For women with low-risk pregnancies who want to give birth at home attended by a midwife, there is no increased risk of harm to the baby, according to a new study from Canada. The research, published online Dec. 21 in the Canadian Medical Association Journal (CMAJ), found that the risk of stillbirth, neonatal death or serious neonatal health problems did not differ from those of women who chose hospital births.
For the study, researchers led by Eileen Hutton, PhD, director of the Midwifery Education Program at McMaster University in Hamilton, Ontario, compared 11,493 planned home births and 11,493 planned hospital births in Ontario from 2006 to 2009. Among the study group, 35 percent were first-time mothers and 65 percent had previous pregnancies. Low-risk pregnancies were considered to be those in which the mothers didn’t have medical conditions such as high blood pressure, diabetes or a history of complications during previous births.
Findings showed that about 75 percent of the study participants who planned to give birth at home were able to do so, and about 97 percent of those women who opted for hospital births had their babies there. Among the home-birth group, 8 percent needed emergency medical services, compared to 1.7 percent in the planned hospital group. The incidence of stillbirths or neonatal deaths was 1.15 per 1,000 births in the home-birth group and 0.94 per 1,000 in the hospital-birth group.
Women in the hospital group, noted the study authors, were more likely to have interventions such as assisted vaginal births or cesarean sections. “Compared with women who planned to birth in the hospital, women who planned to birth at home were more likely to have a spontaneous vaginal birth and were more likely to be exclusively breast feeding at three and 10 days after delivery,” the authors wrote.
“I’d feel very reassured that the outcomes for home birth are good,” Hutton told HealthDay. But she also added that women giving birth at home should have precautions in place in case of an emergency. “As long as there’s coordination between home and hospital, you could say home birth appears to be as safe as giving birth in the hospital,” Hutton said.
However, experts in the U.S. do not share Hutton’s confidence. The American Congress of Obstetricians and Gynecologists (ACOG) is clear on its position that hospitals and birthing centers are the safest place for births and cautions that planned home-birth babies are at a two to threefold risk of neonatal death when compared to planned hospital-birth babies.
Daniela Carusi, MD, director of general gynecology and surgical obstetrics at Brigham and Women’s Hospital in Boston, told CBS News, “The Centers for Disease Control and Prevention and ACOG have discouraged [home birth] because there has been some evidence of worse outcome for babies when moms deliver at home.”
Home birth standards in the U.S. are not consistent from state to state and there’s a need for better regulations to be put in place, added Carusi. “It’s a very different scenario here in the United States compared to Europe and Canada,” she said.
Carusi noted there are different types of midwives in the U.S. with varying degrees of medical experience. She advised women who want to have a home birth to make sure their midwife is skilled and licensed.
Amos Grunebaum, MD, director of obstetrics and chief of labor and delivery at Weill Cornell Medicine in New York City, agreed. While he discourages home births, Grunebaum told HealthDay that women who insist on a home delivery “should make sure their midwife is well-educated and licensed. Most home-birth midwives in the U.S. have no medical liability insurance, so there is no protection if something goes wrong.”