Prospective regional study of planned home births

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Abstract
Objective: To collect data from a cohort of women requesting a home birth and examine the experience and outcome of pregnancy, the indications for hospital transfer, and the attitudes of mothers, midwives, and general practitioners. Design: Follow up study with anonymised postal questionnaires. Setting: Northern Regional Health Authority area. Subjects: The 256 women resident in the Northern region who expected to deliver in 1993 and whose request for a home birth became known to one of the local supervisors of midwives. Limited cross validating information was also collected retrospectively on all other women delivering a baby outside hospital in 1993. Main outcome measures: Rate of and reason for transferred care; maternal, midwifery, and general practitioner views; perinatal outcome. Results: Five women miscarried, leaving 251 in the study. Of these, 142 (57%) delivered at home. There were 17 (7%) caesarean sections but no perinatal deaths. General practitioners had reservations about half of the booking requests. Two thirds of the women thought they had not been offered any option about place of birth, 74 (29%) were referred to hospital for delivery before the onset of labour, and 35 (14%) were referred to hospital during labour. Intrapartum transfers were uneventful, and half the mothers commented spontaneously that they valued having spent even part of their labour at home. Conclusions: Home birth is valued for its family setting. General practitioners' support is sought and influential but uncommon, possibly because of a lack of understanding of the responsibilities of the midwife and general practitioner. Women sought support from their general prac- titioners, which when given was associated with a lower rate of transfer to hospital; most doctors declined to give support, however, because they were concerned about possible complications A change to hospital care was common before labour (29%), though in half of these cases there was no obstetric reason for transfer Transfer in labour was also common (14%), but on no occasion was obstetric intervention required in the first hour after transfer; women transferred appreciated having spent part of their labour at home Midwives found their statutory obligation to help with home births generally rewarding but were sometimes concerned by lack of equipment and professional support