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Home birth for low risk pregnancies 'as safe as hospital'

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Women with uncomplicated pregnancies have no increased risk of harm to their child by giving birth at home compared with a planned hospital visit, according to new research.

The three-year study, published in the Canadian Medical Association Journal, looked at 11,493 planned home births with midwives and the same number of planned hospital births in Ontario, Canada.

“Our findings add further support to the Cochrane review that recommended health care systems include a well-integrated home birth service for women with low-risk pregnancies”

CMAJ study on settings for low risk pregnancies

It investigated the risk of stillbirth, neonatal death or serious events among the group of low-risk women, which included both first-time mothers (35%) and those who had previously given birth (65%).

The incidence of stillbirth or neonatal death was 1.15 per every 1,000 births in the planned home birth group compared with 0.94 per 1,000 in the planned hospital birth group, according to the research paper - called Outcomes associated with planned place of birth among women with low-risk pregnancies.

It also found women in the hospital group were more likely to have interventions such as labour augmentation, assisted vaginal births or caesarean deliveries.

“It is important for women to know that all births carry some element of risk, however small, no matter where they take place”

Louise Silverton

Those behind the study noted previous research – from the Birthplace in England Research Programme - found a significant increase in the odds of neonatal morbidity or death among first-time mothers who planned a home birth compared with those who planned to give birth in an obstetric unit.

“We did not find a difference in risk of neonatal morbidity or death by planned place of birth among first-time mothers,” said the authors. “However, the measures of neonatal morbidity used by the UK Birthplace Study differed considerably from ours.”

“Our findings add further support to the Cochrane review of home births that recommended that health care systems include a well-integrated home birth service for women with low-risk pregnancies, and to the NICE guidelines that support women receiving information about birth outside of hospital settings,” they added.

“As more women choose home birth and as the midwifery profession grows in Ontario, it will be interesting to see whether the lower intervention rates that have been consistently observed to date among women who plan home births are sustained,” they said.

“It is wrong to assume that for women at low risk of complications, hospital birth is safer than that in a midwifery unit or at home”

Louise Silverton

Commenting, the Royal College of Midwives said the findings were “interesting” but added UK midwives should be cautious about whether they could be applied in this country due to differences in maternity services.

RCM director of midwifery Louise Silverton said: “However, it is further evidence of the relative safety of home births – for the mother and child - for appropriately selected women.

“It is important for women to know that all births carry some element of risk, however small, no matter where they take place. It is wrong to assume that for women at low risk of complications, hospital birth is safer than that in a midwifery unit or at home,” she said.

Ms Silverton noted the growing amount of evidence about the reduction in medical interventions such as caesarean sections, amongst women who have a home or midwife-led birth.

“The key is to ensure that women are able to make a choice about where they give birth and that they make that choice based on the best and most up-to-date evidence,” she added.

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