Is home birth safe?

Is home birth safe?

According to the most recent and up-to-date research evidence, yes. On this page, I’ll share some of that with you. I also link to a number of articles and blog posts that I’ve written about this.

In 2019, a large systematic review and meta-analysis was published in The Lancet. It looked at 14 studies including data from around 500,000 intended home births. The authors found that, “The risk of perinatal or neonatal mortality was not different when birth was intended at home or in hospital.” (Hutton et al 2019).

This is just one of many studies that show the same thing. The Hutton et al (2019) study was remarkable because of its size. But, as the studies on this page show, it’s not a unique finding.

 

More on safety

If you’re the kind of person that likes the detail, here are the results of the Hutton et al (2019) study:

“Among nulliparous women intending a home birth in settings where midwives attending home birth are well-integrated in health services, the odds ratio (OR) of perinatal or neonatal mortality compared to those intending hospital birth was 1.07 (95% Confidence Interval [CI], 0.70 to 1.65); and in less integrated settings 3.17 (95% CI, 0.73 to 13.76). Among multiparous women intending a home birth in well-integrated settings, the estimated OR compared to those intending a hospital birth was 1.08 (95% CI, 0.84 to 1.38); and in less integrated settings was 1.58 (95% CI, 0.50 to 5.03).” (Hutton et al 2019).

Hutton et al (2019). Perinatal or neonatal mortality among women who intend at the onset of labour to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses. doi.org/10.1016/j.eclinm.2019.07.005

This paper has also been discussed by Henci Goer and you can read her analysis here.

 

More evidence

If you’re thinking through the options for your pregnancy and birth, you might also enjoy my book on decision making: What’s Right For Me? Making decisions in pregnancy and childbirth.

The findings of Hutton et al (2019) also confirmed those of the meta-analysis conducted by Scarf et al (2018). And both of these reviews are simply the latest in a long series of studies confirming home birth safety.

Here’s how I summarised the Scarf et al (2018) review:

“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.” Read my full blog post and get the reference here.

 

Other benefits

Studies also confirm other benefits of homebirth. For example, increased likelihood of breastfeeding success. When researchers asked fathers about their experiences of homebirth, they described it as magical.

Home birth isn’t just for those who manage to stay in the ‘low risk’ box either! Research shows that home birth is also safer for women who are labelled as ‘high risk’. (Let’s acknowledge that this labelling is often inaccurate, unhelpful and offensive though.) Here’s more evidence from The Netherlands and Australia. We also have papers from the US.

 

The research keeps coming

Many individual studies from around the world have evidenced the safety of homebirth, as well as the reviews. Here are a few of the most recent:

 

Finland

In Finland, researchers were concerned that, “compared to in-hospital births, the long-term outcome of children born out-of-hospital, planned or unplanned, is poorly studied.”

Researchers often use hospital birth as the standard by which the safety of home birth is measured. This is curious, because hospital birth is a relatively new intervention and it was introduced without evidence of safety compared to home birth. But that’s another post.

So they looked at the outcomes of 790,136 children born in Finland between 1996 and 2013. These included planned and unplanned out-of-hospital births. Usually, it’s better to separate the two as there can be quite a difference in outcomes.

The fact that planned AND unplanned out-of-hospital births were included make the results even more interesting.

They actually found that, although on the whole there is no difference in children’s health at the age of seven, “morbidity (illness) related to asthma or allergic diseases and infections by seven years of age appeared to be lower in children born out-of-hospital.”

The paper is by Ovaskainen et al (2021) and it is freely available online.

 

Spain

In 2021, researchers published a descriptive study of planned homebirth in Catalonia (Spain).

“In Spain, official records show that 0.63% of births take place at home, but these records do not state the proportion of planned and unplanned home births. For this reason, official records do not enable the analysis of maternal and neonatal outcomes according to the place of birth; thus, the rate of adverse advents with respect to planned place of birth remains to be determined.”

“Catalonia is the region with the largest number of home births, and thanks to the data collected by CAHBM midwives, we know that most home births in Catalonia were planned.”

