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Creating a dedicated homebirth service: Results of a 3-year pilot

02 March 2018
13 min read
Volume 26 · Issue 3

Abstract

Background

A dedicated homebirth service was established at a large teaching hospital in Birmingham.

Aim

The aim of the 3-year pilot was to increase the homebirth rate from 0.3% to 3% of all Trust births.

Methods

Data were collected on all women referred to the homebirth team and those receiving intrapartum care. This was analysed using Microsoft Excel spreadsheets.

Findings

The pilot achieved a 1.4% homebirth rate and 1.9% intrapartum care rate (a five-fold increase in 3 years) but in spite of extensive promotion of the service, it did not meet the target of 3% of all Trust births. The peripartum transfer rate from home to hospital was 54% for primiparous and 14% for multiparous women with no adverse outcomes.

Conclusions

There has been excellent feedback from the families who planned a homebirth, but increasing the homebirth rate requires a longer term change to the culture surrounding place of birth.

Homebirth is a topic that often elicits a strong emotional reaction from health professionals and women alike. It is a subject that, after being deeply out of favour, now has a positive evidence base that demonstrates low risk women having their second or subsequent baby at home is as safe and is associated with better maternal outcomes than giving birth in hospital (Birthplace in England Collaborative Group et al, 2011). It also continues to gain support in England from influential national reports, such as Changing Childbirth (Department of Health, 1993) and Better Births (National Maternity Review, 2016). While homebirth may now be an acceptable choice, in 2016, only 2.3% of women in England and Wales pursued this as an option; a figure that is unchanged since 2012 and has in fact reduced since 2.9% of women opted for a homebirth in 2007, the highest rate in 30 years (Office for National Statistics, 2016).

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