Characteristics Associated With Intending and Achieving a Planned Home Birth in the United Kingdom: An Observational Study of 515,777 Maternities in the North West Thames Region, 1988–2000

Abstract

BACKGROUND AND OBJECTIVES: This study aims to identify factors that have an independent association with planned home birth. It investigates the social, demographic, and obstetric profile of those who choose home birth as compared with those choosing hospital birth. This crucial evidence is lacking in the U.K. context and is needed when comparing pregnancy outcomes of different birth settings. Otherwise, the comparison is problematic because observed differences in incidence of pregnancy outcomes may be due to the fact that different types of women choose different birth settings. It is important to understand these differences in order to control for them.METHOD: This is an observational study involving secondary analysis of computerized maternity records from 15 hospitals in the former North West Thames Regional Health Authority (RHA) area. All pregnancies that resulted in a live or stillbirth in the years 1988–2000 are included (N = 515,777). Two binary logistic regression models are used: one with intended place of birth at booking as the outcome and the other with actual place of birth as the outcome.RESULTS: Women who are parous, White European, aged 30 and older, living in a relatively affluent area, and partnered are most likely to intend a home birth. Among those who intend a home birth at the end of pregnancy, predictors of achieving a home birth include an uncomplicated and relatively short labor, being parous, a low-risk pregnancy, and being White European. The hospital providing maternity care predicts the outcome for both models.CONCLUSIONS: Key variables robustly predict an intention to deliver at home and the achievement of a planned home birth. Studies comparing the outcomes of different birth settings in the United Kingdom should control for these variables.