Background
Definitions of place of birth
Methods
Study design
Ethical approval
Data sources
Data linkage method
Data definitions and collections
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Stillbirth
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Early neonatal death (<7 days)
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Neonatal encephalopathy
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Meconium aspiration syndrome
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Brachial plexus injury
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Fractured clavicle
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Fractured humerus
Data analysis
Results
Hospital n = 242 936 | Birth centre n = 14 483 | Home n = 742 | P | |
---|---|---|---|---|
Maternal age (years) | ||||
Mean (SD) # | 29.2 (5.67) | 30.0 (5.29) | 32.4 (5.23) | <0.001 |
<20 | 15 280 (6.3%) | 513 (3.5%) | 7 (0.9%) | |
20-24 | 42 544 (17.5%) | 2 122 (14.7%) | 54 (7.3%) | |
25-29 | 73 440 (30.2%) | 4 529 (31.3%) | 159 (21.4%) | <0.001 |
30-34 | 73 404 (30.2%) | 4 788 (33.1%) | 249 (33.6%) | |
35-39 | 32 058 (13.2%) | 2 181 (15.1%) | 185 (24.9%) | |
≥40 | 6 134 (2.5%) | 349 (2.4%) | 49 (6.6%) | |
Missing | 76 (0.03%) | 1 (0.09%) | 39 (5.3%) | |
Previous pregnancies (≥20 weeks) | ||||
0 | 149 459 (61.5%) | 9 145 (63.1%) | 313 (42.2%) | |
1 | 54 445 (22.4%) | 3 328 (23.0%) | 219 (29.5%) | <0.001 |
2 | 24 627 (10.1%) | 1 453 (10.0%) | 143 (19.3%) | |
≥3 | 14 259 (5.9%) | 552 (3.8%) | 59 (8.0) | |
Missing | 146 (0.06%) | 5 (0.04%) | 8 (1.1%) | |
Gestation (completed weeks) | ||||
Mean (SD) # | 39.5 (1.10) | 39.8 (1.12) | 39.9 (1.16) | <0.001 |
37 | 12441 (5.1%) | 541 (3.7%) | 22 (3.0%) | <0.001 |
38 | 31268 (12.9%) | 1424 (9.8%) | 55 (7.4%) | |
39 | 62137 (25.6%) | 3405 (23.5%) | 147 (19.8%) | |
40 | 95992 (39.5%) | 5353 (37.0%) | 309 (41.6%) | |
41 | 37682 (15.5%) | 3347 (23.1%) | 147 (19.8%) | |
≥42 | 3416 (1.4%) | 413 (2.9%) | 62 (8.4%) | |
Complication conditions prior to labour | ||||
Prolonged rupture of membranes* | 72 (0.03%) | 0 | 0 | 0.11 |
Preeclampsia | 2579 (1.1%) | 93 (0.6%) | 1 (0.1%) | <0.001 |
Gestational hypertension | 6997 (2.9%) | 322 (2.2%) | 1 (0.1%) | <0.001 |
Chronic hypertension | 685 (0.3%) | 29 (0.2%) | 2 (0.3%) | 0.38 |
Antepartum haemorrhage | 1293 (0.5%) | 64 (0.4%) | 3 (0.4%) | 0.49 |
Eclampsia | 11 (<0.01%) | 0 | 0 | 0.85 |
Gestational diabetes** | 32 (0.01%) | 0 | 2 (0.3%) | 0.36 |
Pre-pregnancy diabetes (Type I) | 149 (0.06%) | 0 | 0 | 0.03 |
Complications per woman | ||||
0 | 221284 (91.1%) | 13725 (94.8%) | 735 (99.1%) | |
1 | 18460 (7.6%) | 637 (4.4%) | 6 (0.8%) | <0.001 |
≥2 | 3192 (1.3%) | 121 (0.8%) | 1 (0.1%) |
Planned place of birth | No. events/births | Incidence of events/1000 | Unadjusted OR | Adjusted OR* |
---|---|---|---|---|
All women
| ||||
Total* | 1 481/258 045 | 5.7 | ||
Hospital | 1 399/242 860 | 5.8 | 1.00 | 1.00 |
Birth centre | 77/14 482 | 5.3 | 0.92 (0.73-1.16) | 0.87 (0.69-1.10) |
