We blogged about the safety of home births before (read here), but another important study on home births has now been published.
The previous study was conducted in Ontario and compared about 11,000 planned home births to a similar number of planned hospital births.1 This newer study was conducted in the United States, and is a retrospective study of data from all the births that took place in the state of Oregon in 2012 and 2013.2 Nearly 80,000 babies were born in Oregon during that time, including nearly 1,968 born at home and 1,235 born in a birth center. It looked at the rate of complications to the baby and to the mother.
The study found higher rates of infant mortality with out-of-hospital births, which included both home births and those at a birth center. The probability of the baby dying during birth or within a month of birth was 2.4 times greater than for planned hospital births. For planned out-of-hospital births, 3.9 out of 1,000 births resulted in a baby’s death during or within four weeks of birth, while there were 1.8 deaths out of 1,000 in planned hospital births. The actual numbers of babies that died were 15 among the planned out-of-hospital births and 137 deaths among the planned hospital births.
However, obstetrical procedures such as cesarean delivery and induced labor were much more common for women with planned hospital deliveries. For example, the rate of cesarean sections was 24.7 for all births, but only 5.3% for planned home births, where the mother was transported to the hospital.
The study excluded twin or more pregnancies, breech births, and premature deliveries, as well as those where the baby had a birth defect. It also adjusted for the mother’s age, race, and risk factors such as high blood pressure and diabetes.
A few things make this study stand out. The home birth rate in Oregon is 2.4%, the highest of any state. Until 2015, Oregon did not require a license for anyone practicing midwifery. Lastly, Oregon changed its birth certificate at the beginning of the study period to include information on where the birth had been planned to take place when labor started, not just where it took place. This change helped distinguish the births that were intended to be at home but which had to be moved to a hospital; 601 women who planned to give birth at home were transferred to hospitals.
The authors of the study stressed that serious adverse outcomes to either the baby or the mother were rare and that the absolute differences in risk between planned hospital and planned home or birth center deliveries was small.
The Canadian study had found that the risk of having a serious problem with childbirth was the same for a woman giving birth at home as for a woman giving birth in a hospital. About 8%of the home-birth group needed emergency services compared to fewer than 2% in the planned hospital group. However, those in the hospital group had more interventions such as labor augmentation or cesarean section.Stillbirth or newborn death occurred in 1.5 of every 1,000 home births compared to 0.94 of every 1,000 hospital births.
Comparing the two studies, while the Oregon study included about four times as many births as the Ontario study, the Ontario study included equal numbers of home births and hospital births.
Again, as we said in the previous post on home births, the key part of a planned home birth is the planned part. You must be fully informed about the health risks of having your baby at home. You must have a birth plan that includes the possibility of going to the hospital, because despite all your planning, you must be prepared to quickly go to the hospital if you need more medical attention than you can receive at home.
You can read about the experiences of a woman who has given birth in a hospital, in the car on the way to the hospital at home, and at home here.
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- Hutton EK, Cappelletti A, Reitsna AH, et al.: Outcomes associated with planned place of birth among women when low-risk pregnancies. Canad Med Assoc J. First published online 22, 2015.
- Snowden JM, Tilden EL, Snyder J, et al.: Planned out-of-hospital birth and birth outcomes. N Engl J Med 2015;373:2642-53.