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

Y Li; J Townend; R Rowe; Peter Brocklehurst; M Knight; L Linsell; A Macfarlane; C McCourt; M Newburn; N Marlow; D Pasupathy; M Redshaw; J Sandall; L Silverton; J Hollowell

doi:10.1111/1471-0528.13283

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

Y Li, J Townend, R Rowe, Peter Brocklehurst, M Knight, L Linsell, A Macfarlane, C McCourt, M Newburn, N Marlow, D Pasupathy, M Redshaw, J Sandall, L Silverton, J Hollowell

Research output: Contribution to journal › Article › peer-review

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Abstract

OBJECTIVE: To explore and compare perinatal and maternal outcomes in women at 'higher risk' of complications planning home versus obstetric unit (OU) birth.

DESIGN: Prospective cohort study.

SETTING: OUs and planned home births in England.

POPULATION: 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.

MAIN OUTCOME MEASURES: 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.

Original language	English
Pages (from-to)	741-53
Number of pages	13
Journal	BJOG: An International Journal of Obstetrics & Gynaecology
Volume	122
Issue number	5
Early online date	21 Jan 2015
DOIs	https://doi.org/10.1111/1471-0528.13283
Publication status	Published - Apr 2015

Keywords

Adult
Birthing Centers
Delivery, Obstetric
England
Female
Guideline Adherence
Home Childbirth
Humans
Infant, Newborn
Intensive Care, Neonatal
Parity
Patient Care Planning
Perinatal Care
Practice Guidelines as Topic
Pregnancy
Pregnancy Outcome
Prospective Studies
Risk Factors
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

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Li_et_al_Perinatal_and_maternal_outcomes_Intrapartum_Care_2015
https://doi.org/10.1111/1471-0528.13283
Final published version, 128 KBLicence: Creative Commons: Attribution-NonCommercial (CC BY-NC)

https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.13283Licence: Creative Commons: Attribution-NonCommercial (CC BY-NC)

Cite this

Li, Y., Townend, J., Rowe, R., Brocklehurst, P., Knight, M., Linsell, L., Macfarlane, A., McCourt, C., Newburn, M., Marlow, N., Pasupathy, D., Redshaw, M., Sandall, J., Silverton, L., & Hollowell, J. (2015). 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. BJOG: An International Journal of Obstetrics & Gynaecology, 122(5), 741-53. Advance online publication. https://doi.org/10.1111/1471-0528.13283

@article{3118307645cf44a697dfcb657fa0cdbb,

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.DESIGN: Prospective cohort study.SETTING: OUs and planned home births in England.POPULATION: 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.MAIN OUTCOME MEASURES: 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.",

keywords = "Adult, Birthing Centers, Delivery, Obstetric, England, Female, Guideline Adherence, Home Childbirth, Humans, Infant, Newborn, Intensive Care, Neonatal, Parity, Patient Care Planning, Perinatal Care, Practice Guidelines as Topic, Pregnancy, Pregnancy Outcome, Prospective Studies, Risk Factors, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't",

author = "Y Li and J Townend and R Rowe and Peter Brocklehurst and M Knight and L Linsell and A Macfarlane and C McCourt and M Newburn and N Marlow and D Pasupathy and M Redshaw and J Sandall and L Silverton and J Hollowell",

note = "{\textcopyright} 2015 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.",

year = "2015",

month = apr,

doi = "10.1111/1471-0528.13283",

language = "English",

volume = "122",

pages = "741--53",

journal = "BJOG: An International Journal of Obstetrics & Gynaecology",

issn = "1470-0328",

publisher = "Wiley",

number = "5",

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Li, Y, Townend, J, Rowe, R, Brocklehurst, P, Knight, M, Linsell, L, Macfarlane, A, McCourt, C, Newburn, M, Marlow, N, Pasupathy, D, Redshaw, M, Sandall, J, Silverton, L & Hollowell, J 2015, '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', BJOG: An International Journal of Obstetrics & Gynaecology, vol. 122, no. 5, pp. 741-53. https://doi.org/10.1111/1471-0528.13283

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. / Li, Y; Townend, J; Rowe, R et al.
In: BJOG: An International Journal of Obstetrics & Gynaecology, Vol. 122, No. 5, 04.2015, p. 741-53.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Perinatal and maternal outcomes in planned home and obstetric unit births in women at 'higher risk' of complications

T2 - secondary analysis of the Birthplace national prospective cohort study

AU - Li, Y

AU - Townend, J

AU - Rowe, R

AU - Brocklehurst, Peter

AU - Knight, M

AU - Linsell, L

AU - Macfarlane, A

AU - McCourt, C

AU - Newburn, M

AU - Marlow, N

AU - Pasupathy, D

AU - Redshaw, M

AU - Sandall, J

AU - Silverton, L

AU - Hollowell, J

PY - 2015/4

Y1 - 2015/4

N2 - OBJECTIVE: To explore and compare perinatal and maternal outcomes in women at 'higher risk' of complications planning home versus obstetric unit (OU) birth.DESIGN: Prospective cohort study.SETTING: OUs and planned home births in England.POPULATION: 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.MAIN OUTCOME MEASURES: 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.

AB - OBJECTIVE: To explore and compare perinatal and maternal outcomes in women at 'higher risk' of complications planning home versus obstetric unit (OU) birth.DESIGN: Prospective cohort study.SETTING: OUs and planned home births in England.POPULATION: 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.MAIN OUTCOME MEASURES: 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.

KW - Adult

KW - Birthing Centers

KW - Delivery, Obstetric

KW - England

KW - Female

KW - Guideline Adherence

KW - Home Childbirth

KW - Humans

KW - Infant, Newborn

KW - Intensive Care, Neonatal

KW - Parity

KW - Patient Care Planning

KW - Perinatal Care

KW - Practice Guidelines as Topic

KW - Pregnancy

KW - Pregnancy Outcome

KW - Prospective Studies

KW - Risk Factors

KW - Comparative Study

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1111/1471-0528.13283

DO - 10.1111/1471-0528.13283

M3 - Article

C2 - 25603762

SN - 1470-0328

VL - 122

SP - 741

EP - 753

JO - BJOG: An International Journal of Obstetrics & Gynaecology

JF - BJOG: An International Journal of Obstetrics & Gynaecology

IS - 5

ER -

Li Y, Townend J, Rowe R, Brocklehurst P, Knight M, Linsell L et al. 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. BJOG: An International Journal of Obstetrics & Gynaecology. 2015 Apr;122(5):741-53. Epub 2015 Jan 21. doi: 10.1111/1471-0528.13283

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

Keywords

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