Women with low-risk pregnancies who plan a midwife-delivery at home are at no greater risk of harm to the baby, compared to moms with a planned hospital visit, according to a new study published in the Canadian Medical Association Journal (CMAJ).
More women are increasingly choosing a midwife-assisted home birth over a conventional hospital birth. This has raised greater awareness and questions as to the safety of such home births.
In order to evaluate the safety of home births next to hospital births, the researchers compared 11,493 planned home births and 11,493 planned hospital births in Ontario, Canada over a three-year period. They wanted to determine the risk of stillbirth, neonatal death, or serious events among low-risk women. They included both first-time mothers (35 percent) and women who had previously given birth (65 percent).
“Among women who intended to birth at home with midwives in Ontario, the risk of stillbirth, neonatal death, or serious neonatal morbidity was low and did not differ from midwifery clients who chose hospital birth,” writes Dr. Eileen Hutton, Department of Obstetrics and Gynecology and the Midwifery Education Program, McMaster University, Hamilton, Ontario, with coauthors.
In Ontario, about 10 percent of births are attended by midwives, and about 20 percent of these are at home.
Of all the study participants, about 75 percent of the women who planned to give birth at home were able to do so, and about 97 percent of those who planned to give birth in hospital had their babies there. For the planned home birth group, eight percent needed emergency medical services, as did 1.7 percent in the planned hospital group.
Women who had a planned hospital delivery were more likely to have interventions such as labor augmentation, assisted vaginal births, or cesarean deliveries. The incidence of stillbirth or neonatal death was 1.15 per every 1000 births in the planned home birth group compared with 0.94 per 1000 in the planned hospital birth group.
“Compared with women who planned to birth in hospital, women who planned to birth at home underwent fewer obstetrical interventions, were more likely to have a spontaneous vaginal birth and were more likely to be exclusively breastfeeding at three and 10 days after delivery,” write the authors.
“As more women choose home birth and as the midwifery profession grows in Ontario, it will be interesting to see whether the lower intervention rates that have been consistently observed to date among women who plan home births are sustained.”