Home Birth Reference Site

Research Summaries - Page 2

Scroll down to read the studies, or use the index to jump to each individually.

1. British Medical Journal Editorial, 23 November 1996

It doesn't get much more official than the BMJ. This editorial states that home birth is 'safe for normal, low-risk women, with adequate infrastructure and support' - ie given a well-trained midwife, and facilities to transfer to hospital if necessary.

If you don't want to plough through research papers, you could have a quick glance at this editorial. It refers to four studies reporting on home births, which appear in that edition of the BMJ (these studies are summarised below). It explains how data which lump planned home births together with unplanned out-of-hospital births are misleading; the unplanned out-of-hospital births are very high-risk, including teenagers who deliver their babies in secret, and unexpected rapid premature births at 28 weeks, for example.

The editorial is aimed at doctors planning care for their patients, and the tone can be irritating (“care for pregnant women...should focus on patients' individual needs... rather than simply accommodating patients' demands”), but it is a welcome step towards basing patient care on sound research, rather than unproven assumptions. It might be worth printing out the editorial, and accompanying references, and giving them to your midwife/doctor. The editorial and research covers several countries and is not specific to Europe - sound research is relevant all over the world.

BMJ No 7068 Vol 313, 23 November 1996

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2. Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands

by T A Wiegers, M J N C Keirse, J van der Zee, and G A H Berghs
BMJ 23 November 1996; 313: 1309-1313.

'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.'
'In multiparous women, perinatal outcome was significantly better for planned home births than for planned hospital births, with or without control for background variables.'

Read this article in the British Medical Journal

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3. Prospective regional study of planned home births

Davies J, Hey E, Reid W, Young G.
BMJ 1996;313:1302-1306 (23 November 1996)

This study followed 256 women who expressed an interest in home birth. Of those who went on to book a home birth, 14% transferred to hospital during labour, but 'on no occasion was obstetric intervention required in the first hour after transfer; women transferred appreciated having spent part of their labour at home...Intrapartum transfers were uneventful, and half the mothers commented spontaneously that they valued having spent even part of their labour at home. '
Read this article in the British Medical Journal

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4. Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome

Ursula Ackermann-Liebrich, Thomas Voegeli, Kathrin Gunter-Witt, Isabelle Kunz, Maja Zullig, Christian Schindler, Margrit Maurer, and Zurich Study Team
BMJ 23 November 1996; 313: 1313-1318

'During delivery the home birth group needed significantly less medication and fewer interventions whereas no differences were found in durations of labour, occurrence of severe perineal lesions, and maternal blood loss. Perinatal death was recorded in one planned hospital delivery and one planned home delivery (overall perinatal mortality 2.3/1000). There was no difference between home and hospital delivered babies in birth weight, gestational age, or clinical condition. Apgar scores were slightly higher and umbilical cord pH lower in home births, but these differences may have been due to differences in clamping and the time of transportation'.

Conclusion: 'Healthy low risk women who wish to deliver at home have no increased risk either to themselves or to their babies.'
Read this article in the British Medical Journal

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5. Collaborative survey of perinatal loss in planned and unplanned home births

Northern Region Perinatal Mortality Survey Coordinating Group BMJ 23 November 1996; 313: 1306-1309.
Perinatal mortality in planned home births 'was less than half the average for all births, and few of these deaths were associated with substandard care'. Unplanned deliveries outside hospital are associated with far higher mortality rates, because they include high-risk, rapid premature births, concealed pregnancies, etc..

Read this article in the British Medical Journal

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6. Perinatal Deaths associated with planned home birth in Australia

Bastian H, Keirse MJ, Lancaster PA
(PO Box 569, Blackwood SA 5051, Australia. hilda.bastian@flinders.edu.au )
British Medical Journal, 1998; 317: 384-388

This study found that planned home birth in Australia 1985-1990 was more risky than home birth elsewhere in the world. The perinatal mortality rate was 6.4 per 1000 according to World Health Organisation definitions. The mortality rate in infants weighing over 2500g was 5.7 per 1,000 compared to a national average of 3.6 per 1,000, and deaths during labour (intrapartum deaths) not caused by deformities or prematurity were 2.7 per 1,000 compared to a national average of 0.9. Lack of oxygen during the labour/delivery accounted for 52% of the deaths. The main causes of this excess mortality were high-risk deliveries involving twin, breech and post-term births, and a lack of response to foetal distress. The authors concluded that 'Australian home births carried a high death rate compared with both all Australian births and home births elsewhere'. Concerns were raised over midwife skills, and over high-risk mothers planning home births.

The authors stated that 'While home birth for low risk women can compare favourably with hospital birth, high risk home birth is inadvisable and experimental '

Read the full article in British Medical Journal 1998; 317:384-388
See also correspondence on this study covering methodology, and on midwifery training in Australia.

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7. Home Births in South-West Australia

Howe KA
Med J Aust 1988 Sep 19;149(6):296-7, 300, 302

This study covered 165 women planning a home birth with a registered midwife. 31% of the women were first-time mothers. 16% of the study group transferred to hospital, 5% of the group had an assisted delivery, and 1% had caesareans. One baby died, from congenital abnormalities.

'The conclusion is drawn that women who choose to have a home birth in the south-west of Western Australia may do so with a high degree of safety.'

Read abstract on Medline

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8. A matched cohort study of planned home and hospital births in Western Australia 1981-1987

By Woodcock HC, Read AW, Bower C, Stanley FJ, Moore DJ
Midwifery 1994 Sep;10(3):125-35

976 women who booked a home birth were compared with a matched group of 2,928 women planning a hospital birth. Women in the home birth group had longer labours (presumably because they would not have been accelerated with drugs or other interventions), but were less likely to have induction, caesarean, or other operative delivery, and were less likely to have complications of labour overall. However, the home birth group was more likely to have third stage problems such as heavy bleeding or retained placenta (perhaps because home birth mothers were more likely to specify a natural third stage? For example, I chose to have a physiological third stage to avoid side-effects of the drugs involved - often nausea - and early cord clamping, even though I was aware that heavy blood loss was more likely).

Babies in the home birth group were in better condition at birth - hospital group babies were more likely to take a while to start breathing, to need resuscitation, and to have Apgar scores under 8. Perinatal mortality was slightly higher overall in the home birth group - no explanation for this is given, but the authors of the study state that the increase was not (statistically) significant. However, neonatal mortality (after birth) was significantly higher in the hospital group. The authors note that more research is needed.

'KEY CONCLUSIONS: Planned home births in Western Australia appear to be associated with less overall maternal and neonatal morbidity and less intervention than hospital births.'

Read abstract on Medline

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9. Home Birth in New Zealand 1973-1993

Gulbransen G; Hilton J; McKay L; Cox A (Auckland Home Birth Association. )
N Z Med J, 110(1040):87-9 1997 Mar 28

The researchers analysed 9776 births, for which home birth was planned at the start of labour (so it excluded those who had booked a home birth, but had switched to hospital delivery before labour started). They compared these to low-risks births in hospital. Planned home birth made up 2% of the total births in 1993, up from 0.04% in 1973. The home birth perinatal mortality rate for this period was 2.97 per 1000 total births, which was not significantly different from that of the low-risk hospital group. 31% of the deaths were caused by congenital abnormalities. There was one maternal death (maternal mortality rate: 1.02 per 10,000 total births). The researchers concluded that 'Home birth was a safe and increasingly popular: though minor, option for New Zealand women from 1973-93'.

Abstract on Medline

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On to Page Three of the Research Summaries

If you have any suggestions for additions to this page, please contact angela@horns.freeserve.co.uk

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