The British Medical Journal has published a study showing that homebirth with midwives is superior to hospital birth – similar safety is achieved with lower intervention rates. If you are a healthy woman with a normal pregnancy, your chances of having a healthy, normal, safe birth are the same whether you plan a home or hospital birth.
The study analyzed the outcomes and interventions at 5418 births attended by certified professional midwives, CPMs. Some states, such as California, recognize Licensed Midwives (LMs) instead of CPMs, as they have equivalent training and must pass equivalent examination processes.
Over 87% of births planned as homebirths required no medical intervention at all. For women who planned a homebirth but needed to transfer to hospital-based care, most transferred for lack of progress, or because the mother was tired or wanted pharmaceutical pain relief. Only 3.4% of women who began labor at home had a transfer which the midwife thought was urgent, such as for a mother's unusually high blood loss, a congenital anomaly, or a baby who was stabilized at home but transferred to the hospital for observation of breathing irregularities.
Overall, for all the women planning homebirths, intervention rates were: epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low-risk US women planning hospital births.
This study is especially important because it was designed and implemented by an epidemiologist to ensure accurate, meaningful results. This is the only study ever published that has met all three of these criteria: the study is big enough, the study distinguished between planned and unplanned home births, and the data are prospective.
The American College of Obstetricians and Gynecologists still opposes home birth, but has no valid evidence to support this position. The Society of Obstetricians and Gynecologists of Canada and several provinces have written statements either acknowledging that women have the right to choose their place of birth or supporting it.
Much of the safety of homebirth is due to respecting the natural, physiological process of birth. Many hospital-based interventions can actually cause serious problems for the mother and baby: induction, pitocin augmentation, IV narcotics or epidurals. Another significant factor in homebirth safety is that the baby is born with an immune system that mirrors the mother's immune system, so the baby is born with immunity to all their household germs; infection rates for babies at home are only one quarter of those for babies born in hospitals.
Whereas this study focused on safety, other studies have shown that your chances of having an emotionally satisfying birth experience are much higher if you plan a homebirth. Babies born at home are rarely separated from their mothers, and breastfeeding success rates are close to 100%.
Homebirth Safety References - North American Prospective Study, 2005:
Fact Sheet Summary of the New Landmark Study Showing that Planned Home Births Are Safe
Outcomes of planned home births with certified professional midwives: large prospective study in North America [Full-text article]
Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager
BMJ. 2005 Jun 18;330(7505):1416.
Conclusions: Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States. [NOTE - CPMs are equivalent to Licensed Midwives in some states.]
OB/GYN newsletters:
Home superior to hospital birth - "Among low-risk women, home births assisted by certified midwives achieve similar rates of intrapartum and neonatal mortality as hospital births, with lower rates of medical intervention, reveal Canadian researchers." [from obgynworld.com]
Here's the popular press on the homebirth safety study:
Home birth safe for low-risk pregnancies from Reuter
Giving Birth at Home Is Safe, Study Show from foxnews.com or another version from WebMD.
