The largest study ever conducted in the United States of planned home births found that 93.6 percent of the 16,924 women in the study had spontaneous vaginal births, and only 5.2 percent required a cesarean section for delivery.
Both mortality figures and the cesarean rate are lower than those reported at U.S. hospitals, which is to be expected the researchers say because the women in the study were primarily healthy and the pregnancies low-risk. Importantly, however, the numbers reported in this study are consistent with other large home birth studies conducted in Canada and Europe.
Results of the study are being published this week in the Journal of Midwifery and Women's Health. A companion article provides evidence of data validity.
"Given our findings, especially in light of other observational studies published in the last decade, I think it's time to start shifting the discourse around home birth in this country," said Melissa Cheyney, a medical anthropologist at Oregon State University and lead author on the study. "We need to start focusing on who might be a good candidate for a home or birth center birth and stop debating whether women should be allowed to choose these options.
"Home birth is not for every woman and risk factors need to be weighed," she added. "But the evidence strongly suggests that a healthy woman with an uncomplicated delivery and a single, term baby in a head-down position can safely give birth outside the hospital."
Home births are on the rise in the United States – up about 40 percent in the last nine years – but still constitute only 1.2 percent of all deliveries. In contrast, 8 percent of women in Great Britain and 29 percent of women in the Netherlands give birth outside of an obstetric unit.
The study resulted from an analysis of data collected by the Midwives Alliance of North America Statistics Project, commonly referred to as MANA Stats. Most of the nearly 17,000 women in the study were attended by Certified Professional Midwives, who provided detailed reports on outcomes. Among the findings:
Of the 1,054 women who had previously given birth by cesarean section, 87 percent had a successful vaginal birth;
More than 89 percent of the women successfully gave birth at home, while only 11 percent of them required transport for medical treatment. Of those receiving additional medical care, the majority were for "failure to progress," usually indicating that labor was proceeding slowly and that augmentation of the labor may have been needed.
Only 1.5 percent of the babies had a low Apgar score, a measure of how healthy the newborn is in the first five minutes following birth.
"One of the biggest risk factors we did find is with breech births, which have a higher mortality rate than do head-down babies," said Cheyney, an associate professor in OSU's College of Liberal Arts who also is a practicing certified professional midwife. "Most breeches are known prior to birth and many breech babies may successfully be turned to a head-down position prior to delivery.
"But this kind of information is important for mothers, physicians and midwives to discuss as they engage in shared decision-making."
Women in this nationwide study were predominately white and married, and 58 percent were college-educated, according to Marit Bovbjerg, a postdoctoral research associate in epidemiology in Oregon State's College of Public Health and Human Sciences and a co-author on the study.
The study also found that 98 percent of the newborns were breastfeeding six weeks after birth, and 86 percent exclusively so – one of the strongest measures of future health and at a rate much higher than the national average.