Safety of Homebirth

Research on the safety of homebirth
Recent research has shown that unnecessary C-sections may increase the risk of respiratory distress, prolonged hospitalization and transfer into a Neonatal Intensive Care Unit (NICU). A recent study of 5,418 women across North America giving birth at home with certified professional midwives found maternal and infant mortality rates matching those of low-risk women giving birth in the hospital, with a significant decrease in medical interventions: 12.1% of women planning to deliver at home were transferred to a hospital, and only 3.7% of the homebirth group were delivered via C-section. See below abstract with link to full article.

Outcomes of planned home births with certified professional midwives: large prospective study in North America

Kenneth C Johnson, senior epidemiologist1, Betty-Anne Daviss, project manager2

1 Surveillance and Risk Assessment Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, PL 6702A, Ottawa, ON, Canada K1A OK9, 2 Safe Motherhood/Newborn Initiative, International Federation of Gynecology and Obstetrics, Ottawa, Canada

Objective To evaluate the safety of home births in North America involving direct entry midwives, in jurisdictions where the practice is not well integrated into the healthcare system.

Design Prospective cohort study.
Setting All home births involving certified professional midwives across the United States (98% of cohort) and Canada, 2000.

Participants All 5418 women expecting to deliver in 2000 supported by midwives with a common certification and who planned to deliver at home when labour began.

Main outcome measures Intrapartum and neonatal mortality, perinatal transfer to hospital care, medical intervention during labour, breast feeding, and maternal satisfaction.

Results 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated.

Conclusions Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.

http://www.bmj.com/cgi/content/full/330/7505/1416

A recent 2009 Canadian study demonstrated that planned homebirths were associated with lower rates of obstetrical interventions as well as adverse perinatal outcomes. See below abstract with link to full article.

Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician

Patricia A. Janssen, PhD, Lee Saxell, MA, Lesley A. Page, PhD, Michael C. Klein, MD, Robert M. Liston, MD and Shoo K. Lee,

MBBS PhD

From the School of Population and Public Health (Janssen), the Departments of Family Practice (Klein) and Obstetrics and Gynecology (Janssen, Liston) and the Division of Midwifery (Saxell), Faculty of Medicine, University of British Columbia, Vancouver, BC; the Child and Family Research Institute (Janssen, Klein, Liston), Vancouver, BC; the Nightingale School of Nursing and Midwifery (Page), King’s College, London, UK; the Department of Pediatrics (Lee); and the Integrated Centre for Care Advancement Through Research (Lee), University of Alberta, Edmonton, Alta.
Correspondence to: Dr. Patricia A. Janssen, School of Population and Public Health, University of British Columbia, 5804 Fairview Cres., Vancouver BC V6T 1Z3; fax 604 806-8006; pjanssen@interchange.ubc.ca

Background: Studies of planned home births attended by registered midwives have been limited by incomplete data, nonrepresentative sampling, inadequate statistical power and the inability to exclude unplanned home births. We compared the outcomes of planned home births attended by midwives with those of planned hospital births attended by midwives or physicians.

Methods: We included all planned home births attended by registered midwives from Jan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada (n = 2889), and all planned hospital births meeting the eligibility requirements for home birth that were attended by the same cohort of midwives (n = 4752). We also included a matched sample of physician-attended planned hospital births (n = 5331). The primary outcome measure was perinatal mortality; secondary outcomes were obstetric interventions and adverse maternal and neonatal outcomes.

Results: The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician. Women in the planned home-birth group were significantly less likely than those who planned a midwife-attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95% CI 0.29–0.36; assisted vaginal delivery, RR 0.41, 95% 0.33–0.52) or adverse maternal outcomes (e.g., third- or fourth-degree perineal tear, RR 0.41, 95% CI 0.28–0.59; postpartum hemorrhage, RR 0.62, 95% CI 0.49–0.77). The findings were similar in the comparison with physician-assisted hospital births. Newborns in the home-birth group were less likely than those in the midwife-attended hospital-birth group to require resuscitation at birth (RR 0.23, 95% CI 0.14–0.37) or oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24–0.59). The findings were similar in the comparison with newborns in the physician-assisted hospital births; in addition, newborns in the home-birth group were less likely to have meconium aspiration (RR 0.45, 95% CI 0.21–0.93) and more likely to be admitted to hospital or readmitted if born in hospital (RR 1.39, 95% CI 1.09–1.85).

Interpretation: Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.