Are home births safe for low-risk pregnancies?
Home births for women with low-risk pregnancies don't increase the risk of complications, a new Canadian study shows. But home births in the U.S. don't all follow the same standards as Canada, so experts say there are reasons to believe results may be different here.
The large study, reported in the Canadian Medical Association Journal, compared 11,493 planned home births and 11,493 planned hospital births in Ontario. Over the course of three years, the scientists looked at the risk of stillbirth, neonatal death and serious problems among women with low-risk pregnancies.
They reported that about 75 percent of the women who planned to give birth at home were able to do so, and that eight percent of the home-birth mothers needed emergency medical services.
"Among women who intended to birth at home with midwives in Ontario, the risk of stillbirth, neonatal death or serious neonatal morbidity was low and did not differ from midwifery clients who chose hospital birth," wrote study author Dr. Eileen Hutton, of the Department of Obstetrics and Gynecology and the Midwifery Education Program at McMaster University in Ontario.
The study also found that about 97 percent of women who planned to have a hospital birth were able to deliver their babies there, and just 1.7 percent in that group required emergency medical care.
The study included both first-time moms (35 percent) and women who had given birth before (65 percent).
The authors wrote that the research shows that women with low-risk pregnancies who give birth at home with the help of a midwife are not at an increased risk of harm to the baby, compared with a planned hospital visit.
Women in the hospital group were more likely to have interventions such as assisted vaginal births or cesarean deliveries. The incidence of stillbirth or neonatal death was 1.15 per every 1,000 births in the planned home birth group compared with 0.94 per 1,000 in the planned hospital birth group, according to the study.
"Compared with women who planned to birth in hospital, women who planned to birth at home underwent fewer obstetrical interventions, were more likely to have a spontaneous vaginal birth and were more likely to be exclusively breastfeeding at 3 and 10 days after delivery," wrote the authors.
In the United States, approximately 25,000 births (0.6 percent) per year occur in the home, according to the American Congress of Obstetricians and Gynecologists ACOG). Approximately a quarter of these births are unplanned or unattended.
According to ACOG, planned home birth is associated with a two to threefold increased risk of neonatal death when compared with planned hospital birth. But more data is needed to better understand home birth outcomes in the U.S.
Dr. Daniela Carusi, Director of General Gynecology and Surgical Obstetrics at Brigham and Women's Hospital in Boston, told CBS News, "The Centers for Disease Control and Prevention and ACOG have discouraged it [home birth] because there has been some evidence of worse outcomes for babies when moms deliver at home."
In the U.S., she said, home birth standards are not consistent from state to state and there's a role for better regulations to be put in place.
"It is a very different scenario here in the United States compared to Europe and Canada," Carusi said, noting that there are different types of midwives in the U.S., with varying degrees of medical experience. She said women who want to have a home birth need to make sure their midwife is skilled and licensed.
Carusi also noted that as an obstetrician in Massachusetts, she can't legally tend to a patient's a home birth.
"I'm legally not allowed to participate in a home birth, unless someone went into surprise labor. The home birth setting doesn't meet my minimum standard requirements for practicing obstetrics," she said.
In an updated ACOG statement this year, the group noted that women should make medically-informed decisions regarding home births, including knowing the risks and benefits and having access to safe and timely care, including timely transport to nearby hospitals if needed.