Homebirth? Undergraduate Version Max Brinsmead MB BS PhD December 2014

Homebirth? Hotly debated for most of my 40 years in practice Often from a biassed viewpoint Doctors vs midwives Patient vs carer And sometimes patient’s carer vs “system” Now we have definitive and objective data based on RCT’s This talk based on 2014 NICE Guidelines

Every low-risk woman may choose… A PLACE OF BIRTH Obstetric Unit Alongside Midwife-led Unit Freestanding Midwife-led unit Home Provided that each are appropriately staffed and facilities optimal for transfer upwards as required

Low risk multiparous women Rates of intervention are lower if she chooses to deliver in a midwife-led care setting Home, stand-alone or alongside unit compared to an obstetric unit And the outcomes for the baby are no different About 1:10 will require transfer to an obstetric unit

Low risk multiparous women

Low risk multiparous women

Low risk nulliparous women Rates of intervention are lower if she chooses to deliver in a midwife-led care setting Home, stand-alone or alongside unit compared to an obstetric unit Outcome for the baby is slightly worse for planned homebirth About 4 women in every 10 will require transfer to an obstetric unit

Low risk nulliparous women

Low risk multiparous women

NB: This data relates to the UK and is not applicable to all settings All healthcare professionals involved need to know… What constitutes a low-risk woman What local facilities are available including… Access to midwives and the liklihood of receiving one-to-one continuous care Access to medical staff and facilities Access to pain relief including anaesthetists Transport and transfer facilities available

Any Questions or Comments? Please leave a note on the Welcome Page to this website