Home-like versus conventional institutional settings for birth (Cochrane Review)

A substantive amendment to this systematic review was last made on 13 July 2001. Cochrane reviews are regularly checked and updated if necessary.

Background: Many home-like birth centres have been established near conventional labour wards for the care of pregnant women who prefer and require little or no medical intervention during labour and birth.

Objectives: The objective of this review was to assess the effects of care in a home-like birth environment compared to care in a conventional labour ward, on labour and birth outcomes.

Search strategy: The Cochrane Pregnancy and Childbirth Group trials register was searched. Date of last search: July 2001.

Selection criteria: Randomised and quasi-randomised trials comparing a home-like institutional birth environment to conventional hospital care for pregnant women at low risk of obstetric complications.

Data collection and analysis: Trial quality was assessed.

Main results: Six trials involving almost 9000 women were included. Substantial numbers of women allocated to home-like settings were transferred to standard care before or during labour. Allocation to a home-like setting was associated with lower rates of intrapartum analgesia/anaesthesia (odds ratio 0.82, 95% confidence interval 0.72, 0.93), augmented labour (odds ratio 0.72, 95% confidence interval 0.64, 0.81), and operative delivery (odds ratio 0.85, 95% confidence interval 0.70, 0.96) , as well as greater satisfaction with care. There was a non-statistically significant trend towards higher perinatal mortality in the home-like setting (odds ratio 1.49, 95% confidence interval 0.79 to 2.78).

Reviewers' conclusions: There appear to be some benefits from home-like settings for childbirth, although increased support from caregivers may be more important. Caregivers and clients in home-like settings need to watch for signs of complications.

Citation: Hodnett ED. Home-like versus conventional institutional settings for birth (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.

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This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

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