Is a home birth safe?

There has always been debate about the safety of home birth.[1,2,3] Here we look at the following topics:

Why do people think home births are unsafe?

What does the research say?

Further information

A number of research studies have been undertaken across the world, and two summaries of these studies, one in 1997 and one in 2007, found no evidence that hospital birth was safer than home birth for women at low risk of complications.[4,5]

The results of the Birthplace Study 2011 from the National Perinatal Epidemiology Unit (NPEU) provide parents with detailed, up-to-date information about the four different places for planning birth. (The results are specific to England though). The study compares planning to use a ‘midwifery unit’ or birth centre with planning a hospital birth. It also compares planning to have a home birth with planning for a hospital birth.

The main focus of the study is outcomes for women who are ‘low risk’, i.e. those who are healthy, with a straightforward pregnancy, no previous obstetric complications that might affect this pregnancy. The study finds that there are positive reasons for considering planning to use a birth centre or to have a home birth.

Why do people think home births are unsafe?

In the past, debates over the safety of home and hospital birth have been confused by inaccurate statistics. Often, outcomes for births out of hospital included unplanned as well as planned home births. For example, the birth of a very premature baby on the way to hospital would be counted as a home birth.

Similarly, if a woman had concealed her pregnancy, received no antenatal care, and gave birth alone or in secret, that would be counted as a home birth for statistical purposes.

The outcome is often poor in cases like these, but it has little relevance to the safety of planned home birth, with a midwife in attendance, or women with normal, healthy pregnancies.

What does the research say?

Research has found no difference in the death rates of mothers or babies between planned home births and hospital births. Studies have found that, compared to women planning a hospital birth, those planning a home birth have:

• a lower risk of having a caesarean section,
• a lower risk of an assisted delivery, i.e. forceps or ventouse and
• less risk of haemorrhage.

This was confirmed by the Birthplace study which found that women planning a home birth were more likely than women planning for birth in other settings to have a normal birth: 88% of planned home births are ‘normal births’ compared to just under 60% of planned obstetric unit births.

Labour tends to progress well at home, where women feel relaxed and free to move as they wish. You are also under less pressure to labour within strict time limits. This means there is less need for intervention such as drugs to speed up labour, or delivery with forceps or ventouse. These interventions carry risks, as well as potential benefits, and are more likely to be suggested in a hospital birth. Finally, there is less risk of infection at home, for both mother and baby.

Babies born at home are:

• less likely to be in poor condition at birth,
• less likely to have birth injuries and
• less likely to need resuscitation.

Your midwife will monitor your baby's heart and your condition regularly through labour, and will advise that you transfer to hospital if she has any concerns about the health of either of you. The aim is to transfer well before a situation becomes an emergency.

References

1. Springer NP, Van Weel C. Home birth. Editorial. BMJ 1996;313(7068):1276-7.
2. Campbell R, Macfarlane A. Where to be born? 2nd edition Oxford: National Perinatal Epidemiology Unit; 1994.
3. Young G, Hey E. Choosing between home and hospital delivery: Letters. BMJ 2000;320(7237):798-9.
4. Olsen O. Meta-analysis of the safety of home birth. Birth 1997;24(1):4-13.
5. Gyte G, Dodwell M. Safety of planned home birth: an NCT review of evidence. New Digest 2007;(40):20-9.

Further information

The results of the Birthplace study were released in December 2011 and provide useful information for parents about their choice of place of birth.

NCT's helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700. We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby. Other NCT resources include:

• ‘Homebirth All you need to know’ leaflet available from NCT shop.
• ‘Mums the Word’ DVD available from NCT shop.
• 'Daddy Cool' DVD available from NCT shop.
• NCT's shared experiences register, which enables mothers to talk to other women who have had similar experiences. Call 0300 330 0770 or email enquiries@nct.org.uk.
• Local NCT homebirth support groups. Call 0300 330 0770 or email enquiries@nct.org.uk.

If you would like to read more about the evidence on the safety and other advantages and disadvantages of home birth, the following are good resources:

The Home Birth Reference Site provides information and opinions about home birth, for parents who think that it might be the right choice for them, and for health professionals looking for resources. 

BirthChoiceUK provides information on choosing maternity care to help parents make the right choice for them.