METHODS: We compared the outcomes of 862 planned home births attended by midwives with those of
planned hospital births attended by either midwives (n = 571) or physicians (n = 743).
We compared the outcomes of 862 planned home births attended by midwives with those of
planned hospital births attended by either midwives (n = 571) or physicians (n = 743).
We compared the outcomes of planned home births attended by midwives with those of
planned hospital births attended by midwives or physicians.
In order to address the issue of safety of home birth in BC, we compared selected outcomes for planned home births attended by regulated midwives with those for
planned hospital births attended by midwives and by physicians.
They compared them to
planned hospital births attended by registered midwives or physicians in which the mothers met the criteria for home birth.
However, they noted a smaller study of all planned home births attended by midwives in British Columbia, Canada, from 2000 to 2004 that showed no increase in neonatal mortality over
planned hospital births attended by midwives or physicians.
The home birth group was similar to the group who had
a planned hospital birth attended by a physician (physician comparison group) in age, lone parent status, income quintile and parity because of the matching process (Table 1).
The home birth group was younger than the group who had
a planned hospital birth attended by a midwife (midwife comparison group) and weighed slightly less at the beginning of pregnancy.
When compared with newborns of women who
planned a hospital birth attended by a physician, those whose mothers planned a home birth were similarly at reduced risk of birth trauma (RR 0.33, 95 % CI 0.15 — 0.74), resuscitation at birth (RR 0.56, 95 % CI 0.32 — 0.96) and oxygen therapy behond 24 hours (RR 0.38, 95 % CI 0.24 — 0.61)(Table 4, Appendix 1).
Table 1: Characteristics of 12 982 women in British Columbia who planned a home birth or hospital birth attended by a registered midwife or
planned a hospital birth attended by a physician during 2000 — 2004
Our study showed that planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and adverse maternal outcomes compared with
planned hospital birth attended by a midwife or physician.
Not exact matches
By now you may have gathered that instead of choosing to have an OB -
attended hospital birth this time around, we are
planning to have a midwife -
attended homebirth.
Although tragic, cord prolapse and AFE occur rarely at homebirth, 1/5000 and 1/500, 000 respectively, when balanced with the dozens of acute emergency conditions endangering the health of mother and baby that occur at
planned hospital birth caused by intervening in the
birth process, the scales tip easily in favor of
planned attended homebirth for low risk women.
Rates of acute emergencies for low risk
births at
planned attended homebirth vs
planned hospital birth:
Simply: If
hospital birth were useful, the data would support it, but all homebirth studies (1 - 20), show better outcomes of low risk women at
planned attended homebirth.
Planned attended homebirth outshines
hospital birth for low risk women in every category of acute emergency.
Several studies have shown that
planned homebirth
attended by a qualified experienced caregiver is as safe or safer than
hospital birth for low - risk women.
Hutton EK, Reitsma AH, Kaufman K. Outcomes associated with
planned home and
planned hospital births in low - risk women
attended by midwives in Ontario, Canada, 2003 — 2006: a retrospective cohort study.
The coroner has concluded Midwives should not
attend HBs alone, the emergency services should be notified and given prior warning when a HB occurs, and «that the distance of a home
birth from the local maternity
hospital should be factored in whenever home deliveries are
planned.»
Most prospective parents are familiar with what's involved in preparing for a
birth —
attending antenatal classes, packing a
hospital bag, perhaps writing a
birth plan, and certainly bidding a wistful farewell to sleep.
We might also find a number of babies who had lethal congenital anomalies, who would not have survived no matter where they were born or who
attended the
birth; there may be important differences between home and
hospital populations with regard to whether these anomalies were detected prenatally and whether parents changed their
birth plans because of it.
The authors concluded that the decision to
plan a
birth attended by a registered midwife at home versus in the
hospital was associated with very low and comparable rates of perinatal death.
Intervention rates for 5418
planned home
births attended by certified professional midwives and
hospital births in the United States
Be sure to make enough copies to present your customized
birth plan to your doctor, midwife, nurse, doula, birthing center or
hospital and any
attending family or friends.
Note that the total mortality rate for
births planned to be
attended by direct - entry midwives is 6 - 8 times higher than the rate for
births planned to be
attended in
hospitals.
When this 20 % risk of death is compared to the 0.02 % rate of cord prolapse during labor at homebirth that might have a better outcome if it happened in
hospital, this means that a low risk woman has a 1000 times higher chance of having a life threatening complication either to her life or her fetus / newborns life at
planned hospital birth, than if she
plans to have an
attended homebirth with a well - trained practitioner.
There is no research on the rate of infection at low risk
planned attended homebirths, but in theory homebirth prevents infection and
hospital birth increases the risk of infection.
Hutton et al: Quite literally, the trend continued, in that the next study was also Canadian: «Outcomes associated with
planned home and
planned hospital births in low - risk women
attended by midwives in Ontario, Canada, 2003 - 2006,» not surprisingly shows similar results to the Janssen study.
