Home births can be as safe as hospital ones: Study
By Sharon Kirkey, Canwest News Service
Researchers who compared nearly 3,000 home births attended by regulated midwives in B.C. to midwife or doctor-assisted hospital births found that home births were associated with a “very low and comparable rate” of infant death, with less than one death per 1,000 births.
Photograph by: Maartje Blijdenstein, AFP/Getty Images
Giving birth at home with a registered midwife is as safe as delivering in a hospital, a large new study involving nearly 13,000 women in B.C. shows.
Researchers who compared planned home births attended by regulated midwives to hospital births attended by either midwives or doctors, found the risk of infant death in the home births was “very low” and didn’t differ significantly from hospital births.
Women who planned a home birth were significantly less likely to experience any of the obstetric interventions the researchers measured, including using drugs to stimulate or speed labour, narcotics for pain, electronic fetal monitoring and forceps deliveries. They were also less likely to experience a postpartum hemorrhage, and their babies were less likely to suffer a birth trauma, require resuscitation at birth or oxygen therapy.
The study appears in this week’s issue of the Canadian Medical Association Journal.
Few issues in mother-baby care are as controversial as the debate about the safety of home births, the researchers said.
Obstetricians’ groups in Australia and New Zealand are opposed to home births, and the American College of Obstetricians and Gynecologists is unequivocal. The group said complications can arise “with little or no warning even among women with low-risk pregnancies” and that childbirth shouldn’t be influenced “by what’s fashionable, trendy or the latest cause celebre.”
In contrast, the Royal College of Obstetricians and Gynaecologists in the United Kingdom supports home births as a viable choice for women with uncomplicated pregnancies.
The study comes at a time when the leaders of Canada’s pregnancy specialists are urging doctors to “normalize” childbirth and lower the rates of C-sections and other interventions. Today, about 28 per cent of babies born in Canada are delivered via caesarean.
“We definitely understand that it’s a woman’s decision to choose where she wants to give birth, in a hospital or a home,” said Dr. Andre Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada. “We don’t have anything against (home births) for selected, low-risk women.”
It’s the second time the B.C. group has reported on the safety of home births. The team reported in 2002 on a smaller study involving 862 planned home births.
“This one allows us to say definitively what the rates of perinatal death are,” said lead author Patricia Janssen, an associate professor in the School of Population and Public Health at the University of B.C. “Our first study was really too small to look at that with confidence.”
The new study involved 2,889 women attended by a midwife who began labour with the intention of giving birth at home. They were compared to 4,752 planned hospital births attended by the same group of midwives, and 5,331 physician-attended hospital births.
All the women met the same eligibility requirements for a home birth, meaning they were equally low-risk women.
“In B.C, under the College of Midwives of B.C., it has to be one baby in the head down position, born at term, with no pre-existing medical conditions (in the mother) and no important or significant health conditions arising during pregnancy,” Janssen said.
The rates of perinatal deaths — defined as stillbirths after 20 weeks’ gestation, or death in the baby’s first seven days of life — was low in all three groups: it was 0.35 per 1,000 among the planned home births, 0.57 among the hospital births attended by a midwife and 0.64 among physician-attended hospital births.
Home-birth babies were more likely to be admitted to hospital, versus readmissions for babies who were planned hospital births.
“We think that’s because these babies were coming in to have treatment of jaundice,” Janssen said. Many newborns have jaundice. For babies born in hospital, the condition can be identified and treated before babies are discharged.
“In every other measure that we looked at that measures morbidity, there was no difference,” Janssen said. “When we looked at Apgar scores (a test to determine the physical condition of a newborn infant), and asphyxia, and trauma at birth and the need for resuscitation and oxygen therapy — all of those things were not different, or in some cases they were lower in the home-birth group.”
Janssen said studies suggest women in labour feel more in control in their own home.
“They feel more in command of the labour, they feel more confident in themselves.
“It may be that they’re moving around more, they’re more active. It may be that they can rest better. We don’t really know.”
“It may also be that the women who chose birth at home in the first place are particularly motivated to avoid interventions,” she said, or that there is something about them that makes them feel particularly safe to do a home birth.
“We’re not saying it’s better. We’re not trying to say that if you have a home birth you’re guaranteed to have fewer interventions. We’re just saying that the way it is being practised and regulated appears to be as safe as planned births in hospital.”
Erica Overbeek had both her babies at home with the help of midwives. Her youngest, Alice, was born 2 1/2 weeks ago.
“At no point was I ever lying down for any of it, the second time around especially,” said Overbeek, who lives in Muskoka, Ont. Both births were unmedicated, or drug-free.
“I was in my own bed, in my own clothes. I could eat whatever I wanted, whenever I wanted. I wasn’t hooked up to anything. I didn’t have anyone poking me or prodding me at any time,” Overbeek said. “I just sort of went naturally with the way my body felt. When it was time to push, then I did.”
“They (the midwives) prepare you for everything, even the fact that if I did progress really quickly, what would my husband do in case of an emergency, if the midwife couldn’t get there on time,” Overbeek said.
Janssen cautioned that the findings may not be applicable across the country. Midwifery is regulated on a province-by-province basis. The researchers said the findings “do not extend to settings where midwives do not have extensive academic and clinical training.”
The following comes from a list of suggested client supplies for home births, from the College of Midwives of British Columbia’s Home Birth Handbook for Midwifery Clients:
1 small bottle of Hibitane or other anti-bacterial skin cleanser
24 sterile gauze squares
2 rolls of paper towels
1 oral thermometer (preferably Celsius)
1 hot water bottle or heating pad
1 flashlight and extra batteries
2 gel-type cold packs (place in freezer)
1 plastic sheet (shower curtain, vinyl tablecloth or plastic mattress cover) to cover mattress
Ibuprofen or Tylenol (acetaminophen, not aspirin) for after pains
© Copyright (c) Canwest News Service