A new study shows that home births aren't any more dangerous for a low-risk mom and baby than those that take place in a hospital. So will this change U.S. policy?
For most of us, the notion of a home birth sounds a little scary—what if something goes wrong? We are so used to the idea of a hospitalized birth that doing it the old-fashioned way, at home with a midwife, seems, well, old-fashioned. But a new study published in the Canadian Medical Association Journal finds that giving birth at home is just as safe as giving birth in a hospital for low-risk women.
Researchers looked at over 11,000 planned home births and the same number of planned hospital births in Ontario, Canada, to compare outcomes for mom and baby. Women in the hospital group were more likely to have interventions like pain or labor meds, assisted vaginal births or C-sections. The risk of negative outcomes for baby were the same. "The study confirms what we saw in an earlier smaller study, and what was observed in other Canadian, English and Dutch studies—that women giving birth at home have good outcomes that are not different from women giving birth in hospital, and that they experience fewer interventions," lead study author Eileen Hutton, Ph.D., of the department of Obstetrics and Gynecology and the Midwifery Education Program at McMaster University in Hamilton, Ontario, tells Fit Pregnancy.
There's no place like home
Hutton says that the results of the study don't necessarily mean that the hospital interventions are unnecessary, but rather that the nature of the labor settings and the intentions of the women who choose them could factor into it. "It is possible that women giving birth at home are more comfortable in their home environment, and that the labor process moves forward more effectively," reducing the need for meds, she says. "It is also possible that women who choose to give birth at home are more 'intervention averse' and thus do not move as quickly to intervene in their labors with interventions as those women who choose to give birth in hospital."
So if home births are safe, why do we assume it's better to be in the hospital? Hutton says it's because general advances in medicine for pregnant women (like prenatal care, treating high blood pressure in pregnancy and administering antibiotics during or after labor) happened at the same time as the move to hospital births, about 75 years ago. "Improved outcomes for women and newborns coincided with moving birth into hospital, and many people attributed them to giving birth in hospital," Hutton says. "However, in countries like the Netherlands, where birth did not make this shift to hospital, similar improvements in outcomes occurred."
Home birth requires support services
But the results of studies like this one isn't necessarily an argument for more home births, Hutton says. "In order to have a home birth service that will support safe outcomes, it would be important to look at services that are in place in the jurisdictions where studies such as ours have been done," she says. "Typically such a service would include well-trained midwives who are experienced in providing home birth care, and who are well respected and integrated into the local health care system." In Ontario, she says, midwives have hospital admitting privileges, which allows them to move laboring women there seamlessly when necessary.
Because of this, one seemingly alarming statistic in the study—that 8.1 percent of home births required emergency medical services, as compared to only 1.7 percent of the hospital group—was to be expected and is not a concern, according to Hutton. "Midwifery in Ontario, where the study took place, is well integrated into the health care system, and clients of midwives have good access to transportation to hospital when required," she says. Doctors and midwives work closely together, and "typically, smooth transfer of care to other care providers can be arranged." A similar situation exists in the U.K., where last year Britain's National Institute for Health and Care Excellence (NICE) updated their guidelines to confirm that low-risk women can give birth at home attended by midwives.
Should you give birth at home?
Midwifery is much less regulated in the United States, and isn't integrated into the health care system. So it makes sense that the American College of Obstetricians and Gynecologists (ACOG) still holds the position that hospitals and birthing centers are the safest setting for birth in the U.S—and in fact, only about one percent of American births happen at home. The ACOG also notes that there have been some studies suggesting that negative outcomes for babies, although still rare, are more common with home births. But, some of those studies' methodologies have been questioned—because random trials can't be conducted on pregnant women, researchers rely on observational studies, which are sometimes difficult to interpret. Other recent studies, such as this one, show no negative effects for babies born at home.
While safety for mom and baby is always the primary concern, the debate over home versus hospital births often boils down to a woman's right to choose where and how she gives birth—a choice that the U.S. health care system appears to be lacking. "Because midwives [in Ontario] practice in both home and hospital settings, women have a true choice and do not choose setting based on where their practitioner works," Hutton says. "I would not personally advocate for more home births, but rather for more women to have a true choice of birth place. Our study provides information that can help women to make that choice."