PROBLEM: Giving birth at home, away from the culture of medicine and stockpiles of medical paraphernalia at hospitals, is associated with significantly fewer medical interventions for the mother. Unnecessary interventions can put maternal health at risk. The counterargument, of course, is that should the worst occur and intervention be necessary, the greater risk is not being able to get mother to the hospital -- where that care is available -- in time.
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METHODOLOGY: In the Netherlands, midwife-assisted home births are routine and more common than in any other Western country. Researchers there compared the outcomes for 92,333 women who had a planned home birth to 54,419 who had a planned hospital birth between 2004 and 2006. Crucially, they only included women who were at low risk of complications, and they controlled for maternal age, ethnicity, and socioeconomic class.
RESULTS: Contrary to what the researchers were expecting, the rate of serious complications was lower for women who gave birth at home, provided that this wasn't their first child.
For women who had previously given birth, the risk of severe outcomes -- admission into an ICU, uterine rupture, eclampsia, or a major obstetric hemorrhage that required a large blood transfusion -- for home births was 1 per 1,000; for hospital births, it was 2.3 per 1,000. This represented a reduction in risk of 58.3 percent. The rate per 1,000 for postpartum hemorrhage was 19.6 for home births, compared to 37.6 for hospitals: a 47.9 percent reduction. The rates per 1,000 for manual removal of the placenta were 8.5 and 19.6, respectively, representing a risk reduction of 56.9 percent.
IMPLICATIONS: There's a big question that the authors, working with their available data, weren't able to answer: what about the infants? After all, the analysis cited above found, in addition to the thing about fewer maternal complications, that the neonatal mortality rate for home births is tripled. The cultural context, here, is important as well: the authors concluded that planned home births for low-risk women don't lead to an increased risk of serious problems for the mother "in a maternity care system with well-trained midwives and a good referral and transportation system."." In the U.S., where our midwife system is nothing like what the Dutch have, the American Academy of Pediatrics recently agreed to go along with some women's desire to give birth at home, while continuing to insist that hospitals are safest.
The full study, "Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study," is published in BMJ.
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