Home Birth | 5/703 | 7.1 | 1.17 (0.49-2.83) | 1.06 (0.44-2.56) |
Nulliparous women | 1 018/158 866 | 6.4 | ||
Hospital | 949/149 417 | 6.4 | 1.00 | 1.00 |
Birth Centre | 65/9 145 | 7.1 | 1.12 (0.87-1.44) | 1.04 (0.81-1.34) |
Home Birth | 4/304 | 13.2 | 2.03 (0.75-5.44) | 1.72 (0.64-4.63) |
Multiparous women | 461/99 022 | 4.7 | ||
Hospital | 448/93 298 | 4.8 | 1.00 | 1.00 |
Birth Centre | 12/5 332 | 2.3 | 0.47 (0.26-0.83) | 0.45 (0.26-0.81) |
Home Birth | 1/392 | 2.6 | 0.49 (0.07-3.52) | 0.47 (0.07-3.38) |
Women without complications at start of care in labour
| ||||
Total* | 1291/235 611 | 5.5 | ||
Hospital | 1221/221 193 | 5.5 | 1.00 | 1.00 |
Birth centre | 66/13 723 | 4.8 | 0.87 (0.68-1.12) | 0.82 (0.64-1.05) |
Home birth | 4/695 | 5.8 | 0.99 (0.37-2.64) | 0.87 (0.33-2.35) |
Nulliparous women | 887/144 830 | 6.1 | ||
Hospital | 829/135 897 | 6.1 | 1.00 | 1.00 |
Birth centre | 55/8 633 | 6.4 | 1.05 (0.80-1.37) | 0.96 (0.73-1.26) |
Home birth | 3/300 | 10.0 | 1.60 (0.51-4.99) | 1.31 (0.42-4.11) |
Multiparous women | 403/90 632 | 4.5 | ||
Hospital | 391/85 159 | 4.6 | 1.00 | 1.00 |
Birth centre | 11/5 085 | 2.2 | 0.47 (0.26-0.86) | 0.46 (0.25-0.83) |
Home birth | 1/388 | 2.6 | 0.52 (0.07-3.72) | 0.50 (0.07-3.60) |
Planned place of birth | No. events/births | Incidence of events/1000 | Unadjusted OR | Adjusted OR |
---|---|---|---|---|
All women
| ||||
Total* | 266/257 834 | 1.03 | ||
Hospital | 255/242 665 | 1.05 | 1.00 | 1.00 |
Birth centre | 10/14 476 | 0.69 | 0.66 (0.35-1.24) | 0.66 (0.35-1.24) |
Home birth | 1/693 | 1.44 | 1.28 (0.18-9.17) | 1.29 (0.18-9.23) |
Nulliparous women | 169/158 866 | 1.06 | ||
Hospital | 158/149 417 | 1.06 | 1.00 | 1.00 |
Birth centre | 10/9 145 | 1.09 | 1.03 (0.55-1.96) | 0.99 (0.52-1.88) |
Home birth | 1/304 | 3.29 | 3.03 (0.42-21.70) | 2.48 (0.34-18.02) |
Multiparous women | 96/99 022 | N/A | N/A | N/A |
Hospital | 96/93 298 | |||
Birth centre | 0/5 332 | |||
Home birth | 0/392 | |||
Women without complications at start of care in labour
| ||||
Total* | 206/235 462 | 0.87 | ||
Hospital | 198/221 056 | 0.90 | 1.00 | 1.00 |
Birth centre | 8/13 718 | 0.58 | 0.65 (0.32-1.32) | 0.63 (0.31-1.28) |
Home birth | 0/688 | 0.00 | ||
Nulliparous women | 129/144 830 | 0.89 | ||
Hospital | 121/135 897 | 0.89 | 1.00 | 1.00 |
Birth centre | 8/8 633 | 0.93 | 1.04 (0.51-2.13) | 0.95 (0.46-1.96) |
Home birth | 0/300 | 0.00 | ||
Multiparous women | 77/90 632 | N/A | N/A | N/A |
Hospital | 77/85 159 | |||
Birth centre | 0/5 085 | |||
Home birth | 0/388 |
Birth centre | Home | |
---|---|---|
All women
| ||
All women | 4 322/14 483 (29.8%) | 138/742 (18.6%) |
Nulliparous women | 3 551/9 145 (38.8%) | 101/313 (32.3%) |
Multiparous women | 770/5 333 (14.4%) | 37/427 (8.7%) |
Women without complications
| ||
All women | 3 980/13 724 (29.0%) | 135/735 (18.4%) |
Nulliparous women | 3 267/8 633 (37.8%) | 99/309 (32.0%) |
Multiparous women | 712/5 086 (14.0%) | 36/424 (8.5%) |
