Home birth: Proceed with caution
The risks associated with home birth are discussed in the lead Editorial in this week's Lancet, which says that while women have the right to choose how and where to give birth, they do not have the right to put their baby at risk.
The increased demand to give birth outside hospital has increased the rate of home delivery. In the Netherlands, a third of women now have home births. In the UK, 3% of total births occur at home, while in the USA home delivery accounts for 1% of births or 25 000 deliveries per year.
Although home birth seems to be safe for low-risk mothers and, when compared with hospital delivery, is associated with a shorter recovery time and fewer lacerations, post-partum haemorrhages, retained placentae and infections, the evidence is contradictory for outcomes of newborn babies delivered at home.
The Editorial says that recent meta-analysis published in the American Journal of Obstetrics & Gynecology "provides the strongest evidence so far that home birth can, after all, be harmful to newborn babies". The data show that planned home births to healthy and low-risk mothers compared with planned hospital births in the same group of women doubled the risk of neonatal deaths (0.2% vs 0.09%). And when infants with congenital defects were excluded, the risk of neonatal mortality tripled. The main attributable factors for the increase in mortality were the occurrence of breathing difficulties and failed attempts at resuscitation—two factors associated with poor midwife training and a lack of access to hospital equipment.
The Editorial concludes: "Home delivery is an option for mothers with uncomplicated pregnancies, provided they are advised of the risks involved, have one-to-one midwife care (that includes good resuscitation skills and accreditation by a local regulatory body), and live in a location that allows quick access to obstetric care. The ongoing multiyear cohort study, Birthplace in England Research Programme, aims to compare birth outcomes in different settings, and the results are expected to provide additional valuable data later this year."