Homebirth or hospital birth? Study weighs up the evidence

Women with healthy, low-risk pregnancies who had a homebirth with a midwife had comparable rates of stillbirth and neonatal death to healthy low-risk women who gave birth in hospital, a new epidemiological study of births in Victoria from 2000-2015 has found.

However, the rates of neonatal death were up to seven times higher during homebirth in women with high-risk pregnancies (such as post-term, multiple births, a prior caesarean and women with medical conditions like diabetes*) than in similar women who gave birth in hospital.

The findings of the study, led by the Consultative Council for Obstetric and Paediatric Mortality and Morbidity and involving Hudson Institute of Medical Research, Monash University and Safer Care Victoria, have just been published in the journal, BMC Pregnancy and Childbirth.

“In women with normal pregnancies, there were no differences in the rates of perinatal death between those who planned a homebirth and hospital birth,” lead researcher and epidemiologist at Hudson Institute of Medical Research, Dr Miranda Davies-Tuck, said.

“However, for women with risk factors, the rates of stillbirth or neonatal death were significantly higher in women who had planned a homebirth.”

Homebirth: weighing up the evidence

The study analysed de-identified, legislatively reported data on all babies born in Victoria at or after 37 weeks gestation between 2000 and 2015.

The evidence showed that for healthy women with a healthy pregnancy, homebirth was associated with lower rates of unplanned caesarean section, epidural and episiotomy, and higher rates of spontaneous vaginal birth than similar women who gave birth in hospital.

However, for women with pregnancy complications, giving birth in hospital was significantly safer than giving birth at home.

“Healthy women who planned a homebirth with a midwife experienced lower rates of obstetric interventions and some maternal morbidities than women planning hospital births,” Dr Davies-Tuck said.

“However, outcomes for homebirth are not equal for all women, particularly those with high-risk pregnancies, and women should speak with their GP, obstetrician or registered midwife when making choices around planned place of birth. For high-risk women, giving birth in hospital is the safer choice for their baby.”

This study addresses a 2013 coronial recommendation to provide information about the outcomes of homebirth in Victoria, following a perinatal death during a planned homebirth involving a woman identified as having a high-risk pregnancy.

Helping women make informed choices

In Australia, only 0.3 per cent of women plan a homebirth, compared to 3.4 per cent of women in New Zealand, two per cent in Canada and the UK, and 20 per cent in the Netherlands.

Dr Davies-Tuck said this is largely due to a lack of evidence around Australian homebirth outcomes. She said the study findings are consistent with evidence from the UK, and will help inform safe homebirth in Australia.

“The evidence in this study will help Australian women in making informed choices about where to have their baby, as well as assisting health services and policy makers,” Dr Davies-Tuck said.

“For homebirth to be safest, current evidence and guidelines indicate women should be attended by at least one midwife in the early stages of labour, and two midwives at the time of birth and few hours after birth,” she added.