Just in time for celebration of the Nativity, comes a massive British study comparing incidence of adverse outcomes in home births versus births in hospitals and outpatient clinics. For fans of home birth, the news is pretty good!

The study assessed rates of perinatal adverse events occurring in low-risk pregnancies over a 2-year period (2008-2010) in England at different planned locations. The population included women giving birth at home and attended by a midwife provided by the National Health Service (N=16,840); at freestanding midwifery units (N=11,282), at midwife-led units in hospitals (N=16,710) or in hospital obstetrics units (N=19,706).

The primary outcome was a composite of perinatal mortality and intrapartum-related neonatal morbidities (stillbirth after start of care in labor, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, and fractured humerus or clavicle).

In an overall analysis, planned birth location did not significantly affect adverse perinatal outcomes per 1,000 births. Home births showed no statistically significant increase in risk of adverse outcomes (4.2 per 1,000 for home settings; 3.5 for freestanding midwifery units; 3.6 for midwife-led units in hospitals; 4.4 for obstetric units) (level 2 [mid-level] evidence). The findings were published in the British Medical Journal.

Adverse event rates were generally higher for nulliparous women than for multiparous women, and in this subpopulation, birth setting did have some influence: home birth was associated with a higher rate (9.3 per 1,000 births, p < 0.05) compared to other locations in nulliparous women (4.5 for freestanding midwifery units, 4.7 for midwife-led units in hospitals, 5.3 for obstetric units). No such difference was observed in the multiparous women. (DynaMed level 2 [mid-level] evidence).

Planned birth in obstetric units was associated with an increased rate of intervention during labor compared to other locations, a finding that is consistent with other studies indicating that planned births at home and in midwife units can reduce interventions during labor compared to planned births in hospital obstetric units.

This study, led by researchers at Oxford University and sponsored by the Birthplace in England Collaborative Group is the first to provide good quality data on the risk of serious adverse outcomes for different planned birth locations.

Thanks to our friends at DynaMed for this article.