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Intervention Review

Home-like versus conventional institutional settings for birth

  1. Ellen D Hodnett1,*,
  2. Soo Downe2,
  3. Nadine Edwards3,
  4. Denis Walsh4

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 24 JAN 2005

Assessed as up-to-date: 11 NOV 2004

DOI: 10.1002/14651858.CD000012.pub2


How to Cite

Hodnett ED, Downe S, Edwards N, Walsh D. Home-like versus conventional institutional settings for birth. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD000012. DOI: 10.1002/14651858.CD000012.pub2.

Author Information

  1. 1

    University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada

  2. 2

    University of Central Lancashire, Midwifery Studies Research Unit, Preston, UK

  3. 3

    The University of Liverpool, C/o Cochrane Pregnancy and Childbirth Group, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine, Liverpool, UK

  4. 4

    University of Central Lancashire, Midwifery, Leicester, UK

*Ellen D Hodnett, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario, M5T 1P8 , Canada. ellen.hodnett@utoronto.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 24 JAN 2005

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Home-like birth settings have been established in or near conventional labour wards for the care of pregnant women who prefer and require little or no medical intervention during labour and birth.

Objectives

Primary: to assess the effects of care in a home-like birth environment compared to care in a conventional labour ward. Secondary: to determine if the effects of birth settings are influenced by staffing or organizational models or geographical location of the birth centre.

Search strategy

We searched the Cochrane Pregnancy and Childbirth Group trials register (18 May 2004) and handsearched eight journals and two published conference proceedings.

Selection criteria

All randomized or quasi-randomized controlled trials that compared the effects of a home-like institutional birth environment to conventional hospital care.

Data collection and analysis

Standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group were used. Two review authors evaluated methodological quality. Double data entry was performed. Results are presented using relative risks and 95% confidence intervals.

Main results

Six trials involving 8677 women were included. No trials of freestanding birth centres were found. Between 29% and 67% of women allocated to home-like settings were transferred to standard care before or during labour. Allocation to a home-like setting significantly increased the likelihood of: no intrapartum analgesia/anaesthesia (four trials; n = 6703; relative risk (RR) 1.19, 95% confidence interval (CI) 1.01 to 1.40), spontaneous vaginal birth (five trials; n = 8529; RR 1.03, 95% CI 1.01 to 1.06), vaginal/perineal tears (four trials; n = 8415; RR 1.08, 95% CI 1.03 to 1.13), preference for the same setting the next time (one trial; n = 1230; RR 1.81, 95% CI 1.65 to 1.98), satisfaction with intrapartum care (one trial; n = 2844; RR 1.14, 95% CI 1.07 to 1.21), and breastfeeding initiation (two trials; n = 1431; RR 1.05, 95% CI 1.02 to 1.09) and continuation to six to eight weeks (two trials; n = 1431; RR 1.06, 95% CI 1.02 to 1.10). Allocation to a home-like setting decreased the likelihood of episiotomy (five trials; n = 8529; RR 0.85, 95% CI 0.74 to 0.99). There was a trend towards higher perinatal mortality in the home-like setting (five trials; n = 8529; RR 1.83, 95% CI 0.99 to 3.38). No firm conclusions could be drawn regarding the effects of staffing or organizational models.

Authors' conclusions

When compared to conventional institutional settings, home-like settings for childbirth are associated with modest benefits, including reduced medical interventions and increased maternal satisfaction. Caregivers and clients should be vigilant for signs of complications.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Home-like versus conventional institutional settings for birth

Home-like institutional birth settings reduce the chances of medical interventions and increase maternal satisfaction, but it is important to watch for signs of complications.

Home-like birth settings are intended for women who prefer to avoid medical intervention during labour and birth, but who either do not wish or cannot have a home birth. The results of six trials suggest modest benefits, including decreased medical intervention and higher rates of spontaneous vaginal birth, breastfeeding, and maternal satisfaction. However, there may be an added risk of perinatal mortality.