Tuesday, August 4, 2009

New Study: Home Birth as Safe as Hospital Birth

Ahem!
Is anyone in the medical community paying attention?
This wasn't exactly a "small" study.
Will ACOG revise their radical stand opposing homebirth?
I'm just wonderin'. . .

Look at these rates:
Intrapartum death:
Home: 0.03% vs. Hospital: 0.04%

Intrapartum and neonatal death within 24 hours of birth:
Home: 0.05% vs. Hospital: 0.05%

Intrapartum and neonatal death within 7 days:
Home: 0.06% vs. Hospital: 0.07%

Neonatal admission to an intensive care unit:
Home: 0.17% vs. Hospital: 0.20%



It looks like people were just ever so slightly more likely to be "safer" at home. Hmm....
And as a side benefit, more happy and comfortable in their own beds and bathrooms and living rooms. Oh, and it cost less.

No matter where you have your baby, there is no guarantee that it will all turn out well or that you will like the outcome or that whatever happened couldn't have possibly been prevented in the opposite setting. BUT, to say that home is more risky than the hospital for healthy women...
Show me!!


NEW YORK (Reuters Health) Jul 28 -
In terms of perinatal morbidity and mortality, a planned home birth is as safe as a planned hospital birth, provided that a well-trained midwife is available, a good transportation and referral system is in place, and the mother has a low risk of developing any complications, new research shows.

"Low-risk women should be encouraged to plan their birth at the place of their preference, provided the maternity care system is well equipped to underpin women's choice," Dr. A. de Jonge, from TNO Quality of Life, Leiden, the Netherlands, and co-researchers emphasize in the August issue of BJOG: An International Journal of Obstetrics and Gynaecology.

Data regarding the safety of home births in low-risk women are lacking, due in part to the fact that studies with very large sample sizes are needed to assess relatively rare adverse outcomes. Moreover, randomized trials comparing home and hospital births have not been done because women usually want to choose their place of birth, the authors explain.

The present study, an analysis of 529,688 low-risk planned births, was conducted in the Netherlands, the only country in the west with a large enough data set. The group included 321,307 women who wanted to give birth at home, 163,261 who planned to give birth in the hospital, and 45,120 with an unknown intended place of birth.

All of the outcomes studied occurred with comparable frequency in the planned home and hospital birth groups. These included intrapartum death (0.03% vs. 0.04%), intrapartum and neonatal death within 24 hours of birth (0.05% vs. 0.05%), intrapartum and neonatal death within 7 days (0.06% vs. 0.07%), and neonatal admission to an intensive care unit (0.17% vs. 0.20%).

"As far as we know, this is the largest study into the safety of home births," the authors note. The findings, they conclude, indicate that with proper services in place, home births are just as safe as hospital births for low-risk women.

BJOG 2009;116:1177-1184.

11 comments:

DamselFish said...

I can't believe this has been here all day and "Dr." Amy T hasn't commented yet.

This study is great news, although not surprising to those of us who know about these things. I will faint from the shock, though, if ACOG takes this into account and changes their stance.

Anonymous said...

The values reported are so close that they would definitely fall within the margins of error of a study this large. This leads me to believe the validity of the values is questionable.
-current medical student-

Joy said...

VERY interesting.

^ Don't you love when people leave anonymous comments so you can't have a DISCUSSION with them. They just say their peace and hide behind anonymity.

Kristen's Raw said...

Thanks for posting that. :)

Augusta Cherri said...

.....but if the findings were more in favor of hospital birth by a small margin, they would have been happy to point that out then been alarmist about the hundreth of a percent difference between the two.

Shelly said...

Why would the ACOG pay attention to these studies when they could continue making big bucks off the childbirth business?

It sickens me, really.

RosieLayne said...

My opinion is that homebirth is the safest for any low risk mother and baby. Before I left my OB practice I told the doctor (who was destroying my birth plan) that we hadn't died out as a race without her interventions, so apparently the design is pretty good. She just stared at me. Then I hired a midwife and had our babies at home. Even if the stats are not perfect (as To-Be Dr Anonymous said) they are compelling... I'm sure you've read the North American Home Birth Large Prospective Study, which these stats are replicating. One thing I do know- my students to give birth in the hospital do so with a 70% c-section rate. My students at the birth center or at home have a 97% non-medicated vaginal birth rate... go figure.

Amy said...

I would love to read the original study, could you post the link please?
Thanks!

Mary said...

Unfortunately, the entire study isn't available to the general public, but here's the summary available online as well as a BBC news article on it...

http://www3.interscience.wiley.com/journal/122323202/abstract?CRETRY=1&SRETRY=0

http://news.bbc.co.uk/2/hi/health/7998417.stm

Gabriel said...

I am very much in favour of home births (and am hoping to have one soon), but I'm not sure these statistics are a useful argument for your cause. Any high risk pregnancy would most probably go for a hospital birth - and potentially have complications. These numbers are probably included in these statistics - and how did they count births which started as a home birth, but had to go to hospital half way through?

It's comforting to think home births are safer, but I don't recommend to use safety as the main argument. And statistics are dangerous without the accompanying thinking.

Gabriel said...

I apologize, my previous comment suggested a flaw, but I just checked the abstract of the actual paper and they clearly only looked at low risk births.
And this is the professional reading of the statistics:
"No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care unit 1.00 (0.86 to 1.16).

Conclusions  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."