Expectant parents’ level of informed and personal decision making is one of the big differences between the hospital medical model of care and the homebirth midwifery model of care. Choosing homebirth entails a greater level of personal responsibility in researching and understanding your options, and in participating in collaborative care.
As a pregnant woman and couple, you can choose to give birth at home with a midwife, at a birth center, at the hospital, or unattended. Each of these options carries its own set of benefits and risks. Nothing can guarantee a perfect outcome. We recommend that all prospective clients carefully consider their options, ask questions, and do their own research regarding birth options. We hope that in doing your own research and looking within at your own inner knowing and intuitions, you will come to a place of empowered decision making regarding where birth is safest for you.
Is Homebirth Safe?
Here’s what the studies show:
Recent study on homebirth outcomes by the Midwives Alliance of North America Statistics Project, published in the Journal of Midwifery and Women's Health in 2014.
Title: “Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009”
Background:This study analyzes 16,924 planned homebirths in the US between 2004 and 2009.
Conclusion: Of the women studied, 89.1% gave birth at home, and only 4.5% required pitocin augmentation or an epidural. 94% of the women intending home birth had a vaginal birth, and there was an 87% VBAC success rate. This study showed that low risk women intending planned home births had high rates of physiologic birth and low rates of intervention without an increase in adverse outcomes.
In this 2016 comparative study published in The Journal of Midwifery and Women's Health, the researchers look at maternal and neonatal outcomes following waterbirth.
Title: “Maternal and Newborn Outcomes Following Waterbirth: The Midwives Alliance of North America Statistics Project, 2004 to 2009 Cohort”
Background: Data from births recorded in the Midwives Alliance of North America Statistical Project is analyzed to compare 6,534 waterbirths to 10,290 non-waterbirths.
Conclusion: The study found that mothers in the waterbirth group had fewer postpartum transfers and hospitalizations than women who gave birth out of the water. In addition, there was no association with waterbirth and infection. Babies born in the water were found to have a decreased rate of hospital transfer and NICU admission.
Another study of homebirth safety was published in the Canadian Medical Association Journal on September 15, 2009.
Title: “Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician”
Background: This study was based on nearly 13,000 healthy, low-risk pregnant women. It compared outcomes for those who planned a home birth with a midwife, a hospital birth with the same midwives, or a hospital birth with a physician.
Conclusion: Women in the planned home birth group were less likely to have medical interventions including:
- Electronic fetal monitoring
- Augmentation of labor (pitocin)
- Cesarean section
The same women had fewer complications including:
- Postpartum hemorrhage
- Serious perineal tears
- Need for oxygen therapy or resuscitation at birth.
In another excellent study published in the British Medical Journal in 2005, researchers looked at almost all (98%) women who were planning to give birth at home in the United States and Canada in 2000.
Title: “Outcomes of planned home births with certified professional midwives: large prospective study in North America”
Background: Johnson and Davis’s study was a prospective cohort study of 5,418 home births (98% of the births attended by direct-entry midwives with a common certification in the United States and Canada).
Results: The planned home births had:
- Similar rates of intrapartum and neonatal mortality to those of low-risk birth hospital birth. The neonatal mortality rate, excluding deaths concerning life threatening congenital anomalies, was 1.7 per 1,000 planned home births, similar to that of low risk hospital births. No mothers died.
- Lower rate of medical intervention for planned home births than for planned, low-risk hospital births: epidural (4.7%), episiotomy (2.1%), forceps (1%), and vacuum extraction (0.6%).
- Cesarean rate in the home birth group was 3.7%, substantially lower than in the hospital cohort.
- A high degree of satisfaction was reported.
- <12% rate of hospital transfer.
Conclusions: Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.
Another study, published by the Canadian Medical Association Journal in 2002 demonstrates the safety of homebirth.
Title: “Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia”
Background: The choice to give birth at home with a regulated midwife in attendance became available to expectant women in British Columbia in 1998. The purpose of this study was to evaluate the safety of home birth by comparing perinatal outcomes for planned home births attended by regulated midwives with those for planned hospital births.
- Women who gave birth at home attended by a midwife had fewer procedures during labor compared with women who gave birth in hospital attended by a physician. This included epidural analgesia, induction and augmentation with Pitocin, and episiotomy.
- There was no increased maternal or neonatal risk associated with planned home birth under the care of a regulated midwife.
The Homebirth Reference Site has an impressive index of homebirth research. This may be all the research you will ever need to make an informed decision. http://www.homebirth.org.uk/homebirthindex.htm
Midwife Ronnie Falcao, in the Mountain View area, put together a very comprehensive site with a wealth of information regarding the safety of homebirth and the dangers of hospital birth. Her inspirational article entitled “The Dangers of Hospital Birth” can be viewed here: http://www.gentlebirth.org/ronnie/hospitalDangers.html
A link to her compilation of homebirth safety research: http://www.gentlebirth.org/ronnie/homesafe.html
This site reviews some popular “what if’ questions most people have regarding homebirth: http://www.homebirth.org.uk/whatif.htm
The following 2002 Maternity Center Association article, titled “Listening to mothers: Report of the first national U.S. survey of women's childbearing experiences,” discusses some disturbing realities in women’s experiences of mainstream birth, including their attitudes about birth, the levels of interventions used, and their understanding of maternal rights: www.childbirthconnection.org/article.asp?ck=10072