“The rates of maternal and neonatal morbidity show a high degree of safety during birthing and reflect the work of independent midwives in Catalonia. The variety of positions during the birth and the low percentages of high-grade perineal tears and episiotomies, as well as the high percentage of women who used water during birth and of babies who started feeding within an hour of birth, demonstrate that the care provided by the midwives in these planned home births in Catalonia is based on the scientific evidence and on a respect for physiology.”

The full study can be read at https://www.sciencedirect.com/science/article/pii/S0266613821000565

 

Norway

In 2020, a Norwegian study by Skrondal et al (2020) which is freely available here provided more evidence of homebirth safety.

“Planned home birth may be experienced as a very positive occurrence for nulliparous women, and the care those women in this study received contained several elements that can help to promote normal labour and birth at a time in which reducing interventions in maternity care is of importance. Their positive birth experiences gave the women confidence both in their transition to motherhood as well as in other aspects of life.” (Skrondal et al 2020).

 

What about freebirth?

Several studies also look at how, when home birth isn’t made available by the maternity services, some women will decide to freebirth instead. This highlights how important it is that homebirth is offered. It’s important to know that the studies cited on this page showing that homebirth is safe are looking at planned home births attended by midwives.

But I know that people are also interested in freebirth, so here are some recent papers.

An Australian study is beautifully described by its title. Birthing outside the system: the motivation behind the choice to freebirth or have a homebirth with risk factors in Australia (Jackson et al 2020, also freely available).

“The core category was ‘wanting the best and safest,’ which describes what motivated the women to birth outside the system. The basic social process, which explains the journey women took as they pursued the best and safest, was ‘finding a better way’. Women who gave birth outside the system in Australia had the countercultural belief that their knowledge about what was best and safest had greater authority than the socially accepted experts in maternity care. The women did not believe the rhetoric about the safety of hospitals and considered a biomedical approach towards birth to be the riskier birth option compared to giving birth outside the system. Previous birth experiences taught the women that hospital care was emotionally unsafe and that there was a possibility of further trauma if they returned to hospital. Giving birth outside the system presented the women with what they believed to be the opportunity to experience the best and safest circumstances for themselves and their babies.” (Jackson et al 2020)

Another Australian survey of why women choose homebirth showed that, “if a midwife was not available, half of the respondents indicated they would give birth without a registered midwife (freebirth) or find an unregistered birthworker.” (Sassine et al 2020). Unfortunately, this paper isn’t freely available, but you can see the abstract here.

 

Homebirth and cost

There are lots of reasons to opt for a home birth. We know from research studies that home birth is both safe and satisfying, that it leads to fewer interventions, a higher chance of breastfeeding success, and helps to make confident parents.

A 2021 study from the USA also showed that it is also far more cost effective than hospital birth.

Anderson and Gilkison (2021) set out to estimate the cost of home birth in the USA and found that: “On the basis of a nationwide study, we estimate that the average cost of a home birth in the United States is USD 4650, which is significantly below existing cost estimates for an uncomplicated birth center or hospital birth.” “Further, we find that each shift of one percent of births from hospitals to homes would represent an annual cost savings to society of at least USD 321 million.”

No, it’s not just about money.

But it makes you think.

Anderson, D.A.; Gilkison, G.M. The Cost of Home Birth in the United States. Int. J. Environ. Res. Public Health 2021, 18, 10361. https://doi.org/10.3390/ijerph181910361 The paper is freely available at https://www.mdpi.com/1660-4601/18/19/10361

 

How to find out more

A year or so ago, I helped a colleague with putting the evidence on safety together for a book. Homebirth: Safe & Sacred.

It was written by American homebirth midwife Kim Osterholzer. The book’s aim is to get information out to those who have questions in an affordable, readable format. It is written for a US audience, so some of the information about midwifery care is US-specific. But the stories and the evidence transcend national borders. You can find out more about the book here.

 

Articles

This site also contains other articles that might interest you if you’re looking for information on home birth.

Home birth after caesarean

Home births – where are we heading?

Unexpected home birth: let’s keep our shoelaces on…

Homebirth: Safe & Sacred

Further confirmation of home birth safety

Home birth is significantly associated with breastfeeding…

How midwives make a difference when there’s an emergency at home…

Home birth also safer for ‘higher risk’ women

If you’d like to know more about your options, or explore tools for decision making, I can help!

My book What’s Right For Me? has been written to help women and families make the decisions that are right for them.