In planning to have a home birth for each of my children, the response I typically encountered from others was something along the lines of “what if something goes wrong?” or “you are really brave”. These responses underscore the fact that most people in our society have no idea that home birth is a safe option, and they certainly don’t think labor is something we are designed to handle naturally, without interventions or drugs. As an avid researcher of so many decisions in my life, it was surprising that people would think I was somehow being cavalier by deciding to have a baby at home, as if I was potentially sacrificing the safety and health of my unborn child.
What Do The Statistics Say About the Safety of Home Birth?
Home birth is as safe (if not safer) than hospital birth for low-risk women. A recent study of nearly 13,000 births was published in the Canadian Medical Association Journal [1]. There were three groups of women in this study: those planning home births with a registered midwife, those planning hospital births with a registered midwife, and those planning hospital births with a physician. Both groups of women that were attended by a registered midwife were attended by the same group of midwives; additionally, all of these women met the eligibility requirements for home birth, which means that women in both of these groups did not have any preexisting disease, significant complications of pregnancy (such as hypertension and gestational diabetes), or multiple fetuses, among other criterion.
The study showed that rates of perinatal death (i.e. death during the last weeks of pregnancy and up to four weeks following birth) were slightly lower in the planned home birth group (0.35 deaths per 1000 births) than in both of the groups of women planning to give birth in the hospital (0.57 deaths per 1000 births in a hospital attended by a midwife and 0.64 deaths per 1000 births in a hospital attended by a physician). This means that there were fewer deaths of mothers and babies in the planned home birth group than in both of the hospital birth groups.
Fewer Obstetrical Interventions
All obstetrical interventions, such as episiotomy, electronic fetal monitoring and assisted vaginal delivery, pose some risk to the mother and/or baby. The same study [1] showed that “women who planned a home birth were significantly less likely to experience any of the obstetric interventions [that were] assessed, including electronic fetal monitoring, augmentation of labour, assisted vaginal delivery, cesarean delivery and episiotomy.” For instance, 3% of mothers in the planned home birth group received an episiotomy, while the women who planned hospital births with midwives and doctors had episiotomy rates of 7% and 17% respectively. 24% of women who planned homebirths had some augmentation of labor (such as rupture of membranes or oxytocin), while the women who planned hospital births with midwives and doctors had labor augmentation rates of 40% and 50% respectively.
Healthier Mothers and Babies
In the same study [1], women who planned to birth at home were also much less likely to have adverse maternal outcomes, such as 3rd- or 4th –degree perineal tears or postpartum hemorrhage. Additionally, newborns in the home birth group were less likely to have birth trauma, require resuscitation at birth, or have meconium aspiration.
All of these trends make it clear that mothers and babies in the home birth group were safer and healthier than those that planned births in a hospital.
Are these home birth statistics surprising to you? How was your birth experience?
Reference [1] “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, Shoo K. Lee MBBS PhD, Canadian Medical Association Journal, 15 September 2009, Volume 181, Issue 6-7.