Creating a dedicated home birth team in Tower Hamlets: a review of outcomes from the first year
A dedicated home birth team was established at a large teaching hospital in a deprived inner London borough.
To increase the home birth rate in Tower Hamlets and offer continuity of carer to women opting for home birth.
Data were collected on all 90 women receiving care by the team. Data, including demographics, care episodes and maternal and neonatal outcomes, were recorded and analysed using Microsoft Excel 2010.
With a dedicated home birth team, the home birth rate in Tower Hamlets increased by 68% compared to the previous year, while still remaining a small proportion of all births in the borough. The overall transfer rate was 32.6%, in line with national figures. Outcomes for both mothers and babies were very good, with 89% of women who started their labour at home achieving a normal vaginal birth. Feedback was exceptionally positive, with 100% of women who provided feedback recommending the service. The women being referred and choosing homebirth were not demographically representative of the population of the borough.
The provision of a dedicated homebirth team in Tower Hamlets has been a positive addition to the area's existing maternity services. More needs to be done to improve the visibility of the team in order to secure more referrals and increase the homebirth rate, especially among the Bengali and other ethnic minority populations, to enable equitable access to homebirth.
The majority (approximately 87%) of births in the UK take place in a hospital-based obstetric unit (National Audit Office, 2013) with the remainder in midwifery-led settings such as birth centres or the home. While giving birth at home has been shown to be a safe, cost-effective and well received option for women at low risk of complications (Birthplace in England Collaborative Group et al, 2011). In 2017, just 2.1% of babies were born at home in England and Wales (Office for National Statistics, 2019).
Tower Hamlets is home to one of the few freestanding midwifery units in the city, and therefore is one of only three London boroughs that offers pregnant women without complexities the choice of four locations in which to give birth. Despite home birth being an option, without a dedicated team, the home birth rate in 2017 was less than 0.4% in Tower Hamlets, with only 22 women having planned births at home.
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