Ackermann-Liebrich U et al. Home versus hospital deliveries: follow up study
of matched pairs for procedures and outcomes. BMJ, 1996;313: 1313-1318.
During delivery the home birth group needed significantly less medication
and fewer interventions whereas no differences were found in durations of
labour, occurrences of severe perineal lesions, and maternal blood loss.
Conclusion: "Healthy low risk women who wish to deliver at home have no
increased risk either to themselves or to their babies."
Albers LL, Katz VL. (1991). Birth setting for low-risk pregnancies. An
analysis of the current literature. J Nurse Midwifery, 1991; 36(4): 215-20.
The authors concluded that "nontraditional birth settings present advantages
for low-risk women as compared with traditional hospital settings: lower
costs for maternity care, and lower use of childbirth procedures, without
significant differences in perinatal mortality."
Anderson RE, Anderson DA. The cost effectiveness of home birth. J Nurse
Midwifery, 1999; 44(1): 30-35.
"The average uncomplicated lady partsl birth costs 68% less in a home than in a
hospital, and births initiated in the home offer a lower combined rate of
intrapartum and neonatal mortality and a lower incidence of cesarean
delivery."
Anderson RE, Murphy PA. Outcomes of 11,788 planned home births attended by
certified nurse-midwives. A retrospective descriptive study. J Nurse
Midwifery, 1995; 40(6); 483-492.
For those planning a home birth when labor started, the intrapartum and
neonatal mortality rate was 2 per 1,000, falling to 0.9 per 1,000 when
deaths associated with congenital abnormalities were excluded.
Burnett CA et al. Home delivery and neonatal mortality in North Carolina.
JAMA 1980;244(24):2741-2745.
Excluding infants weighing 2000 g or less at birth, the neonatal mortality
rate for hospital deliveries in North Carolina was 7 per 1000 and for
midwife-attended home births it was 4 per 1000. Women attended by midwives
were more likely to be demographically high risk.
Chamberlain G, Wraight A, Crowley P, (eds). Birth at home: The report of the
1994 confidential enquiry by the National Birthday Trust. Pract Midwife
1999;2(7):35-9.
5971 women planning home births at 37 weeks' gestation were matched with
4724 women planning hospital delivery. The cesarean rate was 2.0% for home
births, 4.1% for hospital births. The rate of operative delivery (forceps,
vacuum) was 2.4% for home, 5.4% for hospital. 5.2% of babies planned for
home birth, including transfers, had 1-minute Apgar scores >7, compared to
9.3% of planned hospital babies. Perinatal death rate was too low for both
groups to allow meaningful comparison; both groups were below the national
rate. Exclusive breastfeeding rates at six weeks postpartum were 65% for
planned home births and 44% for planned hospital births.
Conclusion: "In essence it seems that a woman who is appropriately selected
and screened for a home birth is putting herself and her baby at no greater
risk than a mother of a similar low-risk profile who is hospital booked and
delivered." The study included 53 mothers planning home birth after
cesarean.
Duran, AM. The safety of home birth: The Farm study. Am J Public Health
1992;82(3): 450-452.
The Farm cesarean rate was 1.5% versus 16.5% for the U.S. (The Farm midwives
have attended VBACs since 1985. This study included deliveries from
1971-1989.)
"Based on rates of perinatal death, of low 5-minute Apgar scores, of a
composite index of labor complications, and of use of assisted delivery, the
results suggest that, under certain circumstances, home births attended by
lay midwives can be accomplished as safely as, and with less intervention
than, physician-attended hospital deliveries."
Janssen PA, Holt VL, Myers SJ. Licensed midwife-attended, out-of-hospital
births in Washington State: Are they safe? Birth, 1994; 21(3): 141-148.
"The results of this study indicate that in Washington State the practice of
licensed non-nurse-midwives, whose training meets standards set by
international professional organizations, may be as safe as that of
physicians in hospital and certified nurse-midwives in and out of hospital."
(Note: My primary birth attendant meets the requirements for licensure in
Washington State.)
Mehl LE at al. Outcomes of elective home births: a series of 1,146 cases. J
Reprod Med 1977;19(5): 281-290.