Intervention and planned place of birth | No. events/births | Incidence of events/100 births | Unadjusted | Adjusted |
---|---|---|---|---|
Spontaneous vertex birth | 192 432/257 888 | 74.6 | ||
Hospital | 179 307/242 715 | 73.9 | 1.00 | 1.00 |
Birth centre | 12 447/14 477 | 86.0 | 2.17 (2.07-2.28) | 2.73 (2.60-2.87) |
Home birth | 678/696 | 97.4 | 3.76 (2.91-4.86) | 4.05 (3.09-5.32) |
Ventouse delivery | 25 940/257 888 | 10.1 | ||
Hospital | 25 060/242 715 | 10.3 | 1.00 | 1.00 |
Birth centre | 867/14 477 | 6.0 | 0.55 (0.52-0.60) | 0.51 (0.47-0.54) |
Home birth | 13/696 | 1.9 | 0.16 (0.09-0.27) | 0.18 (0.10-0.30) |
Forceps delivery | 13 188/257 888 | 5.1 | ||
Hospital | 12 705/242 715 | 5.2 | 1.00 | 1.00 |
Birth centre | 468/14 477 | 3.2 | 0.61 (0.55-0.66) | 0.55 (0.50-0.60) |
Home birth | 15/696 | 2.2 | 0.37 (0.22-0.62) | 0.44 (0.26-0.73) |
Intrapartum caesarean section | 26 385/257 888 | 10.2 | ||
Hospital | 25 669/242 715 | 10.6 | 1.00 | 1.00 |
Birth centre | 693/14 477 | 4.8 | 0.43 (0.39-0.46) | 0.36 (0.34-0.39) |
Home birth | 23/696 | 3.3 | 0.27 (0.18-0.41) | 0.27 (0.17-0.40) |
3rd or 4th degree perineal trauma** | ||||
with episiotomy extensions | 7 557/231 403 | 3.3 | ||
Hospital | 7 083/216 955 | 3.3 | 1.00 | 1.00 |
Birth centre | 461/13 782 | 3.3 | 1.03 (0.93-1.13) | 0.93 (0.84-1.02) |
Home birth | 13/666 | 2.0 | 0.55 (0.32-0.96) | 0.66 (0.38-1.14) |
Syntocinon augmentation | 51 719/257 888 | 20.1 | ||
Hospital | 50 067/242 715 | 20.6 | 1.00 | 1.00 |
Birth centre | 1 612/14 477 | 11.1 | 0.48 (0.46-0.51) | 0.43 (0.41-0.45) |
Home birth | 40/696 | 5.7 | 0.22 (0.16-0.30) | 0.24 (0.17-0.33) |
Epidural or spinal analgesia for labour | 73 012/257 888 | 28.3 | ||
Hospital | 70 635/242 715 | 29.1 | 1.00 | 1.00 |
Birth centre | 2 321/14 477 | 16.0 | 0.47 (0.44-0.49) | 0.40 (0.37-0.41) |
Home birth | 56/696 | 8.1 | 0.20 (0.15-0.26) | 0.19 (0.15-0.26) |
General anaesthesia *** | 4 429/26 365 | 16.8 | ||
Hospital | 4 357/25 649 | 17.0 | 1.00 | 1.00 |
Birth centre | 70/693 | 10.1 | 0.55 (0.43-0.71) | 0.61 (0.48-0.79) |
Home birth | 2/23 | 8.7 | 0.47 (0.11-1.99) | 0.71 (0.16-3.06) |
Episiotomy ** | 41 885/231 396 | 18.1 | ||
Hospital | 40 506/216 948 | 18.7 | 1.00 | 1.00 |
Birth centre | 1 353/13 782 | 9.8 | 0.47 (0.45-0.50) | 0.41 (0.39-0.44) |
Home birth | 26/666 | 3.9 | 0.17 (0.11-0.25) | 0.18 (0.12-0.26) |
Planned place of birth | No. events/births | Incidence of events/1000 | Unadjusted OR | Adjusted OR |
---|---|---|---|---|
All women
| ||||
Total | 117 447/257 888 | 45.5 | ||
Hospital | 106 869/242 715 | 44.0 | 1.00 | 1.00 |
Birth centre | 9 948/14 377 | 69.2 | 2.79 (2.69-2.90) | 3.51 (3.38-3.65) |
Home birth | 630/696 | 90.9 | 7.16 (5.86-8.76) | 8.00 (6.46¬-9.90) |
Women without complications at start of care in labour
| ||||
Total | 108 167/235 462 | 45.9 | ||
Hospital | 98 050/221 056 9 | 44.4 | 1.00 | 1.00 |
Birth centre | 495/13 718 | 69.2 | 2.82 (2.72-2.93) | 3.54 (3.41-3.69) |
Home birth | 622/688 | 90.4 | 6.98 (5.71-8.54) | 7.82 (6.31-¬9.69) |