Wednesday, April 22, 2009

Grassroots Network: New home birth study from the Netherlands

Dear Friends,

As many of you may have heard, a very large study of home birth in the Netherlands was just published last week. The abstract is below, as well as the link to the abstract on the website of BJOG (an International Journal of Obstetrics & Gynecology). The study concludes that giving birth at home is as safe as hospital (if the birth is planned, with a well-trained midwife, and there is adequate transportation to and communication with medical services). It anticipates a similar study out of the UK that will be forthcoming. Mary Newburn, head of research and information at the National Childbirth Trust, commented that the study "makes a significant contribution to the growing body of reassuring evidence that suggests offering women a choice of place of birth is entirely appropriate."

Molly previously posted some additional links regarding this study. A comment to Rixa's blog included a link to a letter to the editor of the British Medical Journal from Madeleine Akrich, PhD and Bernard Bel, PhD, Collectif interassociatif autour de la naissance), that included these comments:

"We do share Visser & Steegers' concern about high transfer rates in low-risk births. As suggested in their paper, bad rates point at the detrimental effect of discontinuity of care, rather than at unforeseen serious complications. In their words, "healthy pregnant women need care, not cure."

"Besides, the transfer rates of home births seem to be rising in the Netherlands. They were 40% and 9% for nulliparae and multiparae respectively in 2002. It is also significant that these rates were even higher from polyclinics to hospital: 43% and 19% respectively, as deducted from the enclosed graphs. (The leftmost bars indicate home and polyclinic births and the central ones indicate transfers from home and from polyclinics.)

"Midwives comment that they feel more under pressure to accelerate labour when working closer to "the machines". This observation remains consistent with the conclusions of Wiegers and colleagues comparing midwifery practice at home and in hospitals: Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands (TA. Wiegers, MJNC. Keirse, J. van der Zee, GAH. Berghs). BMJ 1996;313:1309-1313"

The bottom line is that the vast majority of women, especially for first births, benefit from continuous support during labor, not more medical attention.

In addition, you may also find it useful to read CfM's article about ACOG and the AMA here and a discussion of "safety" here.

Arielle Greenberg Bywater and Susan Hodges

Article Citation:
de Jonge A, van der Goes B, Ravelli A, Amelink-Verburg M, Mol B, Nijhuis J, Bennebroek Gravenhorst J, Buitendijk S. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG 2009. Accepted 26 February 2009. Published Online 15 April 2009.


Objective: To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care.

Design: A nationwide cohort study.

Setting: The entire Netherlands.

Population: A total of 529 688 low-risk women who were in primary midwife-led care at the onset of labour. Of these, 321 307 (60.7%) intended to give birth at home, 163 261 (30.8%) planned to give birth in hospital and for 45 120 (8.5%), the intended place of birth was unknown.

Methods: Analysis of national perinatal and neonatal registration data, over a period of 7 years. Logistic regression analysis was used to control for differences in baseline characteristics. Main outcome measures Intrapartum death, intrapartum and neonatal death within 24 hours after birth, intrapartum and neonatal death within 7 days and neonatal admission to an intensive care unit.

Results: No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care unit 1.00 (0.86 to 1.16).

Conclusions: This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.


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