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Homebirth Safety

The recently released Dutch study of homebirth safety has caused a sensation around the world. The UK has been trying to expand the percentage of women giving birth at home. Australia has been trying to outlaw homebirth. All of them are now looking at this study closely.

This study on homebirth safety included 529,688 women in The Netherlands over a period of 7 years. It concludes that planned homebirth with a competent midwife is as safe as birthing in the hospital. The Netherlands has about 30% of its pregnant women choosing to birth at home with a midwife. It is a viable option there, and the entire maternal health system is set up so midwives can refer women to specialists when the need arises.

Here in the US, things are a bit different. Many midwives and doctors do not get along, as outlined in a study done by Melissa Cheyney of Oregon State University. She and her graduate assistant studied birth records in Jackson County, Oregon from 1998 to 2003. During this time period, the county saw a rise in prematurity and low birth weight. Their findings showed that none of these issues were related to homebirths with midwives. They did discover that there was a lot of distrust between the doctors and midwives, however. She is currently working with an Oregon OBGYN to set up guidelines for midwives to use when a client needs to decide whether it is time to seek additional medical help.

In the US, many states do not allow homebirth midwives to practice. Many that do allow them to practice limit their services in many ways. When a woman does need to transfer, many midwives are met with hostility or disrespect in the hospital.

The AMA has issued a statement saying they do not believe in homebirth safety, and that the only places to safely birth is in the hospital or affiliated birth center.

The US is rated among the lowest in healthy birth outcomes when compared to other industrialized nations. Yet the cesarean rate continues to climb. If more women had access to midwifery care, as in many other industrialized nations, this might change. Homebirth is as safe as hospital birth with a trained midwife and appropriate access to facilities in case of complications.

Dutch Study Article Citation: de Jonge A, van der Goes B, Ravelli A, Amelink-Verburg M, Mol B, Nijhuis J, Bennebroek Gravenhorst J, Buitendijk S. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG 2009.

ABSTRACT

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 care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.

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