An UpToDate review on «
Planned home birth» (Declercq and Stotland, 2015) stated that «Large cohort studies using intent - to - treat analysis of midwife - attended, planned, out - of - hospital birth of low - risk women in developed countries have reported reduced rates of cesarean birth, perineal lacerations, and medical interventions, and similar rates of maternal and early perinatal morbidity and mortality compared to planned hospital
Planned home
birth» (Declercq and Stotland, 2015) stated that «Large cohort studies using intent - to - treat analysis of midwife -
attended,
planned, out - of - hospital birth of low - risk women in developed countries have reported reduced rates of cesarean birth, perineal lacerations, and medical interventions, and similar rates of maternal and early perinatal morbidity and mortality compared to planned hospital
planned, out - of -
hospital birth of low - risk women in developed countries have reported reduced rates of cesarean
birth, perineal lacerations, and medical interventions, and similar rates of maternal and early perinatal morbidity and mortality compared to
planned hospital
planned hospital birth.
The problem is... there is no explanation for why low risk newborns would have a higher rate of death in the first week after
Planned Attended Homebirth than after
Planned Hospital birth.
She has worked in Bay Area clinics such as
Planned Parenthood and the Women's Community Clinic as well as
attended births at home and at Marin General and San Francisco General
Hospitals.
I'm
planning to go all natural, I really wanted a home
birth, but we live on a smaller rural island quite a distance from a
hospital and midwives will not
attend births where we live.
As I said earlier other classes are done through your
hospital or
birth center.When you explore your options take time to go to the organization's website such as Lamaze or ICEA or Bradley as well as talk to the individual in charge of classes where you're
attending or where you
plan to
attend.
The relative risk of perinatal death comparing midwife -
attended births at home with physician -
attended,
planned hospital births was 2.5 (95 % confidence intervals 0.27 — 24.5).
There were 571 subjects in the midwife -
attended,
planned hospital birth cohort in total.
Our findings from BC support those of previous reports that suggest that there are no indications of increased risk associated with
planned home
birth attended by regulated midwives, compared with those
attended by either midwives or physicians in
hospital.
Women in the
planned home -
birth group were significantly less likely than those who
planned a midwife -
attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95 % CI 0.29 — 0.36; assisted vaginal delivery, RR 0.41, 95 % 0.33 — 0.52) or adverse maternal outcomes (e.g., third - or fourth - degree perineal tear, RR 0.41, 95 % CI 0.28 — 0.59; postpartum hemorrhage, RR 0.62, 95 % CI 0.49 — 0.77).
Because both home and
hospital births were
attended by the same cohort of midwives, we were able to conduct a true comparison of
planned place of
birth unconfounded by type of caregiver.
The authors fails to give any theoretical explanation for what complication of
planned attended homebirth, that is not present at
planned hospital birth could account for 1 in every 625 homebirths dying during labor at the hands of licensed doctors and midwives.
The decision to
plan a
birth attended by a registered midwife at home versus in
hospital was associated with very low and comparable rates of perinatal death.
We also included a matched sample of physician -
attended planned hospital births (n = 5331).
We included all
planned home
births attended by registered midwives from Jan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada (n = 2889), and all
planned hospital births meeting the eligibility requirements for home
birth that were
attended by the same cohort of midwives (n = 4752).
Newborns whose mothers
planned a home
birth were at similar or reduced risk of fetal and neonatal morbidity compared with newborns whose mothers
planned a
hospital birth, except for admission to
hospital (or readmission if born in
hospital), which was more likely compared with newborns whose mothers were in the physician -
attended cohort.
The risk of all adverse maternal outcomes assessed was significantly lower among the women who
planned a home
birth than among those who
planned a physician -
attended hospital birth (Table 3).
In the subgroup analysis in which we excluded women whose labour was induced by outpatient administration of prostaglandins, amniotomy or both (118 [4.1 %] of women in the home -
birth group, 344 [7.2 %] of those who
planned a midwife -
attended hospital birth and 778 [14.6 %] of those who
planned a physician -
attended hospital birth), the relative risks of obstetric interventions and adverse maternal and neonatal outcomes did not change significantly.
We compared them with the outcomes of all
planned hospital births that met the criteria for home
birth and were
attended by the same cohort of midwives.
Results: The rate of perinatal death per 1000
births was 0.35 (95 % confidence interval [CI] 0.00 — 1.03) in the group of
planned home
births; the rate in the group of
planned hospital births was 0.57 (95 % CI 0.00 — 1.43) among women
attended by a midwife and 0.64 (95 % CI 0.00 — 1.56) among those
attended by a physician.
The rate of perinatal death per 1000
births was 0.35 (95 % confidence interval [CI] 0.00 - 1.03) in the group of
planned home
births; the rate in the group of
planned hospital births was 0.57 (95 % CI 0.00 - 1.43) among women
attended by a midwife and 0.64 (95 % CI 0.00 - 1.56) among those
attended by a physician.
This recent article concludes that
planned attended homebirth 2007 - 2010 had 10 times the rate of intrapartum deaths (1/600) during labor than
hospital births (1/6000) during the same period.
RESULTS: The rate of perinatal death per 1000
births was 0.35 (95 % confidence interval [CI] 0.00 - 1.03) in the group of
planned home
births; the rate in the group of
planned hospital births was 0.57 (95 % CI 0.00 - 1.43) among women
attended by a midwife and 0.64 (95 % CI 0.00 - 1.56) among those
attended by a physician.