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Is homebirth safe?

 

Study after study has shown what many women inherently know: homebirth is as safe, if not safer, then hospital birth for healthy women.  But, you needn’t take my word for it.  Have a look at the research yourself:

 

 

"Interpretation: There was no increased maternal or neonatal risk associated with planned home birth under the care of a regulated midwife."

 

"Summary: No strong evidence about the benefits and safety of planned home birth compared to planned hospital birth for low-risk pregnant women. 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."

 

"Conclusion: Home birth was a safe and increasingly popular, though minor, option for New Zealand women from 1973-93."

 

"Conclusion: Home birth is an acceptable alternative to hospital confinement for selected pregnant women, and leads to reduced medical interventions."

 

"Results: There was no relation between the planned place of birth and perinatal outcome in primiparous women when controlling for a favourable or less favourable background. In multiparous women, perinatal outcome was significantly better for planned home births than for planned hospital births, with or without control for background variables.

Conclusions: 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."

 

"Conclusion: Healthy low risk women who wish to deliver at home have no increased risk either to themselves or to their babies."

 

"This study supports previous research indicating that planned home birth with qualified care providers can be a safe alternative for healthy lower risk women."

 

"The outcomes of newborns born at home compared favorably to the national average during the same period. Several findings varied considerably by race or ethnicity of the mother."

 

"Results: The results of this study indicate that in Washington state the practice of licensed nonnurse-midwives, whose training meets standards set by international professional organizations, may be as safe as that of physicians in hospital and certified nurse-midwives in and out of hospital."

 

"Conclusions: Planned home births in WA appear to be associated with less overall maternal and neonatal morbidity and less intervention than hospital births. Implications for practice: whether these observed differences in intervention and morbidity have any relationship to the small, non-significant increase in perinatal mortality could not be determined in this study. Continuing evaluation of home birth practice and outcome is essential."

 

"Report: The present study - together with cohort studies documenting such a reduction, studies showing other benefits of such forms of care, and the increasing reluctance of physicians to provide obstetrical services - suggests that childbearing families would realize many benefits from greatly expanded use of midwives and out-of-hospital birth settings."

 

"Results: Based on rates of perinatal death, of low 5-minute Apgar scores, of a composite index of labor complications, and of use of assisted delivery, the results suggest that, under certain circumstances, home births attended by lay midwives can be accomplished as safely as, and with less intervention than, physician-attended hospital deliveries."

 

"Despite the methodological limitations, nontraditional birth settings present advantages for low-risk women as compared with traditional hospital settings: lower costs for maternity care, and lower use of childbirth procedures, without significant differences in perinatal mortality."

 

"Summary: A retrospective descriptive study of 1001 midwife-attended home births in Toronto, Ontario, was carried out between January 1983 and July 1988. Interviews with 26 midwives and reviews of client records provided data on maternal age, socio-economic status, gestation, ruptured membranes, length of labor, episiotomies and perineal lacerations, transfer to hospital of mother or baby or both, infant resuscitation, and breastfeeding. Of 1001 planned home births, 361 involved primiparous women, of whom 245 (68%) remained at home and 116 (32%) required transfer of mother or baby to hospital during labor or the first four postpartum days. Of the 640 multiparous births, 591 (92%) women remained at home and 49 (8%) required transfer to hospital. Among women transferred, 91 had spontaneous vaginal births, 34 had forceps deliveries, and 35 had cesarean sections. Variables significantly associated with maternal transfer for both primiparas and multiparas were length of latent and active phases of the first stage of labor, length of the second stage of labor, and duration of ruptured membranes. Five neonates were transferred and two died, one each after birth at home and in hospital. There were no maternal deaths. The proportion of mothers breastfeeding without supplement at 28 days postpartum was 98.6 percent. Since this study is descriptive, with no control group for comparison, conclusions about safety of home birth and generalizability of data cannot be made. However, the large sample size and inclusion of all known midwife-attended home births over the defined time period help to increase the validity of the findings."

 

"Summary: Analyses of the published results of national surveys and specific studies, as well as of the official stillbirth statistics, consistently point to the conclusion that perinatal mortality is significantly higher in consultant obstetric hospitals than in general practitioner maternity units or at home, even after allowance has been made for the greater proportion of births in hospital at high pre-delivery risk. Unpublished results of the British births 1970 survey, which have now become available, make possible a direct and authoritative analysis of data on the safest place of birth. Not only does this make the earlier conclusion more certain, but it confounds the doctrine that obstetric intranatal care is particularly beneficial for high pre-delivery risk births. There is no evidence from recent years that the findings of 1970 are not equally valid in the 1980s."

 

"Conclusion: The obstetrical literature is replete with anecdotal accounts of the presumed dangers of home births. However, this report, in addition to the work of others cited in the introduction, shows the safety of home birth in properly selected and motivated individuals. These results confirm that with intense prenatal care and education, and maximum support for the laboring woman, couples desiring a home birth can expect good outcomes."

 

"Women booking a delivery at home are clearly a selected group, and some may have been transferred to hospital during labour and were thus not included in the survey. Nevertheless, these data suggest that the perinatal mortality among births booked to occur at home is low, especially for parous women."

 

"The incidence rate of low birth weight babies was lower for midwife-attended births in every category examined. Apgar scores for babies born both in and out of hospital were also studied but, because of inconsistent reporting, were given less attention. Excellent (9-10) Apgar scores were more common among babies born out of hospital than among those born in hospital (63 percent compared with 49 percent), particularly for out-of-hospital births attended by physicians. At least with respect to birth weight and Apgar scores, the claim that out-of-hospital births are inherently more dangerous than hospital births receives no support from these data... It is important to keep in mind that birth weight and Apgar scores are not perfect measurers of outcomes and that emergencies can occur in any settings; however, the data presented here are based on almost every recorded out-of-hospital birth in the United States in 1978 and therefore cannot be easily dismissed."

 

"Abstract: In 1978, Arizona began licensing lay midwives under regulations designed to maintain adequate standards of care for women desiring a home birth. During four years of this program, 3 per cent of home birth clients were hospitalized for complications and another 15 per cent received postnatal outpatient care, primarily for second degree lacerations. Five per cent of the newborns required medical care after delivery; half of these were hospitalized. Complications declined over the period due to increased experience, close supervision, and continuing education."

 

"Conclusions: The substantial increase in birth weight for out-of-hospital births suggests that women who decided to have their babies at home tended to deliver infants with birth weights characteristic of normal, healthy infants. To the extend that birth weight is indicative of infants' health, we conclude that choosing a home birth is not necessarily associated with high risk. The small number of cases in this study makes it difficult to draw inferences about the safety of planned out-of-hospital birth from neonatal mortality trends. However, the statistically significant decrease in overall neonatal mortality and in neonatal mortality of high-birth-weight infants also points in the direction of greater safety. Using mortality data from vital records for several states, the Executive Board of the American College of Obstetrics and Gynecologists stated that home births are several times more dangerous than hospital births. Since birth certificates do not distinguish between planned and unplanned home deliveries, such mortality statistics reflect the dangers of both emergency and deliberate home births. Therefore, it is inappropriate to use such statistics as evidence about the risks of planning."

 

"Neonatal mortality examined by place and circumstances of delivery in North Carolina during 1974 through 1976 with attention given to home delivery. Planned home deliveries by lay-midwives resulted in three neonatal deaths per 1,000 live births; planned home deliveries without a lay-midwife, 30 neonatal deaths per 1,000 live births; and unplanned home deliveries, 120 neonatal deaths per 1,000 live births. Planning, prenatal screening, and attendant-training were important in differentiating the risk of neonatal mortality in this uncontrolled, observational study."

 

Neonatal Outcomes: In the hospital, 3.7 times as many babies required resuscitation. Infection rates of newborns were 4 times higher in the hospital. There was 2.5 times as many cases of meconium aspiration pneumonia in the hospital group. There were 6 cases of neonatal lungwater syndrome in the hospital and none at home. There were 30 birth injuries (mostly due to forceps) in the hospital group, and none at home. The incidence of respiratory distress among newborns was 17 times greater in the hospital than in the home. While neonatal and perinatal death rates were statistically the same for both groups, Apgar scores (a measure of physical well being of the newborn) were significantly worse in the hospital.

 

"The results of this study have shown that neonatal mortality and morbidity are lower in an unanesthetized natural childbirth population than in the population as a whole. It is also suggested that selected women with benign prenatal courses can labor and deliver at home without a significant increase in neonatal and maternal risks. Certain complications of this series could have been reduced by making oxytocin available at home for the treatment of uterine inertia, by training midwives to perform episiotomies in those cases in which tears were inevitable, by providing appropriate drugs to prevent third stage hemorrhage and by having medical supervision immediately available. The incidence of postpartum infection seen at home is comparable to that seen in the hospital, and indicated that in the less pathogenic environment of the home, hospital asepsis was not necessary to prevent infection. This study, as in that of Levy, et al., confirms that utilization of midwives would benefit the public health of the state."