The cesarean rate was 2.4% compared with a California primary cesarean rate
of about 5%. The forceps rate was 1.5% The episiotomy rate was 7.8% and
12.9% of women had lacerations requiring repair. The perinatal mortality
rate was 9.5 per 1000 versus 20.3 per 1000 for California.
Murphy PA, Fullerton J. Outcomes of intended home-births in nurse-midwifery
practice: A prospective descriptive study. Obstet Gynecol, 1998; 92(3):
461-470.
"Home birth can be accomplished with good outcomes under the care of
qualified practitioners and within a system that facilitates transfer to
hospital care when necessary. Intrapartal mortality during intended home
birth is concentrated in postdates pregnancies with evidence of meconium
passage." "This study supports previous research indicating that planned
home birth with qualified care providers can be a safe alternative for
healthy low-risk mothers."
Northern Region Perinatal Mortality Survey Coordinating Group. Collaborative
survey of perinatal loss in planned and unplanned home births. BMJ 1996;313:
1306-1309.
Perinatal mortality in planned home births "was less than half the average
for all births, and few of these deaths were associated with substandard
care."
Olson O. Meta-analysis of the safety of home birth. Birth, 1997; 24(1):
4-13.
Included six controlled studies covering 24, 092 mainly low-risk women
planning home or hospital births. Perinatal mortality was not significantly
different between the planned home and planned hospital groups, but the
planned home birth group had fewer low Apgar scores and fewer severe
maternal lacerations. There was less intervention in the planned home birth
group: fewer inductions, fewer episiotomies, fewer assisted deliveries, and
fewer cesareans.
"Home birth is an acceptable alternative to hospital confinement for
selected pregnant women, and leads to reduced medical interventions."
Schlenka P. Safety of alternative approaches to childbirth. Unpublished
doctoral dissertation, Stanford University, 1999. Available online:
http://www.domiciliary.org/freedom/@birth/meadsum.html.
Conclusions: "...low-risk women who opt for a natural childbirth in an
out-of-hospital setting will experience a slightly though not significantly
lower perinatal mortality than low-risk women who opt for a hospital birth
under the management of an obstetrician, including the unfavorable results
for transfers from home to hospital. Our data also suggest that even for the
high-risk levels of our study population the natural approach produces the
same perinatal mortality outcomes as the obstetric approach. Given no
differences in perinatal mortality it must be noted that the natural
approach shows significant advantages with respect to lower maternity care
cost as well as reduced mortality and morbidity from unnecessary cesareans
and other obstetric interventions, and significant benefits from avoiding
negative long-term consequences from unnecessary obstetric interventions and
procedures."
Tyson H. Outcomes of 1001 midwife-attended home births in Toronto,
1983-1988. Birth, 1991; 18(1):14-9.
Spontaneous lady partsl delivery rate was 93%, including transfers. The forceps
rate was 3.4%, and the cesarean rate was 3.5% Among all lady partsl births,
17.9% had episiotomies, of which most were performed by physicians at
hospital births. Only 0.5% had third-degree lacerations and 55.2% had an
intact perineum. Perinatal mortality rate was 2/1001. At 28 days postpartum,
98.6% of mothers were fully breastfeeding.
Woodcock HC, Read AW, Bower C, Stanley FJ, Moore DJ. A matched cohort study
of planned home and hospital births in Western Australia 1981-1987.
Midwifery, 1994;10(3):125-35.
Women in the home birth group had longer labors but were less likely to have
induction, cesarean, or other operative delivery; and less likely to have
other interventions overall. Babies in the home birth group were in better
condition at birth. Hospital babies were more likely to take a while to
start breathing, to need resuscitation, and to have Apgar scores lower than
8. Perinatal mortality was higher overall in the home birth group, but it
was not statistically significant. Neonatal mortality was significantly
higher in the hospital birth group.
"Key Conclusions: Planned home births in Western Australia appear to be
associated with less overall maternal and neonatal morbidity and less
intervention than hospital births."
Also, you could certainly get Marsden Wagner or Lewis Mehl to comment as OBs
on the safety of home birth. If you want, I'll look up their email addresses
for you.
