Birthplace follow-on analysis to enhance policy and service delivery decision-making for planned place of birth

Summary

The aim of this follow-on project is to support the development and delivery of safe, equitable and effective maternity services by strengthening the evidence-base relating to planned place of birth. The project will:

• Describe and explore the impact of service configuration, unit characteristics and other aspects of the organisation and delivery of services on birth outcomes, with a particular focus on maternal outcomes which impact on future pregnancies, such as caesarean section or complicated vaginal delivery
• Further describe intrapartum transfers (e.g. transfer rates, duration of transfer) and explore the possible impact on transfers of factors relating to the organisation and delivery of services, for example staffing, time of day, distance from the nearest obstetric unit.
• Explore the clinical characteristics, management and outcomes of 'higher' risk women who opt for a non-OU birth.

Key findings to date

Duration and urgency of transfer in births planned at home and in freestanding midwifery units

• Intrapartum transfers from home or freestanding midwifery unit (FMU) commonly take up to 60 minutes from decision to transfer to first assessment in an OU, even for transfers for potentially urgent reasons.
• Most transfers are not urgent and emergencies and adverse outcomes are uncommon
• Urgent transfer is more likely for nulliparous women

Link to abstract in Pubmed

Publications

Journal Articles

• Rowe RE, Townend J, Brocklehurst P, Knight M, Macfarlane A, McCourt C, Newburn M, Redshaw M, Sandall J, Silverton L, Hollowell J. Duration and urgency of transfer in births planned at home and in freestanding midwifery units in England: secondary analysis of the birthplace national prospective cohort study. BMC Pregnancy Childbirth. 2013;13:224.
• Lukasse M, Rowe R, Townend J, Knight M, Hollowell J. Immersion in water for pain relief and the risk of intrapartum transfer among low risk nulliparous women: secondary analysis of the birthplace national prospective cohort study. BMC Pregnancy Childbirth. 2014;14(1):60.
• Rowe RE, Townend J, Brocklehurst P, Knight M, Macfarlane A, McCourt C, Newburn M, Redshaw M, Sandall J, Silverton L, Hollowell J. Service configuration, unit characteristics and variation in intervention rates in a national sample of obstetric units in England: an exploratory analysis. BMJ open. 2014;4(5):e005551.
• Li Y, Townend J, Rowe R, Brocklehurst P, Knight M, Linsell L, Macfarlane A, McCourt C, Newburn M, Marlow N, Pasupathy D, Redshaw M, Sandall J, Silverton L, Hollowell J. Perinatal and maternal outcomes in planned home and obstetric unit births in women at 'higher risk' of complications: secondary analysis of the Birthplace national prospective cohort study. BJOG. 2015;122(5):741-53.

Reports

• Hollowell J, Rowe R, Townend J, Knight M, Li Y, Linsell L, Redshaw M, Brocklehurst P, Macfarlane A, Marlow N, McCourt C, Newburn M, Sandall J, Silvert. The Birthplace in England national prospective cohort study: further analyses to enhance policy and service delivery decision-making for planned place of birth. 2015 Contract No.: 36.