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).

 

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.

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

These findings confirm those of the meta-analysis conducted by Scarf et al (2018).  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

One of my favourite studies of 2020 was a Norwegian study by Skrondal et al (2020) which is freely available here.

“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.

 

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.

You can

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