Safety of Homebirth
Published in 2013 in the Australian Medical Journal, the retrospective study by the University of Technology Sydney of homebirths in Australia 2005-2010 delivered good news for homebirth services. Professor of midwifery at UTS Caroline Homer summarised results in this article: ”when the expected deaths were excluded, a stillbirth and early neonatal mortality rate of 1.7 per 1000 births was low compared with a rate of about five per 1000 for low-risk women giving birth in hospital. A post-partum haemorrhage rate of 1.8 per cent among the home birth group was also low compared with a rate of about 5-6 per cent for low-risk women in hospital.
Also published in the British Medical Journal in 2013, Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study of 146 752 low risk women in primary care at the onset of labour, with 92 333 (62.9%) women having a planned home birth and 54 419 (37.1%) a planned hospital birth. Conclusion: Low risk women in primary care at the onset of labour with planned home birth had lower rates of severe acute maternal morbidity, postpartum haemorrhage, and manual removal of placenta than those with planned hospital birth. See full article.
Women’s and Newborn’s Health Network publication: “Models of Maternity Care: Updated Evidence on Outcomes and Safety of Planned Home Birth” (2011) states that: “On the evidence available, planned home births by women at low obstetric risk were associated with significant reductions in obstetric interventions of labour and delivery, while demonstrating no increases in perinatal morbidity or mortality. Women should be counselled about the potential for transfer to hospital if complications arise and systems should be put in place for smooth transition to hospital care in the case of complications.”
See also the recent Literature Review on Homebirth from the Australian College of Midwives.
The NICE Guidelines (2007) recommend that women be informed that “.. the available information …. suggests that among women who plan to give birth at home or in a midwife-led unit there is a higher likelihood of a normal birth, with less intervention.” It did recommend 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”. For more details, read the Guidelines here
A Cochrane Review of Home versus hospital birth summarised their findings as follows (in 2009): “(there is)..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.”
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists do not endorse homebirths. You can read their College Statement here.
The Royal College of Obstetricians and Gynaecologist in the UK do support homebirths – see here for their joint statement with the Royal College of Midwives.
The following studies may be of interest:
De Jonge A, van der Goes BY, Ravelli ACJ, Amelink-Verburg MP, Mol BW, et al. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG 2009; DOI: 10.1111/j.1471-0528.2009.02175.x. – seehttp://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2009.02175.x/pdf
Kennare RM, Keirse MJ, Tucker GR, Chan AC. Planned home and hospital births in South Australia, 1991-2006: differences in outcomes. MJA 2009: 192;2 –http://www.mja.com.au/public/issues/192_02_180110/ken10465_fm.html
See also our Links page for further reading.