Homebirth Studies (FOR)

Homebirth is a safe, evidence based birth option for women.

de Jonge A, van der Goes BY, Ravelli ACJ et al. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG, [Via online press release, 15 April 2009. Awaiting publication]

Of the 529,688 women in midwife-led care at the onset of labour, 321,307 (60.7%) planned to have a home birth, 163,261 (30.8%) planned to have a hospital birth, and for 45,120 women (8.5%), the intended place of birth was unknown. Women who were planning a home birth were more likely to be aged over 25, to have had previous children and to be of medium-to-high social/economic status than those planning a hospital birth. No significant differences were found in the relative risks of perinatal mortality among the planned home birth or unknown birth place groups, compared to the planned hospital birth group. This was found in analyses both with and without adjustment for the confounder factors of gestational age, the mother's age, ethnic background, number of previous children and socio-economic status

Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ 2005;330:1416 (18 June) Source link here.

Conclusions Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.

Home superior to hospital birth Source: British Medical Journal 2005; 330: 1416-22

Among low-risk women, home births assisted by certified midwives achieve similar rates of intrapartum and neonatal mortality as hospital births, with lower rates of medical intervention, reveal Canadian researchers.

Choosing between home and hospital delivery. There is no evidence that hospital is the safest place to give birth. British Medical Journal. 2000 Mar 18;320(7237):798.

Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands. BMJ 1996;313:1309-1313 (23 November) Source link here.

"Conclusions: The outcome of planned home births is at least as good as that of planned hospital births in women at low risk receiving midwifery care in the Netherlands."

Meta-analysis of the safety of home birth. Olsen O. Birth. 1997 Mar;24(1):4-13; discussion 14-6
There is an analysis of this on the forums. See discussion here.

* homebirth is not more dangerous than in-hospital births. The rate of infant deaths for both groups was similar. No mothers among the 24,000 died.
* the number of babies born in poor condition (with low APGAR scores) was actually less in the homebirth group
* the number of mothers with severe lacerations was less in the homebirth group
* the homebirth group had fewer medical interventions such as induction, syntocinon augmentation of labour, episiotomy, instrumental vaginal birth (like forceps or ventouse), and c/section.

Fish can't see water: The need to humanize birth in Australia - this article by Marsden Wagner addresses the safety of homebirth in Australia.

Homebirth Studies (AGAINST)

Perinatal death associated with planned home birth in Australia: population based study Bastian et al. BMJ 1998;317:384-388

CONCLUSIONS: Australian home births carried a high death rate compared with both all Australian births and home births elsewhere. The two largest contributors to the excess mortality were underestimation of the risks associated with post-term birth, twin pregnancy and breech presentation, and a lack of response to fetal distress.

KEY POINTS: The higher perinatal death rate in Australian home births was due to the inclusion of predictably high risk births and prolonged asphyxia during labour. While home birth for low risk women can compare favourably with hospital birth, high risk home birth is inadvisable and experimental

REBUTTALS: The Bastian study supports RANZCOG's anti-homebirth/anti-woman views and helps continue the marketing of fear around childbirth. It has already been rebutted by Sally Tracy, an Australian researcher and statistical analyst of perinatal statistics. In addition, the former Maternal and Child Health expert for the WHO, Dr. Marsden Wagner has provided critique on the Bastian study in the BMJ - Wagner M "A Critique of: Bastian H, Keirse M, Lancaster P; Perinatal death associated with planned home birth in Australia: population based study". British Medical Journal Vol 317, 8 August 1998 and is mentioned in this article - Fish Can't See Water - as well. See quotes below;

Is hospital birth safe in Australia? After reviewing the above information, the only rational answer must be a resounding no, most especially for women in private care.

Another more recent publication on homebirth in Australia[34] has methodological flaws so serious as to make their conclusions unjustified. The appendix to this paper includes my scientific critique of this Australian study in which I conclude: "It is well known in Australia that the reason for the several shifts in data collection methods in this study (which effectively eliminated any possibility of scientific validity) is because so many midwives felt betrayed by the researchers that they refused further participation in the research. It is intellectually dishonest not to report this fact in this paper."

Other Resources to Read:

GentleBirth Archives: Safety of Homebirth
Gentle Birth, Gentle Mothering - a book by Dr. Sarah Buckley