Home births are as safe as hospital births for women who have low-risk pregnancies, according to a new study at McMaster University that looked at the risk of a baby’s death during childbirth and in the first four weeks of life. The results showed no significant difference in risks between planned home births and hospital deliveries.
This is the first-ever study about the safety of home births — a hotly contested and unresolved debate in maternity care — to adopt an accepted, published and peer-reviewed protocol. Published in The Lancet‘s EClinicalMedicine Journal, it is also the largest meta-analysis on this topic to date.
Eileen Hutton, who led the study, used data from 500,000 planned home births and compared this with the outcomes on the same number of hospital births. This information was collated from 17 studies from 1990 onwards. The countries from which the data originated include the U.S., Canada, Sweden, England, the Netherlands, Australia, New Zealand, and Japan.
The primary outcome the study analyzed was the death of the baby at any point between when labor began up to 28 days post-childbirth. Other outcomes analyzed were the number of babies who required resuscitation at birth, low Apgar scores (which indicate the health of the baby post-birth), and the number of neonatal intensive care unit (NICU) admissions.
The results showed no significant differences in the baby’s health whether it was born at home or in a hospital. Hutton said in a statement, “More women in well-resourced countries are choosing birth at home, but concerns have persisted about their safety. This research clearly demonstrates the risk is no different when the birth is intended to be at home or in the hospital. Our research provides much-needed information to policymakers, care providers and women and their families when planning for birth.”
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Caveats to the study
These results are only applicable in contexts where healthcare support was available for women with low-risk pregnancies who planned to have home births.
Before Hutton and her team undertook analyses of the collated data, she categorized home births into two categories: those taking place in well-integrated environments and those in less well-integrated environments. A well-integrated environment includes appropriately qualified and licensed midwives/practitioners to help with the delivery, the correct equipment on hand for emergencies and access to timely transfer to hospital if required.
Of the studies analyzed, 13 were in well-integrated environments and four in the other kind. Hutton and her team note many of the studies of home births in less well-integrated settings had to be excluded for the sake of uniformity, that is, in order to find accurate comparisons in the studies about hospital births. This may have biased the results of the study in favor of home births, the authors say, sounding a note of caution.
While this study provides a clearer picture of the pros and safety of home births, it is this caveat that is essential to keep in mind. The notion of ‘safety’ in a home birth setting is very complex and subjective to the woman’s location geographically, as well. For instance, in rural, remote, underdeveloped and developing areas, access to maternity care such as having a readily available transport for an emergency transfer to the hospital, should the need arise, is heavily limited; a significant number of the world’s countries make for a less well-integrated environment for home births currently.
Ideology alone cannot drive the debate about the safety of home births. The resolution of it remains contingent on more and better medical evidence, with the ultimate goal of increasing the quality of global healthcare support to the point that Hutton’s study can stand alone, sans the caveat.
