Introduction
The relative benefits and risks of birth in different settings have
been widely debated in recent years.1-7 A problem when trying
to evaluate the effect of birth setting on perinatal outcomes has
been the use of actual place of birth rather than planned place
of birth to define comparison groups. Available evidence
summarised in the National Institute for Health and Clinical
Excellence (NICE) guideline on intrapartum care indicates that,
although there is a higher likelihood of a vaginal birth with less
intervention for healthy women who plan to give birth at home
or in a midwifery unit compared with an obstetric unit, there is
a lack of good quality evidence comparing the risk of rare but
serious adverse outcomes by birth setting.8-10
The primary objective of this study was to compare intrapartum
and early neonatal mortality and specific neonatal morbidities
for births planned at home, in freestanding midwifery units, and
in “alongside midwifery units” (midwife led units on a hospital
site with an obstetric unit) with births planned in obstetric units,
for babies of women judged to be at low risk of complications
before the onset of labour.
In England almost all maternity care is provided by the National
Health Service (NHS) and is free at the point of care. Births
outside an obstetric unit are relatively uncommon. Of women
giving birth in 2007, around 8% gave birth outside an obstetric
unit—2.8% at home, around 3% in alongside midwifery units,
and just under 2% in freestanding midwifery units