Promoting homebirth: Intermediate homebirth report

The drive for Birmingham Women's hospital to relook at its current service provision and improve choice around place of birth was in direct response to the findings in the Birthplace Study (Birthplace in England Collaborative Group et al, 2011); this research evaluated the relative safety of birth in an obstetric unit compared with birth in an alongside (AMU) or free-standing midwifery unit (FMU) or at home for women who were at low risk of complications at the onset of labour. The results showed that for multiparous women, homebirth was associated with a significant increase in the normal birth rate, and significantly fewer interventions, there were no differences in adverse perinatal outcomes between settings. Although many of the findings have been reported by several researchers over the last few decades (Tew, 1986; Olsen and Jewell, 2000; De Jonge et al, 2009; Overgaard et al, 2011), the study is the largest (n=64 538) to date and was conducted in England. A combination of robust evidence and many maternity services at crisis point due to the 22% increase in births over the last decade, shortage of midwives, limited and over-stretched maternity consultant units, prompted a joint statement on homebirth by the Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (2011). The two colleges recommended that maternity providers need to actively encourage low-risk second-time mothers to birth at home and think creatively about how maternity services could be reconfigured in order to promote homebirth as a real choice, thus improving care, easing pressure on hospitals and reducing costs.