Planned homebirths are safe for low-risk pregnancies, according to a new large study.
The research, published in The Lancet's EClinicalMedicine journal, analysed 14 studies dating back to 1990 and found no difference between babies born at home or in hospital, either during birth or up to four weeks later.
"More women in well-resourced countries are choosing birth at home, but concerns have persisted about their safety," said lead author Eileen Hutton, professor emeritus of obstetrics and gynaecology at McMaster University. "This research clearly demonstrates the risk is no different when the birth is intended to be at home or in hospital."
Researchers compared home and hospital birth outcomes in Sweden, New Zealand, England, Netherlands, Japan, Australia, Canada and the U.S. They examined the safety of place of birth by reporting on the risk of death at the time of birth or within the first month and found no differences in risk between the home and hospital groups. In addition, there were no differences in other neonatal outcomes including NICU admission, Apgar scores, and the need for resuscitation.
"Women who are low risk and who intend to give birth at home do not appear to have a different risk of fetal or neonatal loss compared to a population of similarly low risk women intending to give birth in hospital," the authors write.
In commentary on the research, published in the same issue of the journal, Hanna Dahlen of Western Sydney University, who was not involved in the study, says the evidence to support the safety of homebirth for low risk women attended by professionally educated midwives in well-integrated settings is now "very convincing".
"There is now clear evidence that homebirth leads to better outcomes for women compared to hospital birth and it is time this was given more attention," she notes.
Hilary Rorison of the Australian College of Midwives agrees and says the research is valuable for two key reasons - the size, and the sample of women studied.
"[The study] looked at the outcomes of around half a million women planning a homebirth with a midwife. The sheer size of this sample allows the results to be generalised over a large population," she says. In addition, Mrs Rorison notes that the study only considered those who had a planned homebirth with a midwife. "This is important as previous research has combined the outcomes of women having a planned homebirth with a trained professional, with those who had an unplanned homebirth and those who freebirthed (birthed at home without medical or midwifery support)."
Mrs Rorison says the research also supports ACM's position on homebirths. "[We] support the right of women to choose their place of birth," she notes. "This includes the right of women with straight-forward pregnancies to birth at home with the support of a midwife who upholds their registration with the Nursing and Midwifery Board of Australia (NMBA) who is appropriately trained and qualified, and who is well networked into local ambulance/hospital services."
Mrs Rorison, who is a homebirth midwife herself, says it's fantastic to see more research added to the already known body of evidence.
"Homebirth is a safe option for women having uncomplicated pregnancies, especially when they are cared for by a known midwife," she says. "As a midwife there's something magical about looking after a woman in her own home. You are a guest in her space and as such the woman in control of her own labour and birth. She eats when she likes, she drinks when she likes, she moves around freely. She can labour in the bath, on the couch, in the shower, in the kitchen."
Mrs Rorison adds that women can even choose who will be part of their birth team, "including children, pets, a photographer, a doula or anyone they like".
"As the midwife, it's my job to support the woman, offer encouragement, occasionally offer suggestions – and not interfere unless necessary, something she says gives women the space, time and freedom to enjoy birth in their own way," she says. "It's so nice that a woman doesn't have to travel to and from hospital," Mrs Rorison adds. "After the birth she can enjoy a cup of tea and a slice of toast from her own kitchen."
The ACM encourages all midwives to follow the ACM National Midwifery Guidelines for Consultation and Referral, the ACM Birth at Home Practice Standards and the ACM Transfer from Birth at Home Guidelines. Women can confirm their chosen midwife holds current midwifery registration on the NMBA website.
In Australia, according to the Hudson Institute of Medical Research, just 0.3 per cent of women plan a home birth.