Research on the Safety of Homebirth

To read the complete studies, click on the authors' name(s) following each description.

The 2008 Cochrane Review of the superiority of Midwife-led versus other models of care for childbearing women can been seen in a word doc by clicking here.

A recent study of 5,418 women across North America giving birth at home with certified professional midwives found maternal and infant mortality rates matching those of low-risk women giving birth in the hospital, with a significant decrease in medical interventions: 12.1% of women planning to deliver at home were transferred to a hospital, and only 3.7% of the homebirth group were delivered via C-section.

- Johnson & Daviss, 2005
Full Article Link

A recent study examined 5,762,037 live births and found that neonatal mortality rates were three times higher for babies born via C-section (1.77 per 1000 live births) compared to babies born via vaginal delivery (0.62 per 1000 live births). The two groups were statistically adjusted to rule out any medical risks that could increase the infant mortality rate not related to the mode of delivery.

- MacDorman, Declercq, Menacker & Malloy, 2006

Another study of 862 women in British Columbia found that the women planning to give birth at home by midwives were less likely to receive epidural anesthesia, undergo labor induction or augmentation, or receive an episiotomy than women giving birth in hospitals with either physicians or midwives. 6.4% of women planning homebirths were delivered via C-section, compared to 18.2% of women delivered by physicians in hospitals and 11.9% of women delivered by midwives in hospitals. There was no significant difference in maternal or neonatal mortality between the groups.

- Janssen et al., 2002

A study of 855 women in Zurich, Switzerland found that women delivering at home required significantly less pain medication and fewer medical interventions than women giving birth in the hospital, with no difference in duration of labor, lacerations during delivery or maternal blood loss. Babies born to both groups of women were no different in birth weight or clinical condition, but babies born at home were found to have slightly higher apgar scores.

- Ackermann-Liebrich et al., 1996

A study of 1836 women giving birth at home or in the hospital in the Netherlands found no difference between the groups in perinatal outcomes including fetal distress, newborn 5-minute apgar scores, perinatal death, operative or C-section deliveries. Multiparous** mothers giving birth at the hospital were more likely to have blood loss greater than 1000L and to require blood transfusions. In addition, babies from both primiparous* and multiparous mothers giving birth at the hospital were more likely to have problems within the first 24 hours after birth. Overall, multiparous mothers showed slightly better outcomes at home as compared to the hospital.

- Wiegers, Keirse, van der Zee & Berghs, 1996

A study of 976 women delivering at home and 2928 women delivering at the hospital in Western Australia found that the women giving birth at home were less likely to have labor induced or to have an operative delivery (C-section, forceps, vacuum extraction). Women giving birth at home were slightly more likely to have a postpartum hemorrhage or a retained placenta. Babies in the homebirth group were less likely to have a less-than-8 apgar score at five minutes or to have received resuscitation. In addition, postneonatal mortality was higher amongst babies in the hospital group.

- Woodcock, Read, Bower, Stanley & Moore, 1994

In the Farm Study, 1707 women delivered by lay midwives in a farming commune in Tennessee were matched with 14,033 physician-attended deliveries derived from the 1980 U.S. National Natality/National Fetal Mortality Survey. No significant differences were noted between the groups in terms of fetal and neonatal death, labor-related complication, or low 5-minute apgar scores. However, assisted deliveries (C-section, forceps, etc.) were much lower on the Farm compared to the hospital, with the Farm C-section rate at 1.46% versus the hospital’s 16.46% C-section rate.

- Durand, 1992

Home Birth as Safe as Hospital Delivery for Low-Risk Pregnancies

NEW YORK (Reuters Health) Jun 16 - Planned home births for low risk women using certified professional midwives are no more likely than hospital births to result in intrapartum and neonatal mortality, according to a report in the June 18th issue of the British Medical Journal. Moreover, the good outcomes are achieved using fewer medical interventions.

Dr. Kenneth C. Johnson, with the Center for Chronic Disease Prevention and Control, and Dr. Betty-Anne Daviss, with the International Federation of Gynecology and Obstetrics, both in Ottawa, Canada, conducted what they believe to be the largest prospective study of planned home births to date.

Included were 5418 women in Canada and the US who planned to deliver at home in the year 2000 using certified midwives. The authors compared outcomes for these women with more than 3 million in-hospital births in the US in 2000.

A total of 655 women (12.1%) were transferred to a hospital. Excluding deaths of babies with fatal birth defects, the rate of intrapartum and neonatal mortality was 1.7 deaths per 1000 births, "similar to risks in other studies of low-risk home and hospital births in North America," the authors write.

The rate of medical interventions was less than half of that observed in the comparison group. For instance, 2.1% of those in the home delivery group underwent episiotomy, compared with 33.0% of those in the control group. Similarly, rates of forceps delivery (1.0% versus 2.2%), vacuum extraction (0.6% versus 5.2%), and caesarean section (3.7% versus 19.0%) were lower in the home delivery group.

The authors contacted approximately 10% of mothers to verify outcomes and to question them regarding their satisfaction with care. For all 11 questions, over 97% reported that they were "extremely or very satisfied."

These findings "support the American Public Health Association's recommendation to increase access to out of hospital maternity care services with direct entry midwives in the United States," Dr. Johnson and Dr. Daviss conclude.

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