Choose your font:
 Arimo
 Merriweather
 Mukta Malar
 Open Sans Condensed
 Rokkitt
 Source Sans Pro
 Login


 English 
 Français 
 Português 
 Español 

[Valid RSS] RSS
bar

Database - (CIANE)

Description of this bibliographical database (CIANE website)
Currently 3108 records
YouTube channel (tutorial)

https://ciane.net/id=2430

Created on : 12 Apr 2012
Modified on : 13 Jun 2018

 Modify this record
Do not follow this link unless you know an editor’s password!


Share: Facebook logo   Tweeter logo   Easy

Bibliographical entry (without author) :

Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study BMJ 2011; 343:d7400

Author(s) :

P Brocklehurst

Year of publication :

2011

URL(s) :

http://www.bmj.com/content/343/bmj.d7400
https://doi.org/10.1136/bmj.d7400

Résumé (français)  :

Abstract (English)  :

Objective
To compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies.

Design
Prospective cohort study.

Setting
England: all NHS trusts providing intrapartum care at home, all freestanding midwifery units, all alongside midwifery units (midwife led units on a hospital site with an obstetric unit), and a stratified random sample of obstetric units.

Participants
64 538 eligible women with a singleton, term (>= 37 weeks gestation), and “booked” pregnancy who gave birth between April 2008 and April 2010. Planned caesarean sections and caesarean sections before the onset of labour and unplanned home births were excluded.

Main outcome measure
A composite primary outcome of perinatal mortality and intrapartum related neonatal morbidities (stillbirth after start of care in labour, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus, or fractured clavicle) was used to compare outcomes by planned place of birth at the start of care in labour (at home, freestanding midwifery units, alongside midwifery units, and obstetric units).

Results
There were 250 primary outcome events and an overall weighted incidence of 4.3 per 1000 births (95% CI 3.3 to 5.5). Overall, there were no significant differences in the adjusted odds of the primary outcome for any of the non-obstetric unit settings compared with obstetric units. For nulliparous women, the odds of the primary outcome were higher for planned home births (adjusted odds ratio 1.75, 95% CI 1.07 to 2.86) but not for either midwifery unit setting. For multiparous women, there were no significant differences in the incidence of the primary outcome by planned place of birth. Interventions during labour were substantially lower in all non-obstetric unit settings. Transfers from non-obstetric unit settings were more frequent for nulliparous women (36% to 45%) than for multiparous women (9% to 13%).

Conclusions
The results support a policy of offering healthy women with low risk pregnancies a choice of birth setting. Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes. For nulliparous women, planned home births also have fewer interventions but have poorer perinatal outcomes.

Sumário (português)  :

Resumen (español)  :

Full text (private) :

 ➡ Access requires authorization

Comments :

Comment by AIMS:

The debate about the safety of hospitals and the risks of home birth has been much debated since the publication of a long-awaited large prospective cohort study of 64 538 eligible women with a singleton, term (>= 37 weeks gestation), and “booked” pregnancy who gave birth between April 2008 and April 2010. Planned caesarean sections and caesarean sections before the onset of labour and unplanned home births were excluded. (Brocklehurst, P 2011).

This research (known as the BirthPlace Study) shows that low-risk women are safer when they give birth outside an obstetric unit, in alongside or free-standing midwifery units, or at home. Women have fewer caesarean, ventouse deliveries, episiotomies, less blood loss, and other benefits. These outcomes will have benefits that this study was unable consider, such as better breastfeeding rates and safer future births. The study showed no difference for second or subsequent babies by place of birth, nor for first time mothers between midwifery units and consultant units. However, a small statistically significant increased risk was shown for babies of first time mothers born at home. However, in order to gain finance for the study the researchers will have required an outcome measure that had a chance of showing a statistically significant difference between the groups and baby deaths would have been too few to do this. So they combined: stillbirth after the start of care in labour, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus, and fractured clavicle. So, what can be said is that women are safer having their babies at home or in midwifery units, but there is no evidence about whether there is an increased risk of stillbirth or neonatal death for the baby because the incidence of this is so small we would need a much bigger study than the 65,000 women in this study in order to be able to detect a difference. The attention of the medical profession in every country in Europe should be drawn to this study.

Argument (français) :

Les femmes qui souhaitent accoucher dans une unité de sage-femme, et les multipares qui souhaitent accoucher à domicile subissent moins d’interventions ue celles qui souhaitent accoucher dans une unité obstétricale, sans impact sur les résultats périnataux.

Argument (English):

Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes.

Argumento (português):

Mulheres que desejam dar à luz em uma unidade de obstetrícia, e mulheres multíparas que desejam dar à luz em casa, recebem menos intervenções do que aquelas que desejam dar à luz em uma unidade obstétrica.

Argumento (español):

Keywords :

➡ place of birth ; homebirth ; public health

Author of this record :

Bernard Bel — 12 Apr 2012
➡ latest update : Bernard Bel — 13 Jun 2018

Discussion (display only in English)
 
➡ Only identified users



 I have read the guidelines of discussions and I accept all terms (read guidelines)

barre

New expert query --- New simple query

Creating new record --- Importing records

User management --- Dump database --- Contact

bar

This database created by Alliance francophone pour l'accouchement respecté (AFAR) is managed
by Collectif interassociatif autour de la naissance (CIANE, https://ciane.net).
It is fed by the voluntary contributions of persons interested in the sharing of scientific data.
If you agree with this project, you can support us in several ways:
(1) contributing to this database if you have a minimum training in documentation
(2) or financially supporting CIANE (see below)
(3) or joining any society affiliated with CIANE.
Sign in or create an account to follow changes or become an editor.
Contact bibli(arobase)ciane.net for more information.

Valid CSS! Valid HTML!
Donating to CIANE (click “Faire un don”) will help us to maintain and develop sites and public
databases towards the support of parents and caregivers’ informed decisions with respect to childbirth