April 30, 2009

Largest Study of it’s Kind States: Home births ‘as safe as hospital’

A recent article from BBC News, Home Births “as safe as Hospital”, highlights the largest study of its kind, with over a half million participants. It indicates that for low-risk women, giving birth at home is as safe as doing so in hospital with a midwife.

This study may dispel the negative stigma of home birth as a dangerous and irresponsible choice. Several countries support the practice of home birth with a qualified midwife and are having very favorable outcomes. In fact, countries that incorporate home birth and low intervention practices into their culture tend to have a lower infant mortality rate than those that don’t. Scandinavian (Sweden, Norway, Finland) and East Asian (Japan, Hong Kong, Singapore) countries have the lowest infant mortality rates of 3.5 deaths per 1,000, and 22 countries have infant mortality rates below 5 deaths per 1,000 in 2004. The US infant mortality rate is 6.78 infant deaths per 1,000 live births in 2004; we share the 29th place with Poland and Slovakia.. In the US, approximately 1% of births are currently taking place outside the hospital, while the Netherlands has a home birth rate of 30%, New Zealand about 7%, the UK 2.7% and Japan around 1%. (On a side note, one of our teacher trainees from Japan mentioned that in Japan epidurals are rarely used. Out of 10 of her friends, only one opted for pain medication. She explained to me that the epidural is not widely advertised or encouraged in Japan, and that there is a negative connotation attached to it. Perhaps the lack of intervention could explain their very low infant mortality rates.)

The American College of Obstetricians and Gynecologists (ACOG) stated in 2008 that they do not support births out side of a hospital setting. They maintain that “there is not enough research to substantiate its safety.” But there is now!

“Research from the Netherlands – which has a high rate of home births – found no difference in death rates of either mothers or babies in 530,000 births.” Professor Simone Buitendijk of the TNO Institute for Applied Scientific Research said, “We found that for low-risk mothers at the start of their labour it is just as safe to deliver at home with a midwife as it is in hospital with a midwife.” In the UK, The Royal College of Obstetricians and Gynaecologists (RCOG), recently said it supported home births “in cases of low-risk pregnancies provided the appropriate infrastructures and resources are present to support such a system. In fact the British government has pledged to give all women the option of a home birth by the end of this year.

Part of setting up such a system involves creating a strong maternity service, much like that of the Netherlands. The infrastructure has been designed to meet the high demands of home birth, there is a large pool of qualified midwives, transport services are strong and distances are short if emergency transfer to the hospital is needed. Although, many women start out at home,nearly a third of women who planned and started their labours at home ended up being transferred as complications arose – including for instance an abnormal fetal heart rate, or if the mother required more effective pain relief in the form of an epidural. But even when she needed to be transferred to the care of a doctor in a hospital, the risk to her or her baby was no higher than if she had started out her labour under the care of a midwife in hospital.

While it still is far from the norm to give birth outside the hospital in many places, it is exciting to see that research is supporting a shift in our current paradigm. American culture has embraced diversity and choice in so many areas of society; it seems unfortunate that birth, one of the most basic parts of our existence, is being so stifled and controlled by one ideology. There is no one right way or place to give birth.




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