Researchers who compared planned home births attended by regulated midwives to hospital births attended by either midwives or doctors, found the risk of infant death in the home births was “very low” and didn’t differ significantly from hospital births.
Women who planned a home birth were significantly less likely to experience any of the obstetric interventions the researchers measured, including using drugs to stimulate or speed labour, narcotics for pain, electronic fetal monitoring and forceps deliveries. They were also less likely to experience a postpartum hemorrhage, and their babies were less likely to suffer a birth trauma, require resuscitation at birth or oxygen therapy.
Obstetricians around the world are split on their support of births outside a hospital setting. OB groups in Australia and New Zealand are opposed to home births, and the American College of Obstetricians and Gynecologists is unequivocal.
The group said complications can arise “with little or no warning even among women with low-risk pregnancies” and that childbirth shouldn’t be influenced “by what’s fashionable, trendy or the latest cause celebre.”
In contrast, the Royal College of Obstetricians and Gynaecologists in the United Kingdom supports home births as a viable choice for women with uncomplicated pregnancies.
The study comes just weeks after the leaders of Canada’s pregnancy specialists are urging doctors to “normalize” childbirth and lower the rates of C-sections and other interventions.
“We definitely understand that it’s a woman’s decision to choose where she wants to give birth, in a hospital or a home,” said Dr. Andre Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada. “We don’t have anything against (home births) for selected, low-risk women.”
This is the second study the B.C. group has reported on the safety of home births. In 2002, the team reported on a smaller study involving 862 planned home births.
“This one allows us to say definitively what the rates of perinatal death are,” said lead author Patricia Janssen, an associate professor in the School of Population and Public Health at the University of B.C. “Our first study was really too small to look at that with confidence.”
The new study involved 2,889 women attended by a midwife who began labour with the intention of giving birth at home. They were compared to 4,752 planned hospital births attended by the same group of midwives, and 5,331 physician-attended hospital births.
In order to qualify for the study, all the women met the same eligibility requirements for a home birth, meaning they were equally low-risk women.
The criteria included:
- Singleton pregnancy in the head down position,
- born at term, with no pre-existing medical conditions (in the mother)
- no important or significant health conditions arising during pregnancy
The rates of perinatal deaths — defined as stillbirths after 20 weeks’ gestation, or death in the baby’s first seven days of life — was low in all three groups:
- 0.35 per 1,000 among the planned home births
- 0.57 among the hospital births attended by a midwife
- 0.64 among physician-attended hospital births
The study also revealed that home-birth babies were more likely to be admitted to hospital, versus re-admissions for babies who were planned hospital births.
The research team thinks this is because these babies were brought in to be treated for jaundice. Many newborns have jaundice. For babies born in hospital, the condition can be identified and treated before babies are discharged.
“In every other measure that we looked at that measures morbidity, there was no difference,” Janssen said. “When we looked at Apgar scores (a test to determine the physical condition of a newborn infant), and asphyxia, and trauma at birth and the need for resuscitation and oxygen therapy — all of those things were not different, or in some cases they were lower in the home-birth group.”
They also cautioned that the findings may not be applicable across the country. Midwifery is regulated on a province-by-province basis. The findings “do not extend to settings where midwives do not have extensive academic and clinical training.”
The following comes from a list of suggested client supplies for home births, from the College of Midwives of British Columbia’s Home Birth Handbook for Midwifery Clients:
- 1 small bottle of Hibitane or other anti-bacterial skin cleanser
- 24 sterile gauze squares
- 2 rolls of paper towels
- 1 oral thermometer (preferably Celsius)
- 1 hot water bottle or heating pad
- 1 flashlight and extra batteries
- 2 gel-type cold packs (place in freezer)
- 1 plastic sheet (shower curtain, vinyl tablecloth or plastic mattress cover) to cover mattress
- Ibuprofen or Tylenol (acetaminophen, not aspirin) for after pains
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