proved very risky indeed, for both mothers and babies.

The figures don’t, however, tell the whole story because included in the unplanned homebirth statistics were both those who gave birth unexpectedly before arriving at hospital as well as those who plan to have a birth at home without professional help. If a woman had not booked a home birth, she was deemed to have an “unplanned” homebirth. It was clear from the table showing each hospital’s outcomes that in one unit, there were a large number of “unplanned” homebirths, many more than “planned” homebirths, and yet they had good outcomes. It was not possible to find out why this was the case, but I suspect that in this particular area, midwives don’t ask the woman decide in advance where she wants to give birth, but instead wait until the labour is in progress to make that decision. A birth that occurs at home under these circumstances would be classified as “unplanned”.

Not booking women for a birthplace early in the pregnancy but waiting until the labour to make the final decision is a very good way of boosting home birth rates. The Albany Practice (part of Kings Hospital) has certainly proven this and boasts a 43% home birth rate, easily the best in the UK, and this has been achieved with a caseload of whom 85% are classified as “high risk”. There are lessons to be learned from this approach, and ones that would not only enable better choices for women to be offered, but ones that would enable midwives to get increased job satisfaction. A solution to the chronic shortage of midwives, perhaps?

Posted by andrea at October 13, 2002 11:44 PM

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