LINKS AND ADDITIONAL READING
To read the American College of Nurse Midwives (ACNM) position statement on homebirth, click here.
To read the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives' joint position statement on homebirth, click here.
To read the ACNM response to the American College of Obstetricians and Gynecologists (ACOG) statement on out-of-hospital birth, click here.
MORE ABOUT HOMEBIRTH:
H O M E B I R T H I N F O R M A T I O N
ON MAKING THE DECISION TO HAVE A HOMEBIRTH
There are many reasons women choose to give birth at home. The following sections provide information regarding many issues and considerations involved in choosing homebirth and also some elements of the historical reasons for the current status of this decision. This information is by no means exhaustive and will continue to be expanded as needed.
The central reason women and their families choose homebirth is that they want to fully participate in their birth, have the supportive presence of those closest to them and in the privacy and peacefulness of home.
Sometimes women and their families who have chosen to give birth at home find themselves defending their decision to friends, family members and others who have different beliefs about birth. Many women choose homebirth instinctively. However, while contemplating the ideal setting for birth, families must also consider whether or not they can feel safe giving birth at home.
Women and their families can gain comfort from the following research on the safety of homebirth:
· High quality controlled trials and descriptive studies have shown strong evidence that planned homebirths in the care of a qualified health care provider achieve superior perinatal outcomes, with no increase in risk to mother or baby.
· Planned homebirths with qualified providers have also been found to result in a large reduction in the use of medical interventions. These include C-section, use of forceps and vacuum, labor induction and augmentation, spinal-epidural anesthesia and unnecessary separation of mother and baby during postpartum recovery.
· A decrease in unnecessary C-sections may in turn decrease risk of newborn complications such as respiratory distress, prolonged hospitalization and transfer into a Neonatal Intensive Care Unit (NICU). Recent research has shown that unnecessary C-sections may increase the risk of such complications.
RESEARCH ON THE SAFETY OF HOMEBIRTH
To read the complete studies, click on the authors' name(s) following each description.
A 5-year study comparing the outcomes of planned home births attended by midwives with those of planned hospital births attended by midwives or physicians.
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
To read more about the results of this study, click here.
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.
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.
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
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.