Hospital births have become a standard choice for women in the United States. This level of medical intervention is important for women with high-risk pregnancies. But a hospital birth may not be the best option for everyone. Some women prefer to have a planned home birth, but there is some concern about its safety. Studies on the rates of pregnancy-related deaths associated with home births have been conflicted, largely due to the limited availability of reliable data. Since deaths and other serious complications during home births are thankfully relatively rare events, having sufficient data to draw trustworthy conclusions is always a problem.
The Netherlands medical system relies heavily on certified midwives for low-risk births. Expectant mothers are given the choice of home or hospital births. As a result, the Dutch have higher rates of home births compared to Americans. Researchers reviewed the risks of birth-related complications for both home and hospital births. The study, published in the British Journal of Obstetrics and Gynaecology, found that home births for low-risk women with proper care were as safe as hospital births.
The study reviewed the outcomes of 529,688 births to women with low-risk pregnancies. About 60% of these women had chosen to give birth at home, and 30% planned a hospital birth. The choice of birthplace was unknown in the remaining women. In reviewing the outcomes, the researchers looked for:
There were no significant differences between hospital births or home births in the rates of death or admissions to the NICU after birth. Other factors besides birth location can affect the rates of newborn death such as socioeconomic status and the mother's age. However, the researchers accounted for these factors and there was still no significant difference in the death rates between hospital and home births.
This was a cohort study, meaning no attempt was made to randomly divide the participants into two groups—hospital birth and home birth—and then see who faired better. The cause and effect relationship, therefore, between birth location and newborn health cannot be proven. Also, since the researchers gathered their data from past records rather than interviewing women at the time of their delivery, some of the information may have been missing or inaccurate. Nevertheless, due to its large size, the results of this study add credence to what midwives have been claiming all along: for low-risk pregnancies: quality care provided at home is likely to be as safe as in the hospital.
While the health care system in the Netherlands is far different than that in the United States, it is reasonable to assume that the findings of the study are applicable to American women receiving high-quality obstetrical care. It is important to note that the women in this study had prenatal care by midwives or obstetricians and the home births were attended by certified midwives. Proper prenatal care will determine any risks and allow planning for the best possible outcome.
American Congress of Obstetricians and Gynecologists
My Midwife (American College of Nurse-Midwives)
de Jonde A, van der Goes BY, Ravelli ACJ, et al. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births.BJOG.2009 Apr 15; Published Online 15 April 2009.
Last reviewed June 2009 by Richard Glickman-Simon, MD