U.S. home births found to have low intervention and mortality rates

UBC Midwifery Associate Professor, Saraswathi Vedam (second from left) assists at a home birth.

Planned home births among low-risk women in the U.S. result in low rates of birth interventions without an increase in adverse outcomes for mothers and babies, according to research by the University of British Columbia and three U.S. universities.

The study of 17,000 women and their babies, the largest-ever analysis of women who planned home births in the U.S., found that 5.2 per cent of them were delivered by cesarean surgery (after being transferred to the hospital). In contrast, 31.1 per cent of planned hospital births involving comparably low-risk, full-term pregnancies ended in cesarean surgery.

The study also found that 4.5 per cent of women doing planned home births were given oxytocin to speed labour, compared to 40 per cent in planned hospital births.

Meanwhile, neonatal mortality rates were practically the same — 0.41 for every 1,000 births planned at home, compared to 0.46 per 1,000 planned in the hospital.

The numbers reported in this study are consistent with other large, population-based home birth studies conducted in Canada and Europe. U.S. home births are on the rise – up about 40 percent in the last nine years – but still constitute only 1.2 percent of all deliveries. In British Columbia, 17 percent of deliveries were planned home births.

The study, published Jan. 30 in Journal of Midwifery and Women’s Health, found that for planned home births with a midwife in attendance:

  • More than 93 per cent  of the women experienced a normal, physiologic labor and birth;
  • The rate of vacuum- or forceps-assisted vaginal birth was 1.2 per cent;
  • 1.5 per cent of babies had a low Apgar score (a measure of newborn health in the first five minutes following birth);
  • 2.5 per cent of babies were admitted to the intensive care unit at some point during the first six weeks following birth;
  • 87 per cent of women with a previous cesarean successfully had their babies vaginally;
  • Of the 10.9 per cent of women transferred from home to hospital during labor, most were for non-emergent reasons, such as a slow labor, or maternal exhaustion.

The study also found that more than 99 per cent of women who did planned home births were breastfeeding shortly after delivery. Of women who did planned deliveries in hospital, 76 per cent were breastfeeding at discharge.

“The good news is that, for women who are at low risk for pregnancy complications, low intervention rates appear to be achievable without increasing risk,” said senior author Saraswathi Vedam, an Associate Professor in the Division of Midwifery in the UBC Department of Family Practice. “Poor outcomes, like death or injury to a newborn, are very rare in high-resource countries. The challenge is that they are so rare that very large studies with reliable data sources  are needed to help us understand how safety is affected by planned place of birth.”

“Given our findings, especially in light of other observational studies published in the last decade, I think it’s time to start shifting the discourse around home birth in this country,” said Melissa Cheyney, a medical anthropologist at Oregon State University and lead author on the study. “We need to start focusing on how to support low-risk women who choose  a midwife-attended home or birth center birth and stop debating whether women should be allowed to choose these options.

This study is based on a voluntary data set collected by the Midwives Alliance of North America (MANA). The MANAStats registry, which Vedam helped create, is based on the gold standard of medical records, rather than birth certificate data , which research shows are unreliable for studying intended place of birth and newborn outcomes.

“Our goal was to design a data collection tool  that could help to reliably inform health care providers, policy makers, and families about the outcomes of midwifery care in all birth settings, and the characteristics of normal physiologic birth,” said Geradine Simkins, the Executive Director of the Midwives Alliance of North America. “Planned home births are only a small percentage of all births in the U.S., but the numbers are growing each year. Given these data, we hope providers in all settings can learn from what’s working well at planned home births.”