Giving birth safely at home
Recent figures show that for low-risk pregnant women (= women who are under the care of a midwife) a home birth is just as safe as a hospital birth. This is described in the article “Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births” in the BJOG.
The authors, including gynecologist Jan Nijhuis and TNO researcher Simone Buitendijk, conclude that the cause of the high infant mortality rate in the Netherlands (Euro Peristat 2008) is not due to the home birth culture.
Large-scale controlled research had never been done before. The article appeared in the British Journal of Obstetrics and Gynaecology.
The research
The study involved all low-risk pregnant women who gave birth between January 1, 2000 and December 31, 2006 under the guidance of their primary care obstetrician. All these women could choose whether they wanted to give birth at home or in the hospital. In both cases they were supervised by their own midwife. This was a total of 529,688 pregnant women.
Of the women, 61 percent opted for a home birth and 31 percent for a hospital birth. The other 8 percent were unknown. It was also recorded whether the women were Dutch or non-Dutch, and their age and income group. Mortality rates during and shortly after birth were compared for these groups.
The results
No significant difference in mortality rates was found for the group that wanted to give birth at home compared to the group that wanted to give birth in the hospital. The mortality rates for the first 24 hours were 0.05 percent for both groups and for the first 7 days 0.06 (at home) and 0.07 percent (hospital). Apart from this, higher mortality rates were found for non-Dutch women and women over the age of 35. This is also a known fact. This was corrected for when interpreting the results.
Back support for home birth
A (translated) quote from the article: 'The study shows that the relatively high infant mortality rate in the Netherlands cannot be explained by the large number of planned home births. The results support the policy of allowing low-risk pregnant women to choose their own place of delivery. The results show that planning a home birth is a safe option in a country with a healthcare system in which there are enough skilled midwives who assess the suitability of a home birth, and an integrated referral system.'
Future research
The authors indicate that more research is needed. Unfortunately, the ideal study, in which pregnant women are randomly assigned to one of two groups (home or hospital), is not possible. Jan Nijhuis tried this, but in the end women wanted to decide for themselves. This can lead to self-selection. Women who feel they are healthy and confident in themselves may be more likely to opt for a home birth. This makes a fair comparison of mortality rates between home and hospital difficult. However, this is not a problem for the conclusion of the study. This is because women who want to give birth at home do not run a greater risk of their baby dying. And that is what midwives like to convey.
