Safety of Community Midwifery
Research Supporting Home Birth Safety
Years of evidence overwhelmingly support excellent outcomes for low-risk people and their babies when births are planned at home. Perinatal deaths occasionally occur no matter where babies are born, and both home and hospital births have similar low rates of perinatal death. All in all, home birth is very safe for low-risk pregnant people and your midwife will constantly be assessing your risk status to ensure you and your baby remain low-risk.
This large study examined data from planned home births in North America, reporting excellent outcomes that are consistent with the highest quality observational studies about home birth outcomes. Among 16,924 women who planned home births at the onset of labor, 89.1% gave birth at home and the spontaneous vaginal birth rate was 93.6%. Rates of cesarean section in this study were 5.2%, compared to a 32.8% cesarean rate in hospital-based data samples.
The authors concluded that for low-risk people, home birth reduces the rate of interventions without leading to increased adverse outcomes. Additionally, 98 percent of the newborns in this study were breastfeeding six weeks after birth, and 86 percent exclusively so – one of the strongest measures of future health and at a rate much higher than the national average.
This large study compared midwife-attended planned home births and planned hospital births in British Columbia, Canada. The authors found that the rates of intervention and complications like severe tears, postpartum bleeding, fever, electronic monitoring, and assisted vaginal delivery were significantly less likely in the planned home birth group.
Most complications for babies were less likely in those planning home birth (i.e. resuscitation, oxygen therapy, and meconium aspiration; however, babies were more likely to be admitted to the hospital in the planned home birth group, usually because of jaundice. Rates of perinatal death were similar in all groups.
This study concluded that women in the home birth group more often experienced a spontaneous birth without medical intervention and were less likely to sustain pelvic floor injuries.
This very large study of planned home and hospital births in low-risk people in the Netherlands found that planned home birth was not associated with higher rates of perinatal death or increased rates of NICU admission compared to planned hospital birth.
This study compared births that were attended by midwives in Ontario, Canada. The authors concluded that planned home births were significantly less likely to experience severe postpartum bleeding, severe tears, labor augmentation, and cesarean birth. The study found no differences in rates of perinatal death or serious injury between the two groups.
This study analyzed responses of women who chose to deliver at home. The survey responses illustrated that these individuals do care about safety, that they desire a natural birth experience without medical interventions, and that they wish to feel that they are in control of their birth.
The participants trusted the inherent abilities of their bodies to give birth without interference, in the environment of their own conception. According to their respondents, there is no place like home for a safe, comfortable, peaceful, relaxing birth.
This study concluded that intervention rates were significantly lower in planned home births than planned hospital births. There was no difference in rates of perinatal death.
This systematic review compared the safety of planned home birth with planned hospital birth in low-risk people. The home birth group had fewer severe lacerations, fewer low Apgar scores, and fewer interventions (such as induction, augmentation, episiotomy, operative vaginal birth, and cesarean). Perinatal mortality was not significantly different between the two groups.
This study found that there was no relation between the planned place of birth and perinatal outcome in primiparous women, and concluded that the outcome of planned home births is at least as good as that of planned hospital births in women at low risk receiving midwifery care in the Netherlands.
This study determined that interventions (namely induction, caesarean section, medication, forceps, and vacuum extraction) may be considerably less frequent in women who originally opt for home delivery.
Guidelines & Position Statements
Midwives Association of Washington State Position Statements
Canadian Association of Midwives Position Statement on Home Birth
New Zealand College of Midwives Consensus Statement on Normal Birth
International Confederation of Midwives Position Statement on Normal Birth
National Institute for Health and Care Excellence Clinical Guideline
The Controversy
The American College of Obstetricians and Gynecologists (ACOG) acknowledges that planned home birth is associated with fewer interventions for the parent, but warns families that home birth is associated with double the rates of perinatal death. This sounds alarming, but we know that this claim is due to problematic research.
This meta-analysis also concludes that planned home births are associated with higher rates of perinatal death because the Pang et al., (2002) study made up a large proportion of its data.
Unfortunately, meta-analyses are considered to be at the top of the hierarchy of scientific evidence, so these conclusions are often accepted without question, even though they’re based on biased research.
This study looked at birth certificate data in Washington State and found that home births are associated with about twice the rates of neonatal death. The problem is that birth certificate data includes all babies who were born at home, whether or not that was the plan (including on the car on the way to the hospital with no birth attendant present).
Furthermore, the authors used selective statistical manipulations to make their main outcomes seem statistically significant when they most likely would not have been without the manipulations.
Synthesized from information gathered by Lizz Fay at Wellspring Midwifery
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