By Jeremy Laurance
What are the risks of home births, and are they greater than in hospital? This is the big question many expectant mothers are asking.
Why are we asking this now?
A large study has for the first time calculated the national death rate for home births. The results show that they are safe, unless things go wrong in which case they are risky.
Isn't that blindingly obvious?
It is, but for the first time researchers have been able to quantify the risks. Home was the usual place for birth until a century ago, and even in the 1950s a third of babies were born at home. Over the last half century, place of birth has switched to hospital, and today of the 660 000 births a year, only around 17 000 (2.5 percent) occur at home, of which roughly half are planned.
Obstetricians say hospital is safer but organisations such as the National Childbirth Trust say the switch to hospital has led to the over-medicalisation of what should be a natural, joyful process. Campaigners say that too often women are left feeling powerless, without control and in some cases traumatised.
What did the study involve?
The 10-year study covered all births in England and Wales from 1994 to 2003, totalling 6.3-million, of which 130 000 took place at home. Of these slightly more than half (75 000) were booked to take place at home - the remainder being the "accidental" home births referred to above. The findings, by the National Collaborating Centre for Women and Children's Health, London, are published in the British Journal of Obstetrics and Gynaecology (BJOG).
And what did it find?
It showed that the death rate during labour or after delivery (called the intra-partum perinatal mortality, which includes stillbirths) is one in 2 000 (0.48 per 1 000) for those who planned a home birth that was successfully completed at home. This is nearly half the average death rate for all births of 0.79 per 1 000.
Does that make home births safer than hospital births?
Yes - but not if things go wrong. The researchers also found that for parents who planned a home birth and then got into difficulties and ended up in hospital, the risks were much higher, with a death rate in this group of 6.05 per 1 000. That is 12 times more risky than for birth completed at home and over six times more risky than the average for all births.
How likely were home births to end up as hospital births?
In round figures, they faced a one in seven chance of being taken to hospital. Of the 75 000 women who booked a home birth, 10 750 (14 percent) ended up being transferred - an emergency in which every second counts. The death rate among the babies of these women is correspondingly higher.
Is the risk of ending up in hospital the same for all women?
No. For women having their first baby the risks are much higher - about one in four will end up being transferred and having their baby in hospital. For women having a second or subsequent baby, where the previous birth went well, the risks are much lower - one in 20 have to be transferred. In other words, experienced mothers who have already delivered successfully have a much better chance of enjoying the natural birth in a familiar home environment surrounded by loved ones that many mothers crave. - The Independent