Giving birth: home can be better than hospital

For women with low risk pregnancies in North America, giving birth at home bears similar risks of intrapartum and neonatal mortality as giving birth in hospital, but planned home births are associated with lower rates of medical interventions. In a prospective cohort study, Johnson and Daviss evaluated the safety of home births involving certified midwives in 5418 women who intended to give birth at home when labour began. The study participants experienced substantially lower rates of epidurals, episiotomies, forceps deliveries, vacuum extractions, and caesarean sections than women with low risk pregnancies who gave birth in hospital.

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

Kenneth C Johnson and Betty-Anne Daviss
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 .

For women with low risk pregnancies in North America, giving birth at home bears similar risks of intrapartum and neonatal mortality as giving birth in hospital, but planned home births are associated with lower rates of medical interventions. In a prospective cohort study, Johnson and Daviss evaluated the safety of home births involving certified midwives in 5418 women who intended to give birth at home when labour began. The study participants experienced substantially lower rates of epidurals, episiotomies, forceps deliveries, vacuum extractions, and caesarean sections than women with low risk pregnancies who gave birth in hospital.

Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births

de Jonge A, van der Goes B, Ravelli A, Amelink-Verburg M, Mol B, Nijhuis J, Bennebroek Gravenhorst J, Buitendijk S.

26 February 2009 . Published Online 15 April 2009 . . BJOG 2009; DOI: 10.1111/j.1471-0528.2009.02175.x.
Objective To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care.

Design A nationwide cohort study.
Setting The entire Netherlands .
Population A total of 529 688 low-risk women who were in primary midwife-led care at the onset of labour. Of these, 321 307
(60.7%) intended to give birth at home, 163 261 (30.8%) planned to give birth in hospital and for 45 120 (8.5%), the intended place of birth was unknown.
Methods Analysis of national perinatal and neonatal registration data, over a period of 7 years. Logistic regression analysis was used to control for differences in baseline characteristics.

Main outcome measures Intrapartum death, intrapartum and neonatal death within 24 hours after birth, intrapartum and neonatal death within 7 days and neonatal admission to an intensive care unit

Results No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours
1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care
unit 1.00 (0.86 to 1.16).
Conclusions This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal
morbidity among low-risk women, provided the maternity caresystem facilitates this choice through the availability of welltrained midwives and through a good transportation and referral system.
Keywords Midwifery, perinatal mortality, pregnancy outcome.