NCT response: American Journal of Obstetrics and Gynaecology

Released on: 20 July 2011

A new study published in the American Journal of Obstetrics & Gynaecology Philadelphia found that about 1 in 200 women in the US has a home birth, of which approximately 75% planned home births rather than births planned in hospital or where no care had been arranged.

Researchers from Maine Medical Centre, Portland, Maine, reported that planned home births were associated with fewer interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy and operative delivery. These women were less likely to experience tearing, bleeding and infections. Neonatal outcomes of planned home births revealed less frequent prematurity, low birthweight and assisted newborn ventilation. Although planned home and hospital births resulted in similar perinatal mortality rates, they reported that planned home births were associated with significantly elevated neonatal mortality rates.

Mary Newburn, Head of Research and Information, NCT, said:

“This study needs to be looked at in detail. NCT’s own detailed review of home birth (Gyte and Dodwell) concluded that, although the quality of comparative evidence on safety of home birth is poor, there is no evidence that for women with a low risk of complications the likelihood of a baby dying during or shortly after labour is any higher if they plan for a home birth compared with planning a hospital birth.”

“Until we can look in detail at the way this new review has been carried out, it is not possible to assess the reliability of the findings. However, when comparing the safety of planned home births with that of hospital births, it is important to know whether only good quality studies have been included and those of poor methodological quality have been excluded, using objective criteria.

“We must also ensure that similar groups of women have been compared. Differences in clinical risk factors, age, ethnicity, education and wealth can affect poor outcomes, including baby deaths.

“Plans for labour and birth can change during pregnancy in response to developments, including emerging risk factors such as pre-eclampsia, breech presentation, premature rupture of the membranes or a pregnancy continuing significantly beyond 41 weeks.

“Women who have planned a home birth and then develop risk factors often change their plans for birth and arrange to go into hospital. In many studies these women are included in the planned home birth group despite having transferred their booking before labour starts. For this reason, studies are most useful when they focus on women planning a home birth at the onset of labour. Studies not using this design can be misleading.”