June 17, 2005 - Planned home births are considered unsafe by the nation's largest organization of obstetricians, but a new study shows them to be as safe as hospital births for low-risk women and their babies.
"Home births are common in a number of European countries, and these countries also have very low rates of (birth-related) infant mortality," epidemiologist and lead researcher Kenneth C. Johnson, PhD, tells WebMD. "In North America, and especially in the United States, there has been much less acceptance of home births by the medical communities."
Researchers compared results from roughly 5,400 planned home births within the U.S. and Canada attended by non-nurse midwives with hospital births during the same period.
The death rate among babies born at home was similar to low-risk hospital births. However, the rate of medical interventions, such as epidurals, episiotomies, and cesarean deliveries, was much lower among home births.
The study is published in the June 19 issue of the British Medical Journal.
A Mom's Story
Cupertino, Calif., mom Jennifer Hess, 31, chose to have her second son, Kevin, at home last year based on her experience during the birth of her first son, Gregory, in 2001.
The events leading up to Gregory's hospital birth were uneventful, but as soon as he was born he was whisked away by nurses because of an unspecified breathing difficulty.
For the next two hours, Hess says, she was told nothing about her baby's condition and she imagined the worst.
"I had torn (during delivery) and they didn't sew me up right away," she tells WebMD. "And they sent my husband to the nursery with the baby, which is where he should have been. So I had no information for hours. I would ask the nurses if my baby was OK and they wouldn't tell me. They said I should wait and talk to my husband. Naturally, I was pretty distraught."
To make matters worse, just minutes after she was finally reunited with her baby they whisked him away again so that the doctor could perform routine tests.
"My experience with the birth of my first son wasn't exactly the best, so it's fair to say that I was very open to the idea of a home birth," she says.
Night and Day
Hess says the difference between her first delivery and her second with home-birth midwife Ronnie Falcao was like night and day.
"In the hospital they would examine me when it was convenient for them, even if I was in the middle of a contraction," she says. "But Ronnie was there to offer support and do things on my schedule. It was the best thing ever to have my baby in my environment and not some strange setting."
Falcao, who is not a nurse, has attended at about 100 home births in and around Silicon Valley. She tells WebMD that it has become more difficult over the past few years to find partner physicians to work with her if the mom ends up needing medical care. She says insurance companies in California have adopted a policy of terminating the malpractice insurance of doctors who back up home-birth midwives.
She estimates that just under a third of her first-time moms will end up giving birth in a hospital due to complications, but the rate is much lower among women who have already had babies.
A total of 12% of the women who planned home births in the newly published study ended up being transferred to hospitals due to complications.
Most Midwife Births in Hospitals
According to CDC figures, the number of births attended by midwives increased steadily between 1975 and 2002, rising from just under 1% in the mid-'70s to 8%.
But the vast majority of these births were attended by nurse midwives in hospitals or birthing centers. There are no good figures on home births in the United States, but in a 2000 report the CDC estimated that the numbers are growing.
The American College of Obstetricians and Gynecologists (ACOG) represents more than 46,000 women's health care physicians. The group opposes home birth.
"Labor and delivery, while a physiologic process, clearly presents potential hazards to both mother and fetus before and after birth," the ACOG position statement on home birth states. "These hazards require standards of safety that are provided in the hospital setting and cannot be matched in the home situation."
Pediatrician Concerned About Home Births
In a 2002 study, Seattle pediatrician Jenny W. Pang, MD, MPH, and colleagues from the Washington School of Public Health reported that babies delivered at home have nearly twice the risk of dying shortly after birth as those born in the hospital. The researchers reviewed more than 7,500 home births and 14,000 hospital births in Washington between 1989 and 1996.
Pang tells WebMD that the risk was still very small, with just 0.33% of babies born at home dying, compared to 0.17% of hospital-born babies. And she says she does not believe the findings reflect a difference in competence between attending physicians and midwives.
"Whether you are talking about a physician, a nurse-midwife, or a [non-nurse] midwife, the thing that matters most is how much experience they have," she says. "My reservations about home births have less to do with who is in charge than they do with location. You can't possibly be set up for all the emergencies that may arise in a home setting."