Home Birth Safer Than Hospital Birth: Nation-Wide Study

Photo by Christ Sebastian, Black Photo Studio

by Heidi Stevenson, first published on Gaia Health

In The Netherlands, the majority of births occur at home, not in hospitals. A study reported in the BMJ found that women whose pregnancies were low-risk suffered far fewer severe negative outcomes from home than hospital births, especially after the first pregnancy.

The study, published 13 June 2013, focused on two serious adverse events: postpartum hemorrhage and manual removal of the placenta, both of which are life-threatening, and also included admission to intensive care, eclampsia, and more than four packed cells in a blood transfusion.

They focused on the birth results of virtually all the women whose pregnancies were classed as low risk from 1 August 2004 to 1 August 2006: a total of 146,752. In The Netherlands, the majority of babies are born at home, so there were 92,333 (62.9%) planned home births and 54,419 (37.1%) planned hospital births. The authors concluded:

Low risk women in primary care at the onset of labour with planned home birth had lower rates of severe acute maternal morbidity, postpartum haemorrhage, and manual removal of placenta than those with planned hospital birth. For parous [at least one prior birth] women these differences were statistically significant. Absolute risks were small in both groups. There was no evidence that planned home birth among low risk women leads to an increased risk of severe adverse maternal outcomes in a maternity care system with well trained midwives and a good referral and transportation system.

Below is a summary of the study results. In comparison to women who opted for home births, those who opted for hospital births were:

• 1.8 times more likely to suffer severe morbid events.
• 2.3 times more likely to end up in intensive care.
• 2 times more likely to suffer eclampsia.
• 1.47 times more likely to suffer multiple blood transfusions.
• 1.37 times more likely to suffer from postpartum hemorrhage.
• 1.44 times more likely to require manual removal of the placenta.

The results for women who gave birth for the first time were close, but there may have been a slight benefit in home delivery. In no area was it proven safer to plan a home delivery for first babies. Women who were delivering subsequent babies experienced even better results than the above for home deliveries. These women who chose hospital over home deliveries were:

• 2.3 times more likely to suffer severe morbid events.
• 2.1 times more likely to suffer multiple blood transfusions.
• 1.92 times more likely to suffer from postpartum hemorrhage.
• 2.31 times more likely to require manual removal of the placenta.

Medicalization of Birth

The fact is that modern medicine's push to medicalize all births has never been based on what's best for either mother or child. This Netherlands study included all births for a span of two years.  How much more is required to prove that natural is generally better?

One of the Cochrane Collaboration's celebrated reviews found that birth is less safe in hospitals. Modern medicine's most routine intervention, early cord clamping, steals a third of a baby's own blood—and it's done in nearly every birth. Yet, the push is to move every single birth to a hospital, to destroy this most sacred of experiences and cause an amount of harm that is nearly inconceivable.

Certainly, there's a place for modern medicine. In rare cases, it can save lives. So, as the authors of this study suggest, as long as there's a qualified midwife, along with medical backup and transportation to it if needed, both newborns and their mothers are better off by avoiding the intrusions and dehumanization of medicine's approach to birth.

Sources:

• Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study; BMJ; Ank de Jonge, Jeanette A. J. M. Mesman, Judith Manniën, Joost J. Zwart, Jeroen van Dillen, Jos van Roosmalen; doi:10.1136/bmj.f3263