April 15, 2009

Home Births Just As Safe As Hospital Births

A large-scale study has shown that low-risk women giving birth at home is just as safe as doing so in a hospital with a midwife, BBC News reported.

Researchers found no difference in death rates of either mothers or babies in 530,000 births from the Netherlands, which has a high rate of home births.

Many doctors and experts have debated the safety of home births for years and while many UK obstetricians praised the study, they warned that the results might not apply universally.

Since hitting a low in 1988, the number of mothers giving birth at home in the UK has been rising. The most recent figures from the Office for National Statistics showed that 2.7 percent of all births in 2006 in England and Wales took place in the home.

The research, published in the journal BJOG, was carried out in the Netherlands after figures showed the country had one of the highest rates in Europe of babies dying during or just after birth.

Dutch women are able and encouraged to choose the home birth option, even though it has been suggested that home births could be a factor in those deaths. Still, one third of Dutch women choose to deliver at home.

However, the study found no difference in death or serious illness among either baby or mother in comparison to "low-risk" women who planned to give birth at home with a midwife.

Professor Simone Buitendijk of the TNO Institute for Applied Scientific Research said the results showed that for low-risk mothers at the start of their labor, it is just as safe to deliver at home with a midwife as it is in hospital with a midwife.

"These results should strengthen policies that encourage low-risk women at the onset of labor to choose their own place of birth," she added.

Expectant mothers in the study who had no known complications, such as a baby in breech or one with a congenital abnormality, or a previous caesarean section, were considered low-risk.

The researchers cited the importance of highly trained midwives who knew when to refer a home birth to hospital as well as rapid transportation.

The study, which is considered the most comprehensive yet into the safety of home births, acknowledged that the group who chose to give birth in a hospital rather than at home were more likely to be first-time mothers or of an ethnic minority background - the risk of complications is higher in both these groups.

The study has relevance for countries like the UK with a highly developed health infrastructure and well-trained midwives, according to Professor Buitendijk.

The government has pledged to give all women in the UK the option of a home birth by the end of this year. Currently, only 2.7 percent of births in England and Wales take place at home, due to considerable regional variations.

The study is a "major step forward" in showing that home is as safe as a hospital for low risk women giving birth when support services are in place, according to Louise Silverton, deputy general secretary of the Royal College of Midwives.

She said that in order to begin providing more home births there has to be a seismic shift in the way maternity services are organized.

"The NHS is simply not set up to meet the potential demand for home births, because we are still in a culture where the vast majority of births are in hospital," she said.

Silverton also stated there has to be a major increase in the number of midwives since they are the people who will be in the homes delivering the babies.

Home births, in cases of low-risk pregnancies that are provided the appropriate infrastructures and resources to support such a system, have found the support of The Royal College of Obstetricians and Gynecologists (RCOG).

But it warned that women need to be counseled on the unexpected emergencies, such as cord prolapse, fetal heart rate abnormalities, undiagnosed breech, prolonged labor and postpartum hemorrhage"”which can arise during labor and can only be managed in a maternity hospital.

The RCOG stated that such emergencies would always require the transfer of women by ambulance to the hospital, as extra medical support is only present in hospital settings and would not be available to them when they deliver at home.

Giving more mothers-to-be the opportunity to choose to give birth at home was one of its priority targets of the Department of Health for the 2009/10-year.

"All Strategic Health Authorities (SHAs) have set out plans for implementing Maternity Matters to provide high-quality, safe maternity care for women and their babies," said a spokesman for the department.


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