title: Perinatal and maternal outcomes in planned home and obstetric unit births in women at 'higher risk' of complications: secondary analysis of the Birthplace national prospective cohort study.
abstract: OBJECTIVE
  To explore and compare perinatal and maternal outcomes in women at 'higher risk' of complications planning home versus obstetric unit (OU) birth.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  OUs and planned home births in England.
  
  
  METHODS
  8180 'higher risk' women in the Birthplace cohort.
  
  
  METHODS
  We used Poisson regression to calculate relative risks adjusted for maternal characteristics. Sensitivity analyses explored possible effects of differences in risk between groups and alternative outcome measures.
  
  
  METHODS
  Composite perinatal outcome measure encompassing 'intrapartum related mortality and morbidity' (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus or clavicle) and neonatal admission within 48 hours for more than 48 hours. Two composite maternal outcome measures capturing intrapartum interventions/adverse maternal outcomes and straightforward birth.
  
  
  RESULTS
  The risk of 'intrapartum related mortality and morbidity' or neonatal admission for more than 48 hours was lower in planned home births than planned OU births [adjusted relative risks (RR) 0.50, 95% CI 0.31-0.81]. Adjustment for clinical risk factors did not materially affect this finding. The direction of effect was reversed for the more restricted outcome measure 'intrapartum related mortality and morbidity' (RR adjusted for parity 1.92, 95% CI 0.97-3.80). Maternal interventions were lower in planned home births.
  
  
  CONCLUSIONS
  The babies of 'higher risk' women who plan birth in an OU appear more likely to be admitted to neonatal care than those whose mothers plan birth at home, but it is unclear if this reflects a real difference in morbidity. Rates of intrapartum related morbidity and mortality did not differ statistically significantly between settings at the 5% level but a larger study would be required to rule out a clinically important difference between the groups.
authors.affiliation: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.forename: J
authors.initials: J
authors.lastname: Townend
authors.forename: R
authors.initials: R
authors.lastname: Rowe
authors.forename: P
authors.initials: P
authors.lastname: Brocklehurst
authors.forename: M
authors.initials: M
authors.lastname: Knight
authors.forename: L
authors.initials: L
authors.lastname: Linsell
authors.forename: A
authors.initials: A
authors.lastname: Macfarlane
authors.forename: C
authors.initials: C
authors.lastname: McCourt
authors.forename: M
authors.initials: M
authors.lastname: Newburn
authors.forename: N
authors.initials: N
authors.lastname: Marlow
authors.forename: D
authors.initials: D
authors.lastname: Pasupathy
authors.forename: M
authors.initials: M
authors.lastname: Redshaw
authors.forename: J
authors.initials: J
authors.lastname: Sandall
authors.forename: L
authors.initials: L
authors.lastname: Silverton
authors.forename: J
authors.initials: J
authors.lastname: Hollowell
mesh_terms: D000328:Adult; D016550:Birthing Centers / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000401:mortality / Q000706:statistics & numerical data; D004739:England / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence; D006700:Home Childbirth / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D010298:Parity; D010347:Patient Care Planning / Q000592:standards*; D018743:Perinatal Care / Q000592:standards*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors
keywords: Adverse maternal outcomes; adverse perinatal outcomes; home birth; intrapartum interventions; obstetric risk factors; obstetric unit; planned place of birth; spontaneous labour; straightforward vaginal birth