I have summarised the main
points from research abstracts of home birth studies. The list is intended to give an
objective overview of available research, not just those studies
which support my own point of view. It is updated regularly.
Where the research, or an abstract, is available online, a link
is given so that you can check it for yourself. Direct quotes
from the source are in quotation marks 'like this'.
Which studies should you believe?
Not all scientific studies
are equally valuable. To give an accurate picture of the safety
of planned home birth, studies should compare like with like.
Points to look out for:
- Planned home
births should be compared to planned hospital births.
This means that births planned and delivered in hospital
are compared to those planned and delivered at home, and
those planned at home but which ended in a transfer to
hospital. Failure to do this would mean that hospital
births looked more risky than they actually were, because
hospital birth stats would include the transferred home
births. Most studies are pretty clear about this,
specifying planned home births rather than
actual home births, or, like The National Birthday Trust
separating out all three categories.
- Women booking home
births are generally in a low-risk category, so the
hospital births against which they are compared should be
matched for risk factors such as age, number of previous
pregnancies, and other variables where possible. It is generally considered impossible to eliminate all bias from homebirth studies because the women who choose homebirth tend to have a higher level of education, and higher socioeconomic status, than the general population. These and other traits are also associated with a lower risk of dead or sick babies. Sometimes it's hard to tell whether it is homebirth itself which gets the good results, or the women who choose homebirth.
- Is the study comparing the safety of only low-risk planned homebirths, or all planned homebirths? If high-risk homebirths have been excluded from a study, then high-risk births should also be excluded from the hospital control group.
- Planned home births
should be distinguished from other out-of-hospital
births. These unplanned out-of-hospital births are very
high-risk, including the teenager who has concealed her
pregnancy and delivers her baby in secret with no
midwife, unbooked births where the mother received no
ante-natal care, and sudden premature births, where the
mother could not reach a hospital or midwife in time.
Such cases have little in common with planned home
births, where an informed choice has been made, the
mother is prepared for the birth, and a midwife is in
Some critics of homebirth safety feel that much of the research on homebirth is biased in its favour, and so I intend during 1996 to give more detailed critiques of the studies listed here. I do not believe that homebirth advocates need to rely on substandard research; it is important that women can feel confident in the studies they use to inform their choices.
Further information about
the methodology of each study is usually available in the
original document. Where the study is published in an online
journal, such as the electronic British Medical Journal, correspondence discussing
methodology is often available by links from the original
For detailed discussions
on methodology, see some of the books recommended: 'Where to be born' by Campbell &
McFarlane, and 'Safer Childbirth?' by Marjorie Tew.
If you have any comments on this site, please contact angela @ abcde.homebirth.org.uk
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