The safety implications of giving birth at home with only midwives in attendance has been much discussed across the medical profession. But now the latest research from the University of Oxford shows that home births and midwifery-only units are both safe and cost-effective for the NHS. Many midwife organisations and other interested parties such as the National Childbirth Trust have long argued for easier access to home births in the UK so that women have a genuine choice as to how and where they have their babies. But depending on the PCTs and hospital and midwife practices in an area this has not always been the case. The researchers assessed 64,000 births between 2008 and 2010 in England, looking at a mix of first baby and subsequent births to determine the cost-effectiveness of alternative planned places of birth (i.e. outside a hospital).
The study, published on bmj.com, found that for multiparous (women who’d previously given birth), low-risk women having a baby at home was most cost-effective. Planned home births for these women were safe, resulted in fewer expensive obstetric interventions and cost the NHS less than births in other settings at an average of £780 per woman. Midwifery units were also safe and more cost-effective than hospitals. For women on their second child or more, birth in an obstetric unit cost on average £1,142 per mother. For mothers having their first baby the results varied a little: a planned midwifery unit birth was less expensive than an obstetric unit birth, as was a home birth, but the outcomes for the baby were not as good. The research looked at the costs of planned births in four different settings: obstetric units; midwifery units in the same hospital as an obstetric unit; free-standing midwifery units and at home. The costs considered included midwifery care during labour and immediately after the birth, pain relief and medical care in hospital if complications developed, staying in a hospital, midwifery unit or neonatal unit. Costs associated with planned home births and midwifery unit births included interventions and treatments needed if the women had to be transferred to hospital during labour or after the birth. In all cases cost-effectiveness was determined by looking at the relative costs of achieving a good outcome for the mother and baby. Long term costs associated with serious birth injuries were not taken into account.
Study co-author Liz Schroder said: “At the time of the study, only half of the NHS Trusts in England provided women with access to a midwifery unit, and occupancy levels were often low. The findings of the Birthplace study may encourage women —particularly women having a second or subsequent baby — to request an 'out of hospital' birth. And the potential for cost savings could make offering women more choice an attractive option for the NHS.”