Skip to main content

home birth risks

New and Sometimes Conflicting Research on Out-of-Hospital Birth

Posted by Midwives Alliance on January 7th, 2016

In the past month, two new studies have been released - one in the New England Journal of Medicine (NEJM), the other in the Canadian Medical Association Journal (CMAJ) - examining out-of-hospital birth outcomes. The CMAJ study examined 2006-09 provincial health records while the NEJM study analyzed two years of Oregon vital statistics data. What makes the NEJM study unique is that the Oregon birth certificate now allows researchers and others to track the intended place of birth, providing for more accurate categorization of the outcome of transfers.

The two studies both found that families that choose out-of-hospital birth experience fewer interventions, including labor augmentation, assisted vaginal births, cesarean births, and episiotomies.

Both studies also found that the absolute risk of adverse neonatal outcomes is small regardless of setting. However, the CMAJ study found equivalent risk between home and hospital settings, while the NEJM study found that planned out-of-hospital births were associated with an excess of less than 1 fetal death per 1000 deliveries -- a small but statistically significant difference. 

Resources:

Media coverage. MANA has compiled resources for midwives reviewing the outcomes and providing guidance for interpretation for families. 

First, here's a piece in Forbes that provides balanced coverage (note the article - like many - refers to "home birth" while the study combined birth center and home birth data together). 

MANA provided expert commentary to a number of the recent news articles, including The New York Times and The Washington Post.

Expanded coverage at Science and Sensibility. The official blog of Lamaze International has provided balanced coverage of the New England Journal of Medicine research. In this post, Henci Goer compares and contrasts this newest study with other recent home birth analyses. Missy Cheyney, Chair of the Midwives Alliance Division of Research, provides guidance for families interpreting the new research in this post.

Model transfer guidelines. The authors of the NEJM article call for increased collaboration and integration of out-of-hospital providers into the maternal health care system. The Best Practice Guidelines: Transfer from Planned Home Birth to Hospital, developed by the collaboration committee of the Home Birth Summit, are an important and practical tool to increase integration.

The guidelines were designed to facilitate the safe and mutually respectful transfer of care of a woman and her family from a planned home birth to the hospital. The model blueprint was created as the result of a unique collaboration among physicians, midwives, nurses and consumers.

To learn more or endorse the guidelines, visit here.

Home Birth Research Q & A

Posted by MANA Community Manager on February 7th, 2014

We’ve had lots of questions from families, midwives, and others about the recent release of two articles that were based on the Midwives Alliance of North America dataset (MANA Stats). Here are answers to some common questions, along with a roundup of some of the coverage.

Numbers are useful, but only if they can be compared to something. What outcomes can we compare to the Cheyney article’s findings?

In the study, the authors compare the findings to the best available observational studies of planned home births and birth center births. For low-risk women, the authors find similar rates of both positive and negative outcomes for mothers and babies as nearly every other large, well-designed study.

Some of these well-designed studies are able to compare to hospital rates (which is difficult to do in the U.S.). For example, the Hutton et al (2009) study found no difference in risks to babies between home and hospital in Ontario, Canada. While it is reassuring that the Hutton study had comparable rates of mortality at home as the Cheyney study and it found no difference in risk between home and hospital, more research will be needed to compare U.S. home birth and hospital birth rates.

Why doesn’t the Cheyney study compare home birth to hospital birth mortality rates?

It makes sense to want to draw these comparisons. However, hospital rates in the U.S. are derived from vital statistics data (birth certificates and/or death certificates). A number of organizations, including the American College of Nurse Midwives and Citizens for Midwifery have spelled out the limitations, which include a failure to capture the intended place of birth and inaccurate reporting of some outcomes.

Also, the MANA Stats data captures three kinds of mortality outcomes:
Intrapartum = a baby that was alive at the onset of labor, but died prior to birth
Early neonatal = a baby that was born alive, but died during the first week of life
Late neonatal = a baby that was born alive, but died between 7 and 28 days of life

Vital Statistics data report only two: early and late neonatal deaths. You may have participated in discussions that attempt to make these comparisons. Many have confused the combined rate (intrapartum+early+late neonatal) with rates that include only one or two of these outcomes. When attempting to compare rates, we encourage you to ask whether the rate is for intrapartum, early, or late neonatal, and to ask for the source of their data.

How could the findings of this research be so different from findings that suggest home birth has a greater risk than hospital births?

Those studies primarily rely on Vital Statistics data. For a helpful fact sheet on how to assess the quality of articles based on medical records - the “gold standard” for research and the basis of MANA Stats - against those based on Vital Statistics, see this in-depth look at Citizens for Midwifery.

I’m looking for unbiased analyses of this article and home birth evidence to share with families, policy makers, and others.

Here’s a few we’ve found:
Evidence-Based Birth summary on Facebook. Rebecca Dekker is known for her thoughtful and unbiased approaches to the literature.
Judith Lothian’s review at Science and Sensibility.
ACNM’s preliminary review of the Chervenak/Grunebaum findings. This includes a comment on MANA Stats.
Citizens For Midwifery's summary of the findings.

NEW TODAY:

The Daily Beast’s look at how “alarmist studies . . . from data pulled from vital-statistics data” are getting in the way of ensuring safety for mothers and babies, from the Daily Beast. 

Citations:
Hutton EK, Reitsma AH, Kaufman K. (2009). Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study. Birth 36(3):180-9.

COMMENTERS PLEASE NOTE:

The only comments that have not been published have been because the author did not leave a first and last name. Please check our community guidelines if you have any questions.

Syndicate content