A systematic review and meta-analysis has further confirmed the safety of home birth for healthy women, even if they are having their first baby. After comparing data from births planned at home birth, in birth centres and in hospital, researchers found that high-quality studies found no statistically significant difference in infant mortality between the different settings, although women giving birth at home or in birth centres were more likely to have a normal vaginal birth. In fact, women planning home births were nearly three times more likely to have a normal (that is, non-instrumental) vaginal birth than women planning a hospital birth.
This is an important review because, as the authors explain in the background to their paper, there have been many debates on this area and there exist methodological challenges which have to be taken into account. Some of the so-called evidence that is cited on this topic is not of good quality. The review authors include some world experts on this topic, and in order to produce high-quality research they “reviewed original research from high-income countries (World Bank, 2016) using a birthplace-specific quality appraisal instrument (Vedam et al 2017a), and undertook meta-analysis of outcome data where possible.” (Scarf et al 2018).
In their summary of the findings and conclusions, the researchers noted that, “Meta-analysis indicated that women planning hospital births had statistically significantly lower odds of normal vaginal birth than in other planned settings. Women experienced severe perineal trauma or haemorrhage at a lower rate in planned home births than in obstetric units. There were no statistically significant differences in infant mortality by planned place of birth, although most studies had limited statistical power to detect differences for rare outcomes. Differences in location, context, quality and design of identified studies render results subject to variation. High-quality evidence about low-risk pregnancies indicates that place of birth had no statistically significant impact on infant mortality. The lower odds of maternal morbidity and obstetric intervention support the expansion of birth centre and home birth options for women with low-risk pregnancies.”