Go home, say Oxford birth researchers

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Encouraging mothers to give birth at home could save the NHS up to £565 per birth, Oxford-led research has shown.

Peter Brocklehurst, Professor of Perinatal Epidemiology at the Oxford-based National Perinatal Epidemiology Unit (NPEU), led the study which aimed to estimate the cost effectiveness of alternative planned places of birth.

It concluded that, for women at low risk of complications who had already had at least one child, planned birth at home was the most cost-effective option. However, home births for first-time mothers present a higher risk than giving birth in an obstetric unit.

One of the main differences between the chosen places of birth lies in how often women need to be transferred to a hospital. For first-time births, the transfer rate during labour or immediately after the birth was 45 percent for planned home births, and between 36 and 40 percent for planned maternity unit births. For women having a second or subsequent baby, the transfer rate reduces to around ten percent.

NHS figures show that in England, one in every 50 babies is born at home.

Liz Schroeder, co-author of the study, highlighted the Department of Health’s commitment to “improve and modernise the quality of maternity services in terms of safety, outcomes and satisfaction for all pregnant women… and to offer them the choice of planning birth at home, in a midwife-led unit or in an obstetric unit”.

The NHS commented on the findings, saying: “The findings should not be misinterpreted as meaning that home birth is always the most cost-effective or low-risk option. It did not look at women with complicated pregnancies or those expected to have birth complications. For these women, birth in a facility where expertise is readily to hand is still likely to be the best option.”

Costs for birth at each location were calculated by looking at travel, staff and different treatments given. The average costs were £1,066 for a birth planned at home, £1,435 for a birth planned in a free-standing midwife unit, £1,461 for a birth planned in a midwife unit alongside hospital services and £1,631 for a birth planned in a hospital maternity unit.

Schroeder added that saving money may not be simple, as certain factors have yet to be investigated: “The study noted that the main cost drivers are fixed unit overheads and staffing, making it potentially difficult to realise cost savings based on these figures alone. The shortage of midwifery staff may also present a challenge. Obstetric units currently provide less one-to-one care than other settings.”