A Cohcrane review [Abstract] 1 included 10 studies with a total of 11 795 women. The studies compared the effects of an alternative institutional maternity care setting to conventional hospital care. No trials of freestanding birth centres or Snoezelen rooms were found. Allocation to an alternative setting increased the likelihood of: no intrapartum analgesia/anaesthesia (RR 1.18, 95% CI 1.05 to 1.33; 6 studies, n=8 953); spontaneous vaginal birth (RR 1.03, 95% CI 1.01 to 1.05; 8 studies, n=11 202); breastfeeding at six to eight weeks (RR 1.04, 95% CI 1.02 to 1.06; 1 study, n=1 147); and very positive views of care (RR 1.96, 95% CI 1.78 to 2.15; 2 studies, n=1 207). Allocation to an alternative setting decreased the likelihood of epidural analgesia (RR 0.82, 95% CI 0.74 to 0.87; 8 studies, n=10 931); oxytocin augmentation of labour (RR 0.77, 95% CI 0.67 to 0.88, statistical heterogeneity I2 =61%; 8 studies, n=11 131); instrumental vaginal birth (RR 0.89, 95% CI 0.79 to 0.99; 8 trials, n = 11 202); and episiotomy (RR 0.83, 95% CI 0.77 to 0.90; 8 studies, n=11 055). There was no apparent effect on perinatal mortality (RR 1.67, 95% CI 0.93 to 3.00; 7 studies, n= 10 095), serious perinatal morbidity/mortality (RR 1.17, 95% CI 0.51 to 2.67, statistical heterogeneity I2 =66%; 5 studies, n= 6 385), serious maternal morbidity/mortality (RR 1.11, 95% CI 0.23 to 5.36; 4 studies, n= 6 334), other adverse neonatal outcomes, or postpartum hemorrhage. No firm conclusions could be drawn regarding the effects of variations in staffing, organizational models, or architectural characteristics of the alternative settings.
A meta-analysis 2 compared maternal and perinatal outcomes from different places of birth among women with low-risk pregnancies in high-income countries. 28 studies were included, most of which were retrospective cohort studies. Women planning hospital births had statistically significantly lower odds of normal vaginal birth than in other planned settings. Women experienced severe perineal trauma or haemorrhage at a lower rate in planned home births than in obstetric units. There were no statistically significant differences in infant mortality by planned place of birth, although most studies had limited statistical power to detect differences for rare outcomes. Differences in location, context, quality and design of identified studies render results subject to variation.
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