Posted by: Nicholas Swetenham | April 16, 2009

Who wants home births?

Water Birth

Water Birth

The Department of Health has promised that all women in the UK would have the choice between home and hospital birth. Enter this Dutch Study. It is a retrospective study comparing various outcomes, comprising most Dutch women in midwife-led care 2000-2006. Obstetrician-led care is excluded (it’s not clear whether this is because obstetricians deal with mostly high-risk mothers).

Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births

Conclusion: This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.

BJOG

And, just for kicks, here is an older North Ameican study in the BMJ on the same topic. I read about this story yesterday. But I didn’t blog about it because, as it turns out, it wasn’t yet published on the BJOG website, so for all I could tell, the media were prattling on about an imaginary study.

A pretty balanced report on the BBC:

Home births ‘as safe as hospital’

Research from the Netherlands – which has a high rate of home births – found no difference in death rates of either mothers or babies in 530,000 births.

Home births have long been debated amid concerns about their safety.

UK obstetricians welcomed the study – published in the journal BJOG – but said it may not apply universally.

BBC

Also covered in the Times and Telegraph.

The RCOG/RCM joint guidance on this topic:

The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.1-3

Melanie Reid argues in the Time that, in fact, most reserved tea-sipping pinky-extending British mothers will have no interest in this possibility; we’re not like the sandal-wearing hippies in the Netherlands:

When a pregnant woman announces that she intends to have her baby at home, surrounded by friends and family, I always have an irresistible impulse to glance down and check if she’s wearing sandals. She usually is. Disgraceful stereotyping it may be, but it is impossible to deny that home births are the preserve of homely, principled types who may then go on to breastfeed their child until it goes to secondary school.

Times

That said, home births are not all sunshine and rainbows. NHS Blog Doctor likes to report on the dangers of home births. I wonder what he will have to say on this study which will be used for years to come by proponents of home birth as an evidence base for generalising the practice.

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