Home Births a Realistic and Safe Delivery Option

A new review suggests that home births may be safer than hospital births, with less complications and intervention than hospital births.

Researchers at the University of Copenhagen (Denmark) searched the Cochrane Pregnancy and Childbirth Group's Trials Register (up to the end of March 2012) for randomized controlled trials comparing planned hospital birth with planned home birth in low-risk women who were assisted by an experienced midwife with collaborative medical back up, in case transfer should be necessary. The researchers then assessed trial quality, extracted data, and contacted study authors for additional information when needed.

The review found that women who give birth at home have a higher likelihood of spontaneous labor, since schedules and easy access to medical care can cause unnecessary medical interventions. In all, home delivery showed 20%-60% fewer interventions, including cesarean sections, augmentation, and epidurals among planned home births. There were also 10%-30% fewer complications, such as postpartum bleeding and perineal tears. The researchers concluded however, that there is no strong evidence to support or disfavor home birth over hospital birth, assuming that home birth is planned with an experienced midwife available and with medical back up ready, in the event that a transport is needed. The study was published on September 12, 2102, in the Cochrane Database of Systematic Reviews.

“Patience is important if women want to avoid interference and give birth spontaneously,” said review coauthor Jette Aaroe Clausen, PhD, of the department of public health. “At home the temptation to make unnecessary interventions is reduced. The woman avoids for example routine electronic monitoring that may easily lead to further interventions in birth.”

The American College of Obstetricians and Gynecologists (ACOG; Washington DC, USA), however, found that planned home birth was associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth, and that a prior cesarean delivery significantly increases the risk of uterine rupture and other dangerous complications. Due to a greater risk of perinatal death, ACOG therefore advises women who are post-term (i.e., greater than 42 weeks gestation), carrying twins, or have a breech presentation not to attempt home birth, and that women wishing to attempt a vaginal birth after cesarean should do so only in a hospital with ready access to emergency care.

Related Links:
University of Copenhagen
American College of Obstetricians and Gynecologists