Thursday, September 3, 2009

Home birth with midwife as safe as hospital birth

Updated Mon. Aug. 31 2009 12:51 PM ET News Staff

Giving birth at home with a midwife present is as safe as a hospital delivery accompanied by a doctor, suggests a new Canadian study, which found home births were associated with fewer adverse outcomes for both mother and baby.

The study, published Monday in the Canadian Medical Association Journal, analyzed nearly 2,900 planned home births in British Columbia that were attended by regulated midwives, more than 4,700 planned hospital births attended by the same midwives and more than 5,300 hospital births attended by physicians.

The research found that women who had a planned home birth had a lower risk of having to undergo obstetric interventions such as electronic fetal monitoring, epidural, assisted vaginal delivery and caesarean section, and adverse outcomes such as hemorrhage and infection.
The babies born at home were also less likely to suffer birth trauma, require resuscitation at birth and less likely to have meconium aspiration, where they inhale a mixture of their feces and amniotic fluid.

The perinatal death rate per 1,000 births was also low across all three groups.
"The decision to plan a birth attended by a registered midwife at home versus in hospital was associated with very low and comparable rates of perinatal death," the authors said. "Women who planned a home birth were at reduced risk of all obstetric interventions assessed and were at similar or reduced risk of adverse maternal outcomes compared with women who planned to give birth in hospital accompanied by a midwife or physician."

The findings add to the ongoing debate about the safety of home births. According to the study, research from North America, the United Kingdom, Europe, Australia and New Zealand has not found a link between planned home births and an increased risk of complications.
However, the Canadian researchers say these studies are limited by problems such as incomplete data, non-representative sampling and the inclusion of unplanned home births.
A number of professional medical bodies, including the American, Australian and New Zealand Colleges of Obstetricians and Gynaecologists oppose home births, while the Royal College of Obstetrics and Gynaecologists in the U.K. supports home birth.

The Society of Obstetricians and Gynaecologists of Canada has recommended research into the safety of every birth setting, as is the case with this study.

The researchers say this study does not explain why home birth is linked to fewer complications -- for example, if environmental factors in the home reduce the risks.

The researchers also "do not underestimate the degree of self-selection that takes place in a population of women choosing home birth," which they speculate may be an important component for risk management.

But the findings will help other researchers who study the safety of home births.
"Our population rate of less than 1 perinatal death per 1,000 births may serve as a benchmark to other jurisdictions as they evaluate their home birth programs," the authors conclude.

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