Homebirths as safe as hospital births

Homebirths in a well-integrated midwife setting are as safe as hospital births for low-risk pregnant women, a large international study shows.

Canadian researchers found low-risk pregnant women who intended to give birth at home had no increased risk of perinatal or neonatal death than those who gave birth at hospital.

“More women in well-resourced countries are choosing birth at home, but concerns have persisted about their safety,” said lead author and Professor Emeritus of Obstetrics and Gynaecology at McMaster University, Eileen Hutton.

“This research clearly demonstrates the risk is no different when the birth is intended to be at home or in hospital.”

Data was analysed from 21 studies since 1990 that compared home and hospital birth outcomes in Sweden, New Zealand, England, Netherlands, Japan, Australia, Canada and the US.

Outcomes from approximately 500,000 intended homebirths were compared to similar numbers of births intended to occur in hospital across the countries.

Safety of place of birth was assessed by reporting on the risk of death at the same time of birth or within the first four weeks, with findings showing no clinically important or statistically significant difference in risk between home and hospital groups.

“Women who are low risk and who intend to give birth at home do not appear to have a different risk of fetal or neonatal loss compared to a population of similarly low risk women intending to give birth at hospital,” wrote the researchers.

For women who had never had a child, and intended a homebirth where midwives were well-integrated in health services, the odds ratio of perinatal or neonatal mortality compared to those intending hospital birth was 1.07; and in less integrated settings 3.17.

Despite a three-fold increase in mortality risk in less integrated settings, the results were not statistically significant.

For women who had previously given birth, and had a homebirth in well-integrated settings or compared to those who intended a hospital birth the ratio was 1.08; and in less integrated settings it was 1.58.

A well-integrated setting was described as a place where homebirth practitioners: are recognised by statute within their jurisdiction; have received formal training; can provide or arrange care in hospital; have access to a well-established emergency transport system; and carry emergency equipment and supplies.

Less well-integrated settings were those where one or more of those criteria were absent.

“Our results show that among low risk women who intend to give birth at home when labour starts there is no increase in perinatal and neonatal mortality or morbidity compared to similarly low risk women who intend to give birth in a hospital.

“There were no differences between intended home and intended hospital groups in other neonatal outcomes including NICU admission, Apgar scores and the need for resuscitation.”

The research was published in international journal EClinicalMedicine

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