Women with low risk pregnancies who choose a home birth may have a lower risk of severe complications than women who plan a hospital birth, researchers say today.
Research from the Netherlands, which has the highest home birth rate among Western countries, looked to see if low risk women at the onset of labour with planned home birth had a higher rate of rare but severe outcomes or complications such as haemorrhage, than those with planned hospital births.
The findings, reported in the British Medical Journal, show that between one and two in every thousand Dutch women having a home birth suffered severe complications.
But between 2% and 4% of women giving birth at home suffered haemorrhage.
The findings were welcomed by British midwives – although they stressed that only some women can be advised it is safe to give birth at home.
Cathy Warwick, chief executive of the Royal College of Midwives, said: “This is further evidence of the safety and benefits of home birth for appropriately selected women, particularly women who given birth before.
"Providing choice of place of birth is at the heart of the Government’s agenda so it was disappointing that last year saw a drop in home births. We should be aiming to see home births at the levels of the 1960s when a third of women had their babies in their homes.”
Using data from a national study into maternal morbidity and national birth registry data from August 2004 to August 2006, the Dutch researchers, led by Professor Jos van Roosmalen, a perinatologist at the Leiden University Medical Centre, identified 146,752 low risk women in primary care at the onset of labour.
Of those, 92,333 (63%) had a planned home birth and 54,419 (37%) a planned hospital birth.
For women having their first baby, the rate of severe outcomes for a planned home birth was 2.3 per 1,000 compared with 3.1 per 1,000 for a planned hospital birth. The rate of postpartum haemorrhage was 43.1 per 1,000 for a planned home birth compared with 43.3 per 1,000 for a planned hospital birth.
It found among women who had previously given birth, the rate of severe outcomes for a planned home birth was 1 per 1,000 compared with 2.3 per 1,000 for a planned hospital birth. The rate of postpartum haemorrhage was 19.6 per 1,000 for a planned home birth compared with 37.6 per 1,000 for a planned hospital birth.
Although they emphasise that their findings may only apply to regions where midwives are well trained to assist women at home births and where facilities for transfer of care and transportation in case of emergencies are adequate, they say the fact that they did not find higher rates of severe complications among planned home births “should not lead to complacency” and that “every avoidable adverse maternal outcome is one too many”.
“Low risk women in primary care with planned home birth at the onset of labour had a lower rate of severe acute maternal morbidity, postpartum haemorrhage, and manual removal of placenta than those with planned hospital birth,” they say. “These differences were statistically significant for parous women.”
De Jong A et al. Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study. BMJ. BMJ 2013;346:f3263 doi: 10.1136/bmj.f3263 [abstract]
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