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Place of birth and outcomes for a cohort of low risk women in New Zealand: A comparison with Birthplace England

Abstract:

Background: Choice, safety and availability of different birth settings are important issues for women and midwives in New Zealand (NZ). In England, the Birthplace England Research Study (BPE) has provided detailed information on outcomes for low risk women related to place of birth. These outcomes cannot be generalised to New Zealand owing to differences in context, culture and models of maternity care. Aim: This observational study has used retrospective data to determine demographic differences between planned birth place setting, neonatal outcomes and transfer rates for a cohort of low risk New Zealand women and compared these findings where possible with those of the Birthplace England research. Method: Data from the New Zealand College of Midwives Clinical Outcomes Research (NZCOMCORD) database were analysed for the years 2006 to 2010 inclusive for low risk women. Comparisons have been made between place of birth (home, primary unit) and parity, ethnicity, age, body mass index, transfer rates, and neonatal outcomes (Apgars, NICU admission, perinatal mortality). Results: There were 61,072 women considered low risk, of whom 8% had planned a home birth and 16.6% a primary unit birth. Women who planned to birth at home in New Zealand were older and more likely to be multiparous. These were similar findings to those of the Birthplace England study. The rates of transfer from home (16.9%) or primary unit (12.6%) to hospital were lower than the Birthplace England cohort (21%). There was a higher proportion of nulliparous women (35%) in the planned homebirth group who transferred although this was significantly lower than the Birthplace England cohort (45%) (P<0.002). NZ Maori are the indigenous ethnicity of New Zealand, and a greater proportion of Maori planned birth in a primary unit (27.2%) than a secondary unit (23.2%), home (17.4%) or tertiary hospital (11.1%). The actual number of perinatal mortality outcomes was low across all settings for low risk women in New Zealand and differences in birthplace were not statistically significant (p < 0.14). Conclusion: A greater proportion of indigenous New Zealand women planned to birth at home or in a primary unit. Fewer women were transferred in labour in the NZ study. This research further refines our understanding of who plans to birth where, and reinforces the evidence that, where a low risk woman plans to birth in NZ, does not significantly increase adverse outcomes for her baby.

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Home birth, neonatal outcome, primary unit birth, transfer rates