Home-like versus conventional institutional settings for birth.

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 to 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). REVIEWER'S 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.