Health Northwest: Home vs. hospital births

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Giving birth at home sounds like an old-fashioned idea to many people. In the United States, giving birth in a hospital or birthing center is now the norm. Home births are uncommon these days, but this trend is changing as researchers learn more about the safety of home births and hospital birth costs continue to rise.

A study published in the June 2005 issue of the well-respected British Medical Journal followed more than 5,400 pregnant women in the United States and Canada who planned to give birth at home, with a certified professional midwife in attendance.

The researchers found that home births for women with low-risk pregnancies were just as safe as hospital births. The infant death rate was 1.7 deaths per 1,000 births, regardless of whether babies were born at home or in a hospital. No mothers died during this study.

Midwives recognized potential complications in 12.1 percent of cases, and these women were transferred from home to a hospital either before or immediately after delivery.

After home births, both women and their babies had low rates of complications. Children born at home were more likely to be breastfed.

Women who give birth at home are much less likely to have medical interventions compared to low-risk women giving birth in hospitals. The rate of episiotomies was 2.1 percent at home and 33 percent in hospital births. (An episiotomy is a surgical incision made to enlarge the vaginal opening for delivery of a baby.) The Caesarean section rate was 3.7 percent for women intending to have a home birth (these women were transferred to a hospital and had a C-section there) and was 19 percent of hospital births.

Because there are fewer medical procedures and interventions in home births, they are less expensive. A cost analysis found that hospital births are three times more expensive than home births.

A philosophical divide exists between those who think giving birth at home is a good idea, and those who think hospitals are the only place a child can be delivered safely. The difference between viewing childbirth as a natural process and seeing it as a medical procedure explains much of the divide. The two groups tend to use different language, which is part of the reason why they do not agree.

Midwives and home birth advocates use language like this: midwives guide pregnant women through the birthing process and they say the woman delivers her baby.

On the other hand, those who believe babies should be born in hospitals often use different language; they refer to physicians as being the ones who deliver babies. The American College of Obstetricians and Gynecologists is opposed to home births, citing other studies that found hospital births are safer than home births.

Ideally, pregnancy and childbirth are uncomplicated, with little risk to the pregnant woman and her baby. But for some women, pregnancy is not so simple, and their pregnancies are considered high-risk to themselves or their babies. Some of the conditions that make a pregnancy high-risk are:

• Pregnancy with twins, triplets or more.

• Congenital or growth abnormalities in the fetus.

• Problems with the placenta.

• Breech presentation.

• Preterm labor or a pregnancy that continues longer than normal.

• A woman with a chronic health problem such as diabetes, high blood pressure, kidney disease, lupus or another autoimmune disease, epilepsy or other neurological problems, certain infections and some genetic problems.

• Maternal age under 15 or over age 35.

Home births are not appropriate for everyone. But, for women with low-risk pregnancies who live close enough to a hospital to be transferred if problems should occur, a home birth attended by a midwife is a safe option. In this study, 97 percent of women giving birth at home said they were very or extremely satisfied with their experience.

Details of this study can be found at Keywords: home birth, North America.

Kathryn B. Brown is a family nurse practitioner with a master's degree in nursing from OHSU. Is there a health topic you would like to read about? Send ideas to

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