Home delivery could pay dividends for mothers and NHS

Giving birth at home may be the safest and cheapest option for women who already have children, a study claimed today.

University of Oxford researchers looked at the circumstances of 64,000 births in England between 2008 and 2010. They found that women at low risk of complications could give birth either at home or a midwifery unit to save the NHS money and was healthy for both the mother and child.

The study, published in the British Medical Journal, looked at the relative costs of healthy births in different settings and found that a planned birth in a hospital’s obstetric unit – where more technology and a multidisciplinary team including doctors is on hand – is the most expensive option for mothers who already have children, with a mean cost of £1,142 per woman. A planned home birth is the cheapest, at £780.

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For women who have not had children before, a planned birth in a midwifery unit would also save money, when compared with a planned birth in an obstetric unit, it was suggested. The researchers found that a planned birth at home for such women was also cost- saving, but said it was “associated with poorer outcomes for the baby”.

Health economist Liz Schroder, co-author of the study, said: “At the time of the study, only half of the NHS trusts in England provided women with access to a midwifery unit, and occupancy levels were often low.

“The findings of the birthplace study may encourage women – particularly women having a second or subsequent baby – to request an ‘out of hospital’ birth. And the potential for cost savings could make offering women more choice an attractive option for the NHS.”

The study looked at births in obstetric units, midwifery units located in the same hospital as an obstetric unit, free-standing midwifery units and home.

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It assessed NHS costs associated with the birth, including care during labour, the cost of any stay in hospital, the cost of pain relief and any medical procedures needed in the case of complications.

The costs for planned home and midwifery unit births taken into account included the cost of any clinical intervention needed if the mothers and babies were transferred to hospital but did not include any longer-term costs, such as caring for babies who suffer serious injuries during birth.

The National Institute for Clinical Excellence has previously said that estimating the cost-effectiveness of places of birth should be a priority area for research.

The response to the Oxford research from the Royal College of Midwives is that it points out the substantial benefits of midwife-led care, including home birth. The RCM believes such care is better for mothers and babies, for midwives and for the NHS.

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However 96 per cent of births still take place in hospitals, which underlines the need to make a fundamental change in the way maternity services are organised, says Mervi Jokinen, professional adviser to the College. The Government is demanding more for less, and this is a shining example of how that can be delivered.

Since the 1970s, when there was a huge push by the NHS towards hospital birth as the safest option, the number of births at home has dwindled. It has also suffered from a false perception that it uses more resources and costs more, says Ms Jokinen.

“This report is very timely, as the Government is looking at different ways of providing health services. We promote active care in labour, and in a healthy woman with a normal pregnancy it takes one person to care for her. Having that care in her own home, where she is comfortable and feels less anxious and where her partner can be more comfortable is a very safe option.

“In a hospital, where the care is still midwife-led but the midwife might be running between two to four rooms, the outcomes are still safe but not as good.”

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But with midwives performing so few home births, can mothers be confident that all the bases will be covered if they choose to have their baby at home?

“Midwives are happy to do home births. Yes, they can lose some confidence if they don’t keep using their skills in a home setting but they do have the training, skills and competencies. I think a move back towards home births should be woman-led and woman-centred, and once the mothers are on board and have confidence in their midwife more and more will happen.”