Safety of Home Births

 

Many husbands and wives would like to have their child born at home. However, they are concerned that it may not be as safe as giving birth in the hospital. It can be challenging to determine if the benefits of giving birth at home outweigh the risks of an out-of-hospital birth. In an attempt to help parents make informed and wise decisions regarding place of birth, researchers from England looked at the outcomes of nearly 80,000 births. Their findings were published in the British Medical Journal. 

In England, the most common places to give birth are in the hospital obstetric unit, at home, at a freestanding midwifery unity, or alongside a midwifery unit. Excluded from the study were women with a planned caesarean section, women who presented in preterm labor, had a multiple pregnancy, an unexpected / unplanned home birth, or no prenatal care. The primary outcome examined was the rate of adverse birth events. About 80% of the pregnant women were determined to be at a low risk for an adverse birth outcome. 

The rate of an adverse birth outcome was just over 4 events per 1000 births in this group of low risk women. For women giving birth for the first time, the rate of bad outcomes was higher for those who chose to give birth at home with an adjusted odds ratio of 1.75 (95% confidence interval range was 1.07 to 2.86). For multiparous women, those who had given birth previously and were now pregnant with their second or later child, there was no statistical difference in the rate of adverse birth events regardless of where the birth took place. Women who did give birth in a hospital obstetric unit were more likely to undergo a medical intervention, although as noted previously, this did not appear to decrease the risk of a bad outcome for multiparous women. 

The take home message is that healthy multiparous women who are giving birth to their second or later child can safely give birth in the home setting with proper preparation and coordination. Women giving birth for the first time may have a better outcome in a more structured setting such as in a hospital. Many medical interventions that take place in a hospital obstetric unit appear to have no beneficial impact upon adverse outcomes in multiparous women.