Home Birth Safety
Evidence-based Research Conclusions
There is considerable controversy surrounding home birth safety. However, in general, planned births at home (as against emergency births outside of hospital) seem to be considered at least as safe as hospital births.
In the UK, The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for women with uncomplicated pregnancies:
There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman's likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.
(RCOG and Royal College of Midwives Joint Statement No.2. April 2007)
Quotes on Home Birth Safety
Midwives see birth as a miracle and only mess with it if there's a problem; doctors see birth as a problem and if they don't mess with it, it's a miracle!
Barbara Harper
Unfortunately, the role of obstetrics has never been to help women give birth. There is a big difference between the medical discipline we call 'obstetrics' and some completely different, the art of midwifery. If we want to find safe alternatives to obstetrics, we must rediscover midwifery. To rediscover midwifery is the same as giving back childbirth to women. And imagine the future if surgical teams were at the service of the midwives and the women instead of controlling them.
Michel Odent, MD
The American Medical Association and the American College of Obstetricians and Gynecologists opposes home birth on the basis a medical emergency can arise during any seemingly uncomplicated birth.
They state that, Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby.
(ACOG Statement on Home Births, American College of Obstetricians and Gynecologists. February 6, 2008. http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm. Retrieved 08/08/2010.)
In contrast, advocates of home birth safety, believe that having a baby in hospital carries its own risks.
It therefore remains the responsibility of the pregnant woman to research the risks and benefits of the various birth options and to make informed decisions regarding who will be present and where she will give birth.
Evidence-based Research on Home Birth Safety
To date, the largest and most complete study on the comparison of hospital birth outcomes to that of homebirth outcomes was done by Dr. Lewis Mehl and associates in 1976. This study compared 1046 home births with 1046 hospital births of equivalent populations in the United States.
For each home-birth patient, a hospital-birth patient was matched for age, length of gestation, parity (number of pregnancies), risk factor score, education and socio-economic status, race, presentation of the baby and individual major risk factors. The home birth population also had trained birth attendants and prenatal care.
The results of this study showed a three times greater likelihood of cesarean operation if a woman gave birth in a hospital instead of at home with the hospital standing by.
The hospital population revealed twenty times more use of forceps, twice as much use of oxytocin to accelerate or induce labor, greater incidence of episiotomy (while at the same time having more severe tears in need of major repair).
The hospital group showed six times more infant distress in labor, five times more cases of maternal high blood pressure, and three times greater incidence of postpartum hemorrhage.
There was four times more infection among the newborn; three times more babies that needed help to begin breathing.
While the hospital group had thirty cases of birth injuries, including skull fractures, facial nerve palsies, brachial nerve injuries and severe cephalohematomas, there were no such injuries at home.
The infant death rate of the study was low in both cases and essentially the same. There were no maternal deaths for either home or hospital. The main differences were in the significant improvement of the mother's and baby's health if the couple planned a homebirth, and this was true despite the fact that the homebirth statistics of the study included those who began labor at home but ultimately needed to be transferred to the hospital.
Dr. Lewis Mehl, Home Birth Versus Hospital Birth: Comparisons of Outcomes of Matched Populations. Presented on October 20, 1976 before the 104th annual meeting of the American Public Health Association. For further information contact the Institute for Childbirth and Family Research, 2522 Dana St., Suite 201, Berkeley, CA 94704
The following is a selection of conclusions of other research which focused on various aspects of home birth safety.
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.
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
In some countries almost all births happen in hospital, whereas in other countries home birth is considered the first choice for healthy and otherwise low-risk women. The change to planned hospital birth for low-risk pregnant women in many countries during this century was not supported by good evidence.
Planned hospital birth may even increase unnecessary interventions and complications without any benefit for low-risk women. The review found only one small trial, which provided no strong evidence to favour either planned hospital birth or planned home birth for low-risk pregnant women.
Olsen O, Jewell D. Home versus hospital birth. Cochrane Database of Systematic Reviews 1998, Issue 3. Art. No.: CD000352. DOI: 10.1002/14651858.CD000352
The outcome of planned home births is at least as good as that of planned hospital births in women at low risk receiving midwifery care in the Netherlands. In multiparous women, perinatal outcome was significantly better for planned home births than for planned hospital births, with or without control for background variables.
T A Wiegers, M J N C Keirse, J van der Zee, and G A H Berghs, Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands, BMJ 23 November 1996; 313: 1309-1313.
Healthy low risk women who wish to deliver at home have no increased risk either to themselves or to their babies.
Ursula Ackermann-Liebrich, Thomas Voegeli, Kathrin Gunter-Witt, Isabelle Kunz, Maja Zullig, Christian Schindler, Margrit Maurer, and Zurich Study Team, Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome, BMJ 23 November 1996; 313: 1313-1318
...informed birthing decisions cannot be made without information on costs, success rates, and any necessary trade-offs between the two...The average uncomplicated vaginal birth costs 68% less in a home than in a hospital, and births initiated in the home offer a lower combined rate of intrapartum and neonatal mortality and a lower incidence of cesarean delivery.
Anderson RE; Anderson DA (Dept. of Economics, Centre College, Danville, KY 40422, USA. )The Cost-Effectiveness of Home Birth, J Nurse Midwifery, 44(1):30-5 1999 Jan-Feb
The hospital group rated childbirth pain significantly higher than the homebirth group.
(Morse JM, Park C, Home birth and hospital deliveries: a comparison of the perceived painfulness of parturition, Res Nurs Health 1988 Jun;11(3):175-81)
Every study published shows midwives to be safer than doctors. Every study. No exceptions. If your physician disagrees with this, challenge him or her to produce the data that supports otherwise. They won't be able to do it. Such data does not and never did exist. In a nutshell, that is the strength of the case for midwifery. It is unanimous...[O]ver and over again, throughout history, the data shows that when doctors displace midwives, outcomes get worse.
David Stewart, PhD. (Editor), The Five Standards of Safe Childbearing. Marble Hill, MO: NAPSAC Reproductions, 1982, 1997.
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