Home Birth - Research On Safety

Research On Safety

The data available on the safety of home birth in developed countries is limited and difficult to interpret due to issues such as studies being too small in scope, retrospective in their design, and difficult to compare with other studies because of varying definitions of perinatal mortality. It is difficult to compare home and hospital births because only healthy, low-risk women tend to give birth at home. An additional problem is that transportation time is a significant factor in safety, and data comes from many different countries, which have different population density levels and therefore different average hospital distances.

In 2007, after a comprehensive review of the literature, the UK's National Institute for Health and Clinical Excellence (NICE) expressed concern for the lack of quality evidence comparing the potential risks and benefits of home and hospital birthing environments. Their report also noted that intrapartum-related perinatal mortality was low in all settings. In conclusion, the report recommended that women should be offered the choice of planning birth at home, in a midwifery unit or in an obstetric unit, and informed of the potential risks and benefits of each birth setting.

The uncertain evidence suggests intrapartum-related perinatal mortality (IPPM) for booked home births, regardless of their eventual place of birth, is the same as, or higher than for birth booked in obstetric units. If IPPM is higher, this is likely to be in the group of women in whom intrapartum complications develop and who require transfer into the obstetric unit.

When unanticipated obstetric complications arise, either in the mother or baby, during labour at home, the outcome of serious complications is likely to be less favourable than when the same complications arise in an obstetric unit.

The NICE report concluded that women who give birth at home are more likely to deliver vaginally and to have greater satisfaction from the experience when compared with women who plan to give birth in a hospital. The report compared women's home birth experience to birth in a consultant-led unit. It concluded that the consultant-led setting increased the likelihood that the woman would receive analgesia, obstetrical intervention and a delivery using instruments, and decreased the woman's satisfaction with the experience. It reported that women who give birth at home may experience an equal or lower risk of perinatal mortality equal when they receive care in a consultant-led unit.

Since the 2007 review, a study of 529,688 low-risk planned home and hospital births was reported in the British Journal of Obstetrics and Gynaecology in 2009. The study concluded:

A home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low risk women, provided the maternity care system facilitiates this choice through the availability of well-trained midwives and through a good transportation and referral system.

Further, the study noted there was evidence that "low risk women with a planned home birth are less likely to experience referral to secondary care and subsequent obstetric interventions than those with a planned hospital birth." The study has been criticised on several grounds, including that some data might be missing and that the findings may not be representative of other populations.

In North America, a 2005 study found "similar mortality rates for low-risk hospital births and planned home births." The study found that mothers who gave birth at home were less likely to require medical interventions like a caesarean section or forceps delivery. About 12 percent of women intending to give birth at home needed to be transferred to the hospital for reasons such as a difficult labor or pain relief. However, women in the study were more likely to already have had a child, tended to be older, of lower socioeconomic classes, better educated, and less likely to be African-American or Hispanic.

A 2010 meta-analysis of studies which compared home births with planned hospital births among healthy, low-risk mothers in industrialized countries found no difference in the home and hospital rates of perinatal death, but also found that "planned home birth is associated with a tripling of the neonatal mortality rate." The authors wrote that they found this increase "striking" since women planning home births generally had fewer risk factors than those planning hospital births — lower rates of obesity, fewer prior Caesarean sections, and fewer previous pregnancy complications. This study was controversial for many reasons, most notably that it included a large U.S. study that contained both planned and unplanned home births, the latter of which are known to have much higher rates of perinatal mortality.