More evidence on positive benefits of home birth

Just a quick heads up for anyone who might have missed these two recent studies providing more evidence of the positive benefits of home birth…

small_4284278213Firstly, and kindly made freely available by the folks at the British Medical Journal, we have de Jonge et al’s (2013) study, Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study.  The authors of this research looked at the experiences of 146,752 low-risk women, of whom 92,333 (62.9%) had a planned home birth and 54,419 (37.1%) had a planned hospital birth.  Upon analysing the outcomes, they discovered that, although the absolute risks were small in both groups, low risk women who planned home birth had lower rates of severe acute maternal morbidity, postpartum haemorrhage, and manual removal of placenta than those with planned hospital birth. These differences were statistically significant for women who had had given birth before.

The take-home message, although worded in the negative as is often the case with such studies, is that: There was no evidence that planned home birth among low risk women leads to an increased risk of severe adverse maternal outcomes in a maternity care system with well trained midwives and a good referral and transportation system (de Jonge et al 2013). 

small_3594986840The second study, also freely available thanks to the Medical Journal of Australia, is Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years.  This comprises the first national evaluation of 97% of the women who chose publicly funded homebirth between 2005 and 2010.  While 97% is a significant proportion of the available sample, however, the rarity of poor outcomes means that the sample size isn’t big enough to be conclusive about safety.  What the evaluation shows is that 84% of the women who planned to give birth at home actually did so, and 90% of the women (which will include a few of those who transferred to hospital) had a normal vaginal birth.

Other positive outcomes included that intervention rates among these women were low.  Women choosing homebirth had low rates of postpartum haemorrhage (which is particularly significant given that around three quarters of the women had physiological placental births) and third degree perineal tears and stillbirth and early neonatal death rates were also low.  In other good news, 69% of the women were breastfeeding at 6 weeks postpartum.  Transfer rates were high though and, although this is consistent with some other studies, it warrants further exploration.

In a related editorial, Professor Marc Kierse addresses those who may question the need for publicly funded homebirth programs, especially as only around half a per cent of Australian women currently choose homebirth, noting that, ‘It is a woman’s prerogative and her fundamental human right to determine her reproductive behaviour, and this includes how and where to give birth.” (Kierse 2013: 575).

References

Catling-Paull C, Coddington RL, Foureur MJ and Homer CSE, on behalf of the Birthplace in Australia Study and the National Publicly-funded Homebirth Consortium (2013).  Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years. Med J Aust 2013; 198 (11): 616-620. doi: 10.5694/mja12.11665

de Jonge A; Mesman JAJM; Manniën J; et al, (2013).  Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study. BMJ, 13 June 2013.  Online version ahead of print.

Keirse MJNC (2013). Planned homebirth in Australia. Med J Aust 2013; 198 (11): 574-575.

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