Are Home Births Safe?

Digging Deeper

In 2013, a reprint of a Cochrane review was published called "Planned Hospital Birth Versus Planned Home Birth," which assessed the effects of a planned hospital birth compared with a planned home birth in selected low-risk women who had the assistance of an experienced midwife and a backup plan in case of a hospital transfer. Cochrane reviews are well respected for providing an unbiased and comprehensive picture of available research.
 
This review concluded that there was no strong evidence to favor planned hospital or planned home births for low-risk pregnant women. In contrast, in the October 2013 Issue of the American Journal of Obstetrics & Gynecology (AJOG), an extensive study was published that involved the examination of Apgar scores in babies born in various birth settings with certain birth attendants (hospital physician, hospital midwife, freestanding birth center midwife, and home midwife) in the United States from 2007 to 2010.
 
The study looked at the occurrence of five-minute Apgar scores of 0 and seizures or serious neurological dysfunction in the various birth settings/attendants among singleton "term" births (no multiples and no preemies). An Apgar score of 0 at five minutes is basically synonymous with stillbirth because very few babies with such a score will live. Because Apgar scores are used universally and are always documented, they are an easy way to calculate stillbirth rates.
 
The data was quite extensive, looking at 13,891,274 babies born during this four-year period. Notably, women who planned home births but were transferred to hospitals were counted as hospital births, and the study did not include unattended home births or births attended by someone other than a doctor or midwife.
 
Despite the fact that women who have home births have a lower risk profile because the high-risk women typically have hospital births, there was an increased rate of problems for home births. Also, for freestanding birth centers, there is an increased risk compared to hospital deliveries, although the risk is lower than for home birth.
 
Specifically, the medical evidence showed that the relative risk of a five-minute Apgar score of 0 for midwife home deliveries was 10.55 times higher than those for physician-attended hospital births. The relative risk for midwife home deliveries for women who were having their first child increased to 14.24 times higher than physician-attended hospital births. For freestanding birth center midwives, the relative risk was less than home deliveries but was higher than hospital deliveries by physicians or midwives. Similar risk patterns were seen for the risk of seizures or serious neurologic dysfunction.
 
It's interesting to note, however, that the midwife-attended deliveries in the hospital had a lower relative risk than those hospital births attended to by a physician. This suggests that it is the setting, not the type of birth attendant (doctor versus midwife), that is important.
 
Due to the increased risk of five-minute Apgar scores of 0 and increased rates of seizures or serious neurologic dysfunction with out-of-hospital births, it was the conclusion of this extensive study that women who desire home births should be warned about these risks in order to help them make informed decisions. They also warn that the problems and risks for home birth are not solved by transport to a hospital, since the time required for transport is too long.
 
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