Home births

Replies to This Discussion

Permalink Reply by Orie on April 20, 2009 at 10:52am

Alina, in reading the study that you mention, I found that the title is a little misleading. In no way does this article or the authors of the study claim that home births are as safe as hospital births in the absolute, but only in a specific situation and apparently only in the specific country that the study was conducted; the Netherlands. (“…it should be noted that these Dutch findings may not be representative of outcomes that would be seen in other countries”)

To quote the article:
This study of 530,000 births has demonstrated that, for low-risk women who remain under sole midwife care during pregnancy, labour and birth, there is no difference in risk of death or severe illness in the newborn. It is important to note that this analysis has excluded a large number of women with pregnancy and labour complications, as well as those who had premature onset of labour, required induction or who had additional risk factors such as a previous caesarean or twin pregnancy.

Already this excludes a great number of women, especially those who are first time mothers over the age of 35 (a common occurrence these days, as well as women who have their second or third children, etc, over 35 years of age). This study also excludes women, who require pain relief or drugs during labour, fetal monitoring or induced labour, and if there is an onset of an irregular fetal heartbeat, or complications in having a successful delivery.

This 6 year study “included only low risk women who were solely under midwife care at the time of onset of labour”, and compared the number of infant deaths during birth, 24 hours after birth, up to 7 days after birth and admission to a neonatal intensive care unit, between planned home births and hospital births.

The women that the study said were 'low-risk', all gave birth “to a single baby at term (between 37 and 42 weeks gestation) and did not have any medical or obstetric risk factors that were known before labour, such as breech presentation or a previous caesarean section. Additionally, the study excluded women who remained under midwife care but who had risk factors including history of postpartum hemorrhage, those with prolonged rupture of membranes, or a child with congenital abnormality.”

What this study ultimately finds is that home births do not increase the risks of death or illness for the baby when the mother is considered a low–risk case (under the definition of low-risk as already defined above), has been solely under a midwife’s care during pregnancy, labour and birth, and lives in the Netherlands. The authors of this study also advocate “a successful system relies upon a good maternity care that facilitates the choice of place of birth through the availability of well-trained midwives combined with a good transportation and referral system to secondary care where necessary”. Therefore, an emergency back up plan for transport to the nearest hospital is recommended.

I would not like to think that anyone who does not read this article or the findings of its study would assume that home births are a safe option for most pregnant women.

In my opinion, the risks of what could go wrong are too great and unpredictable, and as such I would always prefer to be on site of a medical facility when giving birth instead of being at home. My experiences in Canada where I gave birth to my children were good ones and the care and 'comfort' I received were excellent. The security of being as close as possible to proper medical attention and equipment was the only option I ever considered.

▶ Reply to This

Permalink Reply by Alina on April 21, 2009 at 12:25am

You read the article really thoroughly, thanks for the analysys. I don't think that home birth is for everybody. But a lot of women can do this safely if they got the chance. The probelm is that in a lot of countries (e.g. Poland) home birth is considerd as something from Middleages and the women who want to choose for home birth have hardly chance to make that choice. Of course, it's important to check if there are risk factors.
In Holland the whole care system around pregnancy is quite unique. But maybe some of the elements can be also used in other countries. The doctors should accept the choices of mother to be and support her if she wants to give birth at home. This kind of reaerches shows that with more cooperation of the medical system giving birth at home is not so risky as often is thought.

▶ Reply to This