Is a home birth safe?
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When considering the safety of a home birth, it's helpful to know about the results of the Birthplace Study 2011 from the National Perinatal Epidemiology Unit (NPEU). The survey provides parents with detailed information about the four different places for planning birth. It compares home birth preparation with planning for a hospital birth, as well as comparing planning to use a ‘midwifery unit’ or birth centre with planning a hospital birth. (The study is specific to England.)
Guidance from the National Institute for Health and Care Excellence (NICE), updated in December 2014, also supports your right to be informed about your options and choose where you have your baby. The NICE guidance advises that planning to give birth at home or in a midwifery‑led unit is particularly suitable for women with straightforward pregnancies who have already had a baby. For women with straightforward pregnancies who are expecting their first baby, it is advised that planning to give birth in a midwifery‑led unit is particularly suitable, but that there is a small increase in risk for the baby if they plan birth at home.
The main focus of the study is outcomes (benefits and risks) for women who are ‘low risk’, i.e. those who are healthy, with a straightforward pregnancy and no previous obstetric complications that might affect this pregnancy. Giving birth is generally very safe for healthy women with a straightforward (‘low-risk’) pregnancy.
The research study looks at ‘adverse outcomes’ for babies (a combination of both deaths, potentially serious injury and illness). These outcomes are rare regardless of where women plan to give birth, occurring overall, in just four to five births in every 1000.
- For women having a second or subsequent baby, planned home births are as safe for the baby as planned birth in hospital and offer health and other benefits for the mother.
- For women having a first baby, a planned home birth increases the risk for the baby somewhat. In all groups of women, there were at least 990/1000 births without adverse outcomes. There were 9.3 adverse outcomes for babies per 1000 planned home births compared with 5.3 per 1000 for ones planned in obstetric units, and this finding was statistically significant. So there may be around four extra adverse outcomes in every 1000 planned home births compared with ones planned in obstetric units.
The Birthplace study 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.
The study found that women planning a home birth were more likely than women planning for birth in other settings to have a ‘normal’ birth. In this context, normal birth is defined as labour that starts spontaneously without induction, progresses without the use of an epidural, and the baby is born without assistance from forceps or ventouse nor the need for an unplanned caesarean.
Birthplace results show 88% of planned home births were ‘normal births’ compared to fewer than 60% of planned obstetric unit births.
Other studies have shown that labour tends to progress well at home, where women feel relaxed and free to move as they wish. It is usual to have continuous care and support from a midwife that you have met, or come to know quite well, during pregnancy. 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.
As well as potential benefits, these interventions carry risks, and are more likely to be suggested if you have your baby in a hospital. Finally, there is less risk of infection at home, for both mother and baby.
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.
It's important to remember that having a baby in the UK is generally very safe. The choice you have about where to have your baby will depend on your wishes, any needs for clinical support you may have and, to some extent, on where you live. Wherever you choose, the place should feel right for you.
The results of the Birthplace study were released in December 2011 and provide useful information for parents about their choices regarding where they have their baby.
NCT's helpline offers practical and emotional support in all areas of pregnancy and early parenthood: 0300 330 0700. We also offer antenatal courses which are a great way to find out more about pregnancy, 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 firstname.lastname@example.org.
- Local NCT homebirth support groups. Call 0300 330 0770 or email email@example.com.
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 having a baby at home